So, the company I work for has a department that just checks everyone's work to make sure that we are compliant with government regulations for billing insurance. We creatively called it the "Compliance Department".
They're job is to check the work of the coders (my job) and make sure that we are interpreting the Doctor's dictations correctly to get the right code number off to the insurance companies. They do many other related things, but that's what my perception is because I never see them do anything else.
What bugs me, is how they do this process. They host training sessions every month to show us coders how to do our job. I love that because I could use the extra training, and improvement. But often, they tell us that the dictations/documentations that we are reading, are not complete, or that the doctor's did not document well enough.
Say Doctor "Bob" sees a patient for a twisted ankle and he asks the patient if there's anything else wrong. If the patient says "Yes, I have a scab on my elbow that won't heal" the doctor ought to write that down. If Doctor "Bob" does not think it is not related to the ankle, he might leave it out of the documentation. But then when I read it and I see that Doctor "Bob" prescribed a medical ointment for the elbow, I'll say "Why?" I can't bill for the ointment because Dr. "Bob" didn't say what was wrong with the elbow.
So, us coders get this training first and the Doctors get it months down the road. - sometimes only weeks or days, but still...
That means that when Dr. "Bob" finds out that I didn't bill for the ointment, he asks me why and I have to tell him that it's his fault. Now he's mad at me because I didn't tell him. But it's not my job to tell him how to document properly. He's been a doctor longer than I've been out of high school. And as my job stands, I am supposed to interpret the documentation as it is written and assign a code number based on what the doctor wrote.
This is a simple version of what really goes on, but Can't Compliance educate the doctors around the same time we are getting education?
Friday, January 25, 2008
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