Question

You receive a call from Cindy, who is quite upset. She has just received an EOB from her insurance company clearly stating a diagnosis of AIDS. Although HIV positive, she has not been diagnosed with AIDS. You have checked Cindy’s medical record and her diagnosis has not changed. In looking at Cindy’s insurance claim, you see that the new coder did indeed use the diagnosis code for AIDS instead of HIV. How will you help Cindy’s immediate concern of her diagnosis? How can this be corrected with the insurance company? What will you say to the coder regarding the need for accuracy when coding any claim?

Answer 1

Resubmitting the claim can help to locate the error. sometimes error occurs when typing and create a mismatch of codes and documentation or something could heave missed from the submission cause coding error, and incorrect patient and provider information, etc. Incorrect coding cause problem in reimbursement and affect patient care. It also makes payment to be denied and delayed.
EOB document sent by the insurance company once you received health care services and claims submitted to the insurer. submit an appeal if denied is justified. Appeal process help to deal with this situation to gather information about the issues and review the benefits if any processing errors occurred. insurer consider the appeal and make an external review. advice coders to do correct coding with up to date information. Verify the codes once completed. if any confusion with coding call doctors office and get billing clerk or staff for clarifying the doubts.