Question.1470 - Week 2: Discussion - Introduction to the Patient Record - Part 1 99 unread replies.1818 replies. Introduction to the Patient Record - Topic Description A physician sees a patient for a medical procedure and an x-ray. The physician tries to bill for both the medical procedure and the x-ray, however, they forgot to document the medical procedure in the patient's medical record. Can the insurance company refuse to pay for a medical procedure if it isn't documented? Why or why not? Discussion Guidelines: Each week you will have a topic to answer and then respond to at least two classmates. This means, that if you follow the minimum posting requirements you will have one main substantive answer in each thread, and one response to at least two classmates. Altogether 3 posts, 2 of which will be on different days of the week. Be sure to check in if you have questions. Grading rubric for discussion posting per thread: Main post - 10 points (high quality) Response posts - 10 points (total of all responses) Post by Wednesday - 5 points
Answer Below:
The insurance company has the full right to refuse to pay for the medical procedure if it is not documented. The documentation of the medical procedure serves as proper evidence in order to claim the payment from the insurance company. The main reason for documenting the medical procedure is it shows whether medical procedure is actually required or not in order to provide the proper treatment to the patient. An insurance company has several guidelines to fulfil the claims. If the medical procedure meets the specific guideline of the insurance company, then only the claim will be approved. There have been many instances where the insurance company refused to pay the claims only due to the lack of documentation. There should be a clear communication between the insurance company and the patient as to what are the requirements which are necessary for the insurance company in order to approve the claims of the patient because the claim may get rejected because of lack of submission of the proper documentation. The submission of the documents should also be done in a timely manner so as to avoid any kind of delay in submission of the claim(skywaymedia, 2023). It is important to maintain the documentation of the entire medical procedure because it acts as a backup for both the insurance company and the patient. For the patient, it serves as the basis on which their claim will be approved and even if it gets rejected, they can file an appeal against the insurance company. On the other hand, on the basis of submission of the valid documents, the insurance company can decide whether they should approve or reject the claim of the patient. Therefore, we can conclude that it is important to maintain the documentation of the medical procedure, otherwise it can lead to the rejection of the claim by the insurance company. Reference skywaymedia. (2023, September 21). How Clinical Documentation Impacts Commercial Payor Denials. Brundage Group. https://brundagegroup.com/how-clinical-documentation-impacts-commercial-payor-denials/ More Articles From Strategic Management
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