Post Bill Queries
Recently we had an audit by an external vendor. They are recommending that we go back and query the physician for missed opportunities. If the physician agrees, then re-bill the record for the higher weight DRG. We are told that retrospective queries (post-bill) are quite common and there is no time constraint on when you can submit a query, only timely filing for billing purposes.
I am aware of the CDI Strategies Q and A article from March 3, 2011 on Re-billing an account after a late query response.
Has anyone experienced this? Did you do retrospective (post-bill) queries? If so what was the outcome?
Is there any other guidance on this topic out there?
Thank you for your help.
Comments
It has been some time since I have researched this, but Medicare does permit one to submit a ‘rebill’ up to 60 days past the date of original payment. Other contractors may have similar restrictions, and you would have to check the contracts for other 3rd parties.
The outcome depends upon the charting and the coding. The payor will ask for a copy of the record in order to substantiate the updated coding, and they will review the documentation as well as the updated coding. My personal experience with this has been very favorable in that we only pursued this process if their was strong support charted and we were very careful to ensure the correct codes were applied. (I worked for a consulting firm and this was a routine process).
P Evans, RHIA, CCDS
Paul, Thank you for your response. We reached out to our billing dept as well and were also told that we had 60 days from remittance of the claim to re-bill.
My concern for these records was lack of strong support, documented only once, etc.
In my 14 years as a CDS this is the first time I have been asked to query a physician post bill, and then to re-bill if the physician agreed. I have completed many retrospective queries but they were all pre-bill for completeness of the record.
Understood..Personally, I would not rebill anything unless I had strong confidence the documentation, query and coding were up to par. In regards to documentation, once may be sufficient, provided clinical support is present; it depends upon a multitude of factors. As I am sure you know, there is no rule stating how often a condition must be documented in order to be coded.
Hopefully, you have a strong Coding team working with your CDI team on this advanced process.
PE