late documentation

What are the limitations ethically/legally/regulatory regarding late documentation?


We have had some requests lately coming form a few different angles for charts to be rebilled significantly after (6-8wks) post original bill. some of these are from quality and this is after the doctor added an addendum to the record. Then today, a coder asked one of our CDI's to query for additional documentation after she received an audit back that suggested one. This chart had been billed 3/27....

Our coding manager is out on maternity leave and I have asked around and no one seems to really know what it 'okay' in these circumstances....


any help would be great. Especially any references :)


thanks!


Katy

Comments

  • Katy 
    Have you looked at :
    https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM4022.pdf

     September 30, 2005
    When a carrier, DMERC, or intermediary (also referred to as Medicare contractor(s)), cannot make a coverage or coding determination from the information that has been provided on a claim and its attachments, they may ask for additional documentation by issuing an Additional Documentation Request (ADR). The Medicare contractor must request records related to the claim(s) being reviewed. The Medicare contractor may collect documentation related to the patient’s condition before and after a service in order to get a more complete picture of the patient’s clinical condition. Your Medicare contractor will not deny other claims related to the documentation of the patient’s condition before and after the claim in question unless they review and give appropriate consideration to the actual additional claims and associated documentation.
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