Re: Billing Report Reads

[Adam Mlynarcik]

Thanks for the clarification guys.  I am trying to learn.

I know insurance companies do retroactive audits constantly. I didn't know if it the documentation would affect the billing process or the legality.  It is clearly the legality.  You may collect the bill without a problem. It is proving the legitimacy of it that gets dicey if your Physician hasn't done his part correctly.

Adam Mlynarcik

[Steve Verno]

To add to Michelle

While you may receive a charge sheet to bill  99243 (Consultation), and you got a payment.  Nothing stops the insurance company from performing a retroactive audit or a regulaory agency for investigating.  If the documentatoin the chart doesnt support the charges billed, the provider could be brough up on charges of Fraud, lose his license, and pay hefy fines, not to mention returning the payment to the insurance company.

I was charged for a 99243 and 99213. Both visits werent documented to support the charges.  The biller called and said, I have a charge sheet for both visits.  My letter to the biller showed that the consultation was illegally billed and was upcoded which is a violation of Florida Law.  The 99213 was also upcoded. 

[Adam Mlynarcik]

Mel,

What do you mean by "he must document his findings in the patient's medical record at the hospital." and how does this affect the billing process? 

Basically what I am trying to ask is how does it affect the biller if the Physician hasn't documented his findings? 

Say I receive charge information from the physician for reading and interpreting and apply the modifier and bill correctly.  How will his documentation or lack there of affect the billing procedures?  Or is it one of those things that it really won't, but if he where to be audited and didn't have supporting documentation on those claims he would be up shit creek?

Thanks

Adam