coding and billing

[meerkat111]

---

Members do not see this ad.

How common is it for hospitalists to regularly get audited using random samples of charts? My company wants us to pass with 90%, fail people who even scored 89%. I have asked a friend of mine who does outpt clinic and it is nicer for them in that their charts get flagged but they are not punished otherwise, they just fix their charts with coder's findings.

 

[end stage fibro]

Hospitalists get randomly audited your first year. If you agree with coder >90% of time, you get direct billing privilege and your charts go straight to the insurance company. If <90, you get some coding education and another year of audits. No punitive measures. Sometimes charts get flagged with missing info, mostly the billing just gets changed automatically on the backend.

This system is heavily dependent on having a good coder, which is not always a guarantee.

 

[meerkat111]

Hospitalists get randomly audited your first year. If you agree with coder >90% of time, you get direct billing privilege and your charts go straight to the insurance company. If <90, you get some coding education and another year of audits. No punitive measures. Sometimes charts get flagged with missing info, mostly the billing just gets changed automatically on the backend.

This system is heavily dependent on having a good coder, which is not always a guarantee.

Thank you. They want to hold my R V U in escrow until I achieve 90%, seems extreme...

 

[end stage fibro]

Thank you. They want to hold my R V U in escrow until I achieve 90%, seems extreme...

That's a major WTF. I get X% of Rvu every quarter and true up yearly. they're never held hostage.

 

[meerkat111]

That's a major WTF. I get X% of Rvu every quarter and true up yearly. they're never held hostage.

Yes, that is what I thought. I started sending my resume out.

 

[DoubleBogey]

Yes, that is what I thought. I started sending my resume out.

Crazy to keep your RVUs in purgatory. When I worked at the hospital that I trained at, they performed random audits and want us at...95% — I was in the 80s (first time working as an attending). At my current hospital, they code the chart themselves - you can submit your level to them, but they will change it (up or down) as they see fit. Which, in my opinion, is fine with me - I’d rather someone else do it (even with the potential of a few down codes) then have to bicker back and forth about the code and documentation and editing (they add codes anyways if missed). If I was strictly inpt though I might be a little more hands-on.

 

[michaelrack]

At my current hospital, they code the chart themselves - you can submit your level to them, but they will change it (up or down) as they see fit. Which, in my opinion, is fine with me - I’d rather someone else do it (even with the potential of a few down codes) then have to bicker back and forth about the code and documentation and editing (they add codes anyways if missed). If I was strictly inpt though I might be a little more hands-on.

Any changes in coding should be authorized by the doc.....u r on the hook for any Medicare fraud (as they define it) that occurs..

 

[meerkat111]

I really love hospital medicine but it seems in my geographic area, all current openings are outpatient (I do not live in a big city). Will I be ruining my chances of getting back into in patient medicine if I switch to outpatient?

It seems I failed the audit mostly because of having a resident for the first time as an attending (this is my first year as an attending) and not remembering to bill it with a GC modifier.