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Medical billers, coders, auditors, compliance officers, and other healthcare business professionals joined AAPC on Nov. 1 for the first day of a two-day deep dive into the world of auditing. The virtual conference features three tracks and 24 sessions so students can customize their education according to experience level. The day began with a riveting […]
The post AUDITCON: Day 1 Sets the Record Straight appeared first on AAPC Knowledge Center.
A whistleblower lawsuit alleges the University of Chicago Medicine shared hundreds of thousands of medical records with Google that retained identifiable information. Chicago-based law firm Edelson PC filed on behalf of a former patient and claiming this is a direct violation of HIPAA given the data-mining tech giant has access to a plethora of public and nonpublic information that […]
The post Greatest Medical Record Heist in History appeared first on AAPC Knowledge Center.
I was curious to see if anyone was having issues with United Healthcare with upholding preventative services for medical record request. We bill for Pediatric and Family Medicine we have seen an increase with claims being pended for additional information and to please submit to Optum for review.
My current workflow is to submit the medical records via UHC Link and follow up with Optum directly with the Ticket number to confirm records received and under review. Most cases Optum has received them and will be approved for payment.
However the past month I have had nothing but issues with the Optum in regards to the vaccines/vaccine administration codes/escalated cases/communication back to the claims department.
Optum requires 5 pieces of information in regards to the vaccine details: Vaccine Name, Dosage, Administration Site, Route of Administration and the employee’s name/credentials that provided the vaccine. All of this information is included in our documentation however Optum has still denied stating documentation is insufficient.
Escalated cases sent back for review but often no action is taken.
Optum reviewed medical records and approved line items for payment. However when communication is submitted to UHC claims department only partial claim is paid out or payment is never issued. Therefore I’m having to go back an forth between Optum and the Claims Department and in some case had to have a 3-way call with these departments. Very frustrating to say the least!
For now I have submitted an claim list to our UHC provider rep to get some assistance in regards to our outstanding claims. Is anyone else having issues? If so, please comment as this is an ongoing issue for our practice.
Thank you in advance for any feedback you may have.
She has asked her lawyer, the medical board etc. and most of them say that oh yeah you have to keep the records for 10 years.
I have read on our state website that states "…physician death is not considered abandonment of records…"
I feel that since the office is closed, she no longer has the obligation nor responsibility to even access and make available the records. She stayed open for the past 6 months after his passing to try to help the patients and doctors get their records. I told her this is additional expense with no income coming in. She is not an owner of the practice, just helping out her husband.
Any thoughts or advice ?
She is closing down the EClinical at the end of the year but someone had told her not to download the records bec if she downloaded them she will have to be responsible.
Thanks for any advice.
I am wondering if anyone could clarify the correct way to document a Final Report in the ED.
To my knowledge – especially when dealing with Medicare Claims; a Preliminary Radiology Report should not be a part of a Final ED Note. In other words – the Radiology Report should be finalized as well, when it is interventional and a part of the diagnosis decision making process. Am I correct in this thought or is it incorrect? Please enlighten me.
Thank You –
Examples being lab tests, x-rays, EKG etc…
We are also not to review E/M levels and bill as is.
So basically we’re just making sure charges are on claims.
Thanks
If you just got one in the mail, don’t panic. Here’s why you probably received it, and how you should respond to it. The Comprehensive Error Rate Testing (CERT) program, which calculates the Medicare fee-for-service (FFS) program improper payment rate based on stratified random samples of Medicare FFS claims, continuously finds the same five leading causes […]
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In her new book, Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick, Maya Dusenbery describes difficulties women experience when trying to be heard and understood by medical providers. As a physician and professional coder, compliance officer, and auditor, I find all patients—and especially females—are poorly heard […]
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