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Reimbursement Methodologies

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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 precedure, but you don't see the procedure report anywhere in the record. As the third-party payer representative, what will your action be reguarding the code that was submitted on the claim form?

I would go back to whomever input the code and make sure they used the right code. Am i anywhere close to where i need to be?

  • Reimbursement Methodologies -

    I think you're right.

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