PPV: Avoid inappropriate physician queries
HIM Connection, September 2, 2008
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Since the implementation of Medicare Severity DRGs in October 2007, the volume of physician queries has undoubtedly increased. Many of these queries are warranted and consistent with the aims of greater specificity and accurate reporting of patient severity.
However, some situations show few clinical indications for querying the physician other than the coder’s knowledge that additional specificity is necessary, says Paula Archer, RHIA, managing consultant at BKD, LLP, in Little Rock, AK.
The practice of inappropriate querying could lead to questions of ethics, and an auditing party, such as a recovery audit contractor, could interpret the practice as reimbursement-led querying.
Editor’s note: For more information on queries or to purchase a copy of this article for $10, visit www.hcpro.com/content/217375.cfm. Subscribers to Briefings on Coding Compliance Strategies have access to this article in the September issue of the newsletter.
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