you work for a third party payer performing medical records review, your job is to match codes that are submitted on the claim form to documentation in the medical record. the code has been inputed but you don't see the procedure report anywhere in the recordwhat will your action be regarding the code that was submitted on the claim form

Question

you work for a third party payer performing medical records review, your job is to match codes that are submitted on the claim form to documentation in the medical record. the code has been inputed but you don't see the procedure report anywhere in the recordwhat will your action be regarding the code that was submitted on the claim form

can anyone tell me of a website that may give me the answer

thanks

Answer 1

As a third-party payer performing medical records review, your role is to ensure that the codes submitted on the claim form match the documentation in the medical record. If you cannot find the procedure report in the medical record, there are a few actions you can consider:

1. Double-check the medical record: Review the documentation again to ensure that you have not missed any relevant information. Sometimes the procedure report may be located in a different section or under a different title.

2. Communicate with the healthcare provider: Contact the healthcare provider or the facility to inquire about the missing procedure report. They may be able to provide further information or assist in locating the document.

3. Follow your organization's guidelines: Refer to the policies and procedures established by your organization to determine the appropriate steps to take in such situations. They may have specific instructions or protocols for handling missing documentation.

Regarding your second question about a website that may provide further information, unfortunately, as an AI text-based bot, I do not have access to specific websites. However, you can try searching for professional medical coding websites, such as the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA), as they may provide resources and guidance on medical coding and documentation review.