Q&A: Pre-bill query process requires careful analysis

April 14, 2011

Q: What does ‘pre-bill retrospective physician query process’ mean?

A:A pre-bill retrospective query process is when the patient is already discharged and the physician is queried (or an unanswered query is closed out) before final coding and billing takes place. In many facilities the query is “owned” by the CDI specialist until an answer is obtained. In other facilities unanswered queries or query opportunities identified after discharge become the responsibility of the coder.

In either situation it is best practice to design a process for getting the required documentation before final coding and billing takes place. We think of this as “getting it right the first time.” You don’t want to have to re-code and re-bill the case if you obtain additional information after the bill goes out since doing so often raises “a red flag” from an auditing perspective.

For example, a coder might see that there is an outstanding query remaining in the documentation and then flags the case as containing a deficiency and delays final billing until an answer is obtained from the provider.

Of course you don’t want to hold these cases forever since it impacts the revenue cycle. To combat this problem, your facility should create a series of policies and procedures which outlines exactly how long to hold the case, defines who is responsible for query follow- up, and what to do if the provider doesn’t respond.

Editor’s Note: Lynne Spryszak, RN, CPC-A, CCDS, CDI education director for HCPro, Inc., in Danvers, MA, and a member of the ACDIS advisory board, answered this question. Contact her at lspryszak@hcpro.com.

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