Doc asking for info on reimbursement

Evelyn_KizziaEvelyn_Kizzia
in CDI Talk Archive
While posting a query the doc wants me to include the potential reimbursement with it. Do you not provide it & tell him its inappropriate for me to do so? Consult my director? other suggestions?

Comments

  • ddouthitddouthit
    edited April 2016
    What about showing impact of severity of illness and risk of mortality on the query? I do believe it would be inappropriate to place financial impact on a query.

    Dorie Douthit RHIT,CCS
    AHIMA-Approved ICD-10-CM/PCS Trainer
    ddouthit@stmarysathens.org


  • lsipos@monument.healthlsipos@monument.health
    edited April 2016
    We were always told that can be misconstrued as "leading" so we do NOT do it on the queries!

    We do have monthly meetings with the HOSP providers and show them comparisons at that time, for say; LOS, financial impact etc. for a Complicated PNA vs Simple PNA or Sepsis with and without cc/MCC. Do it enough, and after a while they have started to "get it".

    Juli

  • catladyrncatladyrn
    I would remind them ever so gently that we don't ask queries based on the impact on reimbursement, but that we make every effort to insure that our medical records reflect the most accurate severity of illness and resource utilization for each patient. Sometimes a query actually lowers reimbursement but is a more accurate and ethical reflection of the case. You can point out if they get pushy that you wouldn't know the financial impact for certain until the chart gets final coded, and it could get reduced by the transfer DRG rules or, later on, by a denial. If they're really interested, they can go look at CMS's Table 5, find out what the hospital's blended rate is, and do the math when a query response changes the DRG, but I doubt they'd care that much.

    When that doesn't work, then yep, I'd redirect them up the chain and let TPTB explain the true meaning of Christmas. :)

    Renee

    Linda Renee Brown, RN, MA, CCDS, CCS, CDIP
    Director, Clinical Documentation, Core Measures and Outcomes
    Tanner Health System
  • annnd2009@gmail.comannnd2009@gmail.com
    edited April 2016
    Hi,

    I just tell them I can not tell them prior to answering a query. BUT I can show them after or show them one that was NOT answered and the revenue lost.

    Ann
  • Evelyn_KizziaEvelyn_Kizzia
    edited April 2016
    Thank you all for responding. Helpful!

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