Post denial query?

stephetccs@yahoo.comstephetccs@yahoo.com
in Denials

What are your thoughts on post-denial queries? We have an outside consultant that reviews our post payment DRG audit denials and recommends querying the physician for clarification on the codes that were denied and using that query response to file an appeal to support the original coding.

Comments

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    Is not this simply admitting the original documentation did not support code assignment and subsequent compliant billing?   I’d not issue a query after a case has been denied.  I would contest any denial in which I felt the auditor was interpreting documentation my site deemed adequate of the code assigned; But,  the thought of issuing a query to modify documentation after a denial is not something I’d recommend.  
  • stephetccs@yahoo.comstephetccs@yahoo.com
    Thank you Paul. I agree but wanted validation.
  • lprescott1lprescott1
    I agree Paul, this is not a good practice.
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