Question: Case Study 1 (Real World Case) Cure All Hospital Has Received A Number Of Payer Denials For Services Billed With Incorrect ICD And CPT Codes Along With And Revenue Codes. After Investigating, Jane Discovered That Several Departments Were Submitting Their Charges Using Electronic Source Systems Or Paper Charge Tickets That Had Not Been Updated To Match …

Question: Case Study 1 (Real World Case) Cure All Hospital Has Received A Number Of Payer Denials For Services Billed With Incorrect ICD And CPT Codes Along With And Revenue Codes. After Investigating, Jane Discovered That Several Departments Were Submitting Their Charges Using Electronic Source Systems Or Paper Charge Tickets That Had Not Been Updated To Match …

Case Study 1 (Real World Case)

Cure All Hospital has received a number of payer denials forservices billed with incorrect ICD and CPT codes along with andrevenue codes. After investigating, Jane discovered that severaldepartments were submitting their charges using electronic sourcesystems or paper charge tickets that had not been updated to matchthe billing system’s charge master. In addition, the documentationin the medical record does not support the ICD and CPT codesselected by the HIM Coding Department.

  1. Explain what Jane should do to correct this problem andmeasures that should be put in place to ensure that the CDM iscorrect and that electronic source systems and paper charge ticketsare updated.
  2. Explain a CDI Matrix that would support a concurrent,retrospective, and post-bill review and how this will help tocorrect the issues present in the department.  Summarizeyour findings.
  3. Develop a policy that would ensure compliance to thedocumentation, query process, and coding of the inpatientrecords.  Include timelines and interpretation of theresponse and the retention of the queries.  Your responseshould be two to three pages in length.