Revenue Cycle

Q&A: Re-billing an account after a late query response

Recovery Auditor Report, March 10, 2011

Q: AHIMA’s 2008 practice brief, “Managing an Effective Query Process,” appears to allow the initiation of post-bill queries as a result of an audit or other internal monitor. Historically we believed that a query completed after the initial bill was not permitted to be submitted for rebill (unless the documentation was present and the coder missed it) because the documentation was not present at the time of the original coding and bill submission.

We have had a few cases in which our CDI nurse has initiated a concurrent query that was continued retrospectively; however the coder released the bill prematurely in error. If the physician answers the query after the bill has dropped would it be appropriate to rebill the account?

We have also had coding audits with recommendation that a query should have been initiated. Would it also be appropriate to initiate a post bill query in this situation? Again, we have not been rebilling up to this point but if it is permissible then we would develop a policy which would include billing parameters. We want to ensure that we are interpreting the guidance in the practice brief correctly.

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