Forum - Questions & Answers

May 19th, 2015 - MedicalBilling101 2 

Incomplete Documentation

Hi,

Please guide us that how to respond the requests of medical claims submission where we see that a provider/practice is not giving us the enough supporting documentation for a particular service performed?

Thank you

May 19th, 2015 -

re: Incomplete Documentation

As a coder/auditor for a large obgyn practice, I audit/scrub each encounter for documentation before I release the claims to be billed at the EOD. We bill for over 230 to 300 claims a day, so we allow the providers 48hours to complete the documentation, so we bill 48hrs in the past. If the docmentation does not support the E&M level or the procedure being billed, i send an internal message to them to complete the documentation. If the claim was released without supporting documentation, you can ask the provider to addemn the documentation letting them know that the claim needs to be appealed w/supporting documentation and that theirs does not meet the guidelines per the American Medical Association. If providers pay is based on their turnover this will surely get their attention as it will effect their pay. hope this helps:)

May 20th, 2015 - MedicalBilling101 2 

re: Incomplete Documentation

Thank you so much for your response. Actually I need standards/guidelines for claims submission with OIG/CMS guidelines about documentation so that we may guide our providers to complete this in time. We are often receiving the medical claims with future date of service and providers says that they have planned the surgery so put this information in system.

May 20th, 2015 -

re: Incomplete Documentation

http://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html?redirect=/home/regsguidance.asp


go to the link above and in the search window put in documenataton guidelines. Certified coders have to adhere to the guidelines set by CMS and AMA. If your provier is telling you to bill for future services that have not been provided/done and there is no supporting documentation, your practice is committing medical fraud.

May 21st, 2015 - MedicalBilling101 2 

re: Incomplete Documentation

Thank you, This really works now.

May 21st, 2015 -

re: Incomplete Documentation

Your very welcome, I hope you keep them on thier toes:)



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