How should administration respond in this situation?

Hospital policy states that physician responses to queries should be no longer than timely payer filing requirements. A physician responds to a query after the final bill has been submitted.

How should administration respond in this situation?
A . Evaluate the payer’s timeframe for billing and reasons for the physician’s delayed response
B . Review the record to determine any potential data integrity impact and/or rebilling implications
C . Maintain the original billing as supported by documentation in the medical record
D . Report the physician’s delayed response to the Ethics and Compliance Committee

View Answer

Answer: B

Explanation:

Administration should respond to this situation by reviewing the record to determine any potential data integrity impact and/or rebilling implications. According to the AHIMA Practice Brief on Managing an Effective Query Process, post-bill queries are generally initiated as a result of an audit or other internal monitor, and healthcare entities can develop a policy regarding whether they will generate post-bill queries and the timeframe following claims generation that queries may be initiated. The practice brief also states that healthcare entities should consider the following three concepts in the development of a post-bill (including query) policy: applying normal course of business guidelines, using payer-specific rules on rebilling timeframes, and determining reliability of query response over time 2. Therefore, administration should review the record to see if the physician’s response to the query affects the quality of care, patient safety, severity of illness, risk of mortality, or reimbursement, and if so, whether it is appropriate and feasible to rebill the account based on the payer’s rules and the normal course of business guidelines. Administration should also evaluate the reasons for the physician’s delayed response and provide feedback and education to prevent future occurrences.

References: 1: AHIMA CDIP Exam Prep, Fourth Edition, p. 133 3 2: AHIMA Practice Brief: Managing an Effective Query Process 4