Which policy should the hospital follow to avoid a compliance risk?

A clinical documentation integrity practitioner (CDIP) generates a concurrent query and continues to follow retrospectively; however, the coder releases the bill before the query is answered. The CDIP wonders if it is appropriate to re-bill the account if the physician answers the query after the bill has dropped.

Which policy should the hospital follow to avoid a compliance risk?
A . A rebilling is permissible when queries are answered after the initial bill.
B . A post-bill query rarely occurs as a result of an audit or other internal monitor.
C . A second bill should not be submitted when the first bill was incomplete.
D . A post bill query is not appropriate when an error is found after an audit.

View Answer

Answer: A

Explanation:

A rebilling is permissible when queries are answered after the initial bill, as long as the hospital follows the appropriate guidelines and procedures for rebilling, such as submitting a corrected claim within the timely filing limit, notifying the payer of the reason for rebilling, and documenting the query process and outcome in the health record. Rebilling may be necessary to ensure accurate coding and reporting of the patient’s condition and treatment, as well as appropriate reimbursement and quality measures. [3][3]

References: 1: https://www.ahima.org/media/owmhxbv1/cdip_contentoutline_2023_final.pdf [3][3]: https://my.ahima.org/store/product?id=67077