The intermediaries will then conduct focused Medical Reviews on the data submitted by the hospitals. If some of the services furnished and billed were not deemed reasonable and necessary, those services will be denied. If a primary procedure is determined to be non-covered and is denied by medical review, then the APC package including the associated ancillary or component services may also be denied. We are still quite a way from the ideal. Creating a team approach to altering the documentation tools so they are user friendly and complete can eliminate many of the potential coding errors.
Documentation has to be a major focus for both managers and the clinical staff.
Diana Contino, RN MBA is a nurse with over 14 years of clinical and administrative nursing. She is passionate about creating environments and processes that give nurses and physicians at the bedside the information, support and autonomy they need to provide the excellent patient care they desire to deliver and patients expect to receive. She gives many thanks to Darlene, Keith, Richard and Carolyn for taking the time to review and comment on the above article.