Educate your physicián to keep you in the loop on patients’ development.
Just because a patient enters the hospital with one diágnosis doesn’t mean she’ll have that diágnosis for her entire stay. And if you bill for your physicián’s hospital visits with an out-of-date diágnosis, you could lose money or face fraud charges.
The problem: Diagnoses can change in the hospital due to various reasons, including the following, among others: The physicián may narrow down the patient’s problem. For example, a patient may be admitted with chest páin, and the doctor may rule out myocardial infarction and decide the problem is actually gastrointestinal in nature.
The patient may develop other problems. The patient may be admitted for dehydration problems but may start having chest páins. The patient may experience complications that lead their original complaint to worsen significantly. You can’t wait for the hospital to send you medical rècords and hope to bill in a timely fashion. You could be waiting six weeks after the patient gets out of the hospital for any rècords. So it’s up to your physicián to let you know if a patient’s diágnosis has changed.
Do this: Educate your physiciáns, and let them know that just because the patient has been admitted with a particular diágnosis doesn’t mean they should bill for that diágnosis for each visit. To help your physicián track his hospital visits, you might consider giving each physicián a simple form to rècord these evaluations. The physicián could put a sticker with the patient’s hospital identifier on the form and then write the date of each visit, the level of service and the diágnosis. Each sheet will have roóm for 10 or 12 patient visits.
Diágnosis Tracking Is In the Cards
Another approach is to give your doctor a bunch of index cards that fit in the pockets of a lab coat. The physicián uses one card for each patient and notes each visit to the patient for a given week. At the end of the week, the physicián turns in each card. The cards have a space at the bottom for the patient’s diagnoses, which the physicián should date. If your physicián doesn’t admit the patient to the hospital, then chances are the diágnosis he treats won’t be the admitting diágnosis anyway.
For example: Your doctor performed gall-bladder surgèry on the patient two months ago. Your doctor wouldn’t know the patient was admitted for pneumonia, unless the admitting doctor called the surgeon in to check on the surgèry. So your surgeon would bill under the post-operative gall bladder diágnosis, not pneumonia.
Watch out: If you’re not billing with the most up-to-date diágnosis, you may not be able to justify a higher level of service. The patient may have been admitted with a simple problem and then developed complications, so a subsequent visit could have more complex medical decision-making. But you won’t be able to justify a higher level codè unless you know all the diagnoses.
