09/28/2016 – Importance of complete documentation

 

Question: Why is it so important for our documentation to be complete if it isn’t being sent out with the claim?

Full documentation allows coders and billers to properly submit claims to insurance companies with accurate and correct codes.  Even in this day and time, when claims are sent electronically to the insurance, it is the responsibility of the provider to make sure all the information submitted is complete.  In the event the insurance company decides they need documentation of the claim prior to payment, they will suspend payment until they receive what is needed from the provider.

 

Example:  Post-op pain blocks – provider marks on billing slip that they performed a post-op pain block with the use of ultrasound guidance.  Coders will mark the charges to be billed.  The insurance comes back to us requesting documentation of these services.  If we have the proper documentation, it is sent to the insurance company and payment is made.  Without proper documentation, the insurance company denies the claim and the provider receives no payment for the services performed.


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