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Petlorilea

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I have a naughty provider who has never been motivated to complete and/or sign her charts. Throw in the fact that she has given notice, and claims are just piling up. Its obviously not up to me to suspend her until/unless the charts are signed BUT I have taken it upon myself to be concerned that the CFO has asked that the charges just be written off as they approach the 90 day mark.
SHOULD I be concerned? It doesn't feel right....
Thanks for your help
 
I would be concerned. I would ask the CFO for written documentation asking that the charges be written off so it does not come back to haunt you later if someone questions why the charges were written off.

I may be off base completely, but years of experience have taught me that having written documentation is always the safest route when such a scenario occurs!
 
The request was verbal, then when there was hesitation an email followed. So there is a paper trail......all the way to my home where I forward important messages. I learned years ago that CYA are the best letters in the alphabet!

I get not wanting the provider to come along weeks (months) later to complete the documentation of the chart documents. I just am unsure about an organization that will not hold a provider accountable, then have a coder do some shady accountING.
 
Write offs

there are several way to go about this. schedule a meeting with the CFO. make sure to have printed off a copy of all claims. then sit down in this meeting and show the CFO the claims and the reason as to why this has to be written off. at my office we have now created two orange form that is given to the patent at check in. one form is for the patient and the other is for the patient to sign and given back to me to keep up with for sending to collections or creating payment arrangement. the best part of this is the fact that i take this form to my boss (the practice manager) or depending on the patient's doctor, i can take the forms to him. if i have to go to the physician i ask the physician about having a talk with the patient or "do u want to write this off" if the doctor says yes. they then write what is to be done and sign the form. this is my paper trail.

this is also good because when i have to sit down with anyone i have all the documents show what i have done and the reasons why this problem has occured.

i hope this helps you.
 
Have these claims actually been billed to the insurance companies? If not, then there is no shady accounting if you write them off for no documentation as long as the reason is clearly stated. If they have gone to the insurance companies and been paid you would need to refund any money you received to the insurance company.

I worked for a provider like this once (unfortunately he owned the practice) and I just refused to enter charges or submit claims until the charts were completed. I got fired of course because he was losing money, but it worked out better for me in the long run. Anyway if you have the CFO behind to not bill these charges you're should be ok. As for the doctor, if her paycheck is dependent on either charges billed or payment received and all of these are written off, she will be suffering the consequences. If she's paid salary no matter what then she probably doesn't really care.
 
I should not have said 'claims' as no charges can be entered because either the provider has not signed the chart, or there are chunks of missing documentation. At this point they are 'open tickets'; electronic fee slips. The mindset is that too much time has passed to complete them, and rather than file and receive a denial for untimely submission, to get them off the books. I don't know how the provider is compensated; but no doubt the ACO has lost revenue coming and going.

I guess my concern is compliance. The same fee for the same service needs to be billed across the board. Then again, the only way to get these completed is to put said provider in a basement with only the EMR, withholding food, water, light etc. A slightly different legal issue. hahaha
 
Talk to the CFO, personally I would complete the tickets then write them off and not send them to insurance. If you can add adjustment codes to the system make one especially for no documentation so it's consistent. That way it shows that you are charging the same fee for the same service, but do to other circumstances they are not being billed.

As for the basement with no food or water, well ..........
 
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