Medical Record Reviewers: Do You Feel Pressure to Deny?
As a medical records reviewer, do you ever feel the pressure to deny everything? Integrity Advantage's Terri Riis-Christensen shares her insight on this topic critical to the med review process.
Hi, I’m Terri, a medical reviewer with Integrity Advantage. Do you feel pressured to deny everything? Spend time looking for reasons to deny? As a coder I was taught we don’t look at money, we just code what was documented. I feel the same logic applies to reviews. I need to determine, based on the information I am given, whether the documentation contains the potential for fraud, waste, and abuse. .But, I should be out to get the provider. Just the facts, please.
Denying lines just to deny them sends a message that we are against our healthcare providers. It can lead to taking resources out of contexts, which then reflects poorly on the reviewer. It provides the possibility of wasting time and it can promote animosity towards the reviewing entity. These do not create beneficial relationships.
Obviously, there are going to be valid denial reasons, and those need to be documented as such. But there will be other items that are less definitive. It’s at those times I ask myself: is this a one off? Meaning, it doesn’t appear to be a regular practice. Or is it something that maybe the provider is unaware of and just needs to be educated on? Can I find a credible source to validate my reason for denial or am I really stretching it?
Well, I am on the hunt for bad providers. I am not out to make every provider the bad guy. Integrity in the review will soften the stigma and hopefully promote providers to take a look at their practices and apply the necessary changes to be compliant. Just my thoughts. Thank you!
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