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Hi CHUG,
This has come up quite a bit lately so I thought the best approach is to do a survey on how others are dealing with this scenario.
There is no audit tool built in to audit PM charges verses EMR Orders. Billers are often given the discretion to make changes to the ticket (claim) before filing to insurance. Sometimes they remove or change the diagnosis or CPT codes and then it doesn't match what is in EMR.
1. Do you allow your billers to make changes in PM to the ticket?
2. If so, what is your policy/process in reflecting those changes in EMR?
Any and all ideas and best practices are welcome.
Thanks!!
Posted : February 5, 2015 11:26 am
We do allow our billers to make changes is PM to the ticket.
Billers will inform the staff of the change in CPT code or Dx code via a flag and then the clinical staff makes the change in EMR by appending the visit (full update) and resubmitting the correct charge and or Dx code.
Posted : February 5, 2015 11:31 am
We only allow are certified coder to make a change if necessary, and that change always comes in the form of an Append to the original document.
Primarily our coder will append the note for the provider put in the appropriate ICD (according to the note), and CPT changing the date of service on the order to match the original DOS and then route it to the provider to sign.
This is work for our coder, but it has been the best way we have found as a practice to ensure that the note matches what was submitted to insurance and that the correct DOS gets entered into the billing visits so it does not create a duplicate billing visit.
Heather Adams
FQHC in CT
Posted : February 26, 2015 6:32 am
