Coding, Classification and Reimbursement

Query reasons billing vs accuracy

  • 1.  Query reasons billing vs accuracy

    Posted 01-02-2019 11:04
    ​My coders query physicians for clarification related to billing and also documentation accuracy. We hold these accounts from billing until the query is returned, which takes a long time in some cases. Does anyone else not release the account for billing if the query is only for documentation accuracy? For example, the account is ok to bill based on coding guidelines, edits, etc. but the coder wants more information on a diagnosis/procedure for quality reasons. So she will not drop the account for billing.

    Thoughts? Thanks.

    Maria Grode
    HIM Supervisor

  • 2.  RE: Query reasons billing vs accuracy

    Posted 01-02-2019 18:04
    In cases like this, we may submit the documentation to our CDI group for QA review. They will let the coder know whether or not to release as is and also decide to conduct an audit on the provider to see if "education" is needed.

    Robb Rogers RHIT, CCS