Quote:
Originally Posted by JMintzer
I'm respected? Well, shame on you! 
But yes, administrators/billing depts are most definitely trying to find ways to maximize charges, including changing diagnoses...
I've seen it in person... And I've seen the arguments that ensued... |
Maximizing payments is a must and you know it. Changing a diagnosis is absolutely fine IF the medical record documentation supports that change. And that's the bottom line. Do you know how frequently the coder has to chase down a doc that picked the wrong diagnosis in the electronic system? Or left out a supported dx? Picking the wrong dx is so easy to do too but it's the hospital, and just as often, the patient that loses because of a wrong key stroke entry. Now I would never say there isn't greed out there, all you need to do for proof of that is take a gander at the OIG's Fraud&Abuse Enforcement page. Those providers are not only greedy, they're incredibly arrogant to think they can scam the system and keep getting away with it. But it's not generally hospital administrators or billing clerks being prosecuted and convicted of fraud, can you guess which profession is the usual culprit? Have a look, it's actually quite interesting
Enforcement Actions | Office of Inspector General | Government Oversight | U.S. Department of Health and Human Services