Retro Queries to prevent quality fallouts

katysuegood@gmail.comkatysuegood@gmail.com
in CDI Talk Archive
Does your facility query after billing in order to fix a quality fallout? One of our quality nurses recently came to me with a core measures fallout that likely would have been resolved with a query (no concurrent review on this record) and wants to know if we can query and potentially rebill. We are roughly 6wks post discharge. I have never been asked about querying this late in the game. Is this common practice?

Thanks!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
AHIMA Approved ICD-10CM/PCS Trainer
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

Comments

  • rmhosler1rmhosler1
    edited April 2016
    To my knowledge we have never done that. Mary


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    Yes: We will query after discharge, too.

    However, many facilities adopt a local P&P restricting the time allowed after D/C for a post D/C query.

    Paul

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited April 2016
    Currently, we query retrospectively. But I don't think we have queried after billing that I can think of.....

    I appreciate the feedback. Keep it coming :)

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • sharon.cooper@owensborohealth.orgsharon.cooper@owensborohealth.org
    edited April 2016
    Yes, we query retrospectively, pre & post bill (preferably pre). We have the claim rebilled if necessary.

    Sharon

    Sharon Cooper, RN-BC, CCS, CCDS, CDIP, CHTS-CP
    AHIMA-Approved ICD-10-CM/PCS Trainer/Ambassador
    Manager Clinical Documentation/Appeals

    sharon.cooper@owensborohealth.org
    (270) 417-4612 Office
    (270) 316-9088 Cell
    (270) 417-4609 Fax

    Owensboro Health Regional Hospital
    P.O. Box 20007
    Owensboro, KY 42304-0007

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited April 2016
    CMS allows one to submit a correction to a paid claim NLT 30 days after the day a facility receives payment for the initial claim. Some use this as a guide...the key phrase is 30 days after initial payment, not discharge. However, because it may be problematic to determine the 'exact date of payment record on the Remittance Advice', which is a document recording the precise MS-DRG and amount paid for every claim, many find it more practical to use the 30 days after discharge as a cutoff date.

    Paul


    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

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