Question about Post-Bill Queries after external audit


After an external-post-bill-audit do you send queries to capture higher paying opportunities? Or only use them as an education opportunity.,of%20time%20since%20initially%20billed.

My impression from that article is that you should not do that, but our auditor used the exact same article to claim that it's perfectly acceptable.

I'm interested in the consensus. Thanks.


  • We generally do not send post-bill queries...if the documentation is unclear, then that is used as education to prevent future occurrences

  • Thanks for the response!

    I'm definitely feeling a bit uncomfortable doing it, but my admin is pushing, and the consultants are claiming that all their clients do this and it's not a big deal.

    My feeling is that if the chart is complete when it is billed, that should be the end of it.

    Is there anybody out there that does do it? Just trying to get some varying opinions here.

  • IPPS DRG Adjustment

    Under Inpatient Prospective Payment System (IPPS), adjustment requests are required from the hospital where errors occur in diagnoses and procedure coding that change the Diagnosis Related Grouper (DRG) or where the deductible or utilization is affected. If diagnostic or procedure coding errors are identified, a hospital is allowed 60 days from the payment notice date to submit adjustment bill(s). Adjustments reported by the Quality Improvement Organization (QIO) have no corresponding time limit and are adjusted automatically by Noridian without requiring the hospital to submit an adjustment bill. If diagnostic and procedure coding errors have no effect on the DRG, adjustment bills are not required.

    If an adjustment to correct coding errors and to increase DRG payment is not received within 60 days from the payment date, no adjustment may be submitted. If the adjustment is to decrease the DRG payment and the 60 day timeframe has passed, providers must submit the claim with detailed remarks indicating the adjustment was created to repay Medicare a DRG overpayment.

    Under IPPS, for long-stay cases, hospitals may bill 60 days after an admission and every 60 days thereafter, if they choose. For subsequent services, past the first 60 days, a provider must submit an adjustment to the original interim bill(s) to correct the from date indicated on the claim. In this case, the 60-day requirement for correction does not apply.



    Last Updated Dec 27 , 2019

  • @BTC2018 Appreciated, however, I don't believe this addresses queries. Certainly an audit can be performed and rebilling submitted. But a query to change the documentation that far afterwards an issue.

  • Hi, there's absolutely nothing wrong in clarifying documentation post discharge and/or post bill. ICD 10 CM/PCS  Guidelines, query brief or coding clinics don't indicate timing of queries and state that query post bill is not compliant. . In fact, when you find errors in documentation through an audit (external or internal) you should send a query to clarify for most accurate code assignment, when appropriate. In some instances reimbursement may increase, in other instances reimbursement may decrease.. for example if you find diagnosis coded with missing or vague clinical criteria. We try to query concurrently, however also have post discharge and post bill queries. Hope this helps, thank you.

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