You Work For A Third-party Payer Performing Medical Records Review. Your Job Is To Match Codes That Were Submitted On The Claim To Documentation In The Medical Record. You Notice That A Code Has Been Input For A Colonoscopy Procedure, But You Don't S?


1 Answers

Anonymous Profile
Anonymous answered
This happened to me once, but for a colostomy.  I checked the medical record thoroughly and when I didn't find the surgery had been performed I called the business office manager of the physician involved.  I will say I got in a lot of trouble, but I'd do it again.  It could be an honest mistake and the wrong code was put on.  In hindsight I should have acted like that is exactly what I thought had happened.  Instead the office manager could tell I suspected foul play.  The error was corrected and what had been paid was deducted from the next packet going to that physician.  I did notice about a year later though - I had left that job by then - on the news was a story about that same doctor being investigated for Medicare fraud.  I think if you have a supervisor you let them know what you've found and let them deal with it.  If you are at the top it's not so easy but you should give them a chance to make it right if you think there is any possibility it wasn't deliberate.  Of course if it's happened repeatedly, then you just have to report it to the powers that be and let what happens happen.  I'd hate to be in your shoes right now.  Good luck.

Answer Question