Quote:
Originally Posted by Becca9800
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 |
I realize you must have worked in medical billing/coding at a hospital and therefore tend to blame all coding irregularities on the physicians. However, with a 20% premium on the DRG cohort at stake, if you don't think the word went out to medical staffs at every hospital in the country to add COVID as a diagnosis, even if only suspected, then you are living in Fantasyland.