I was recently asked to give my thoughts on the importance of keeping medical records as a financial tool. My reasons centered on using the medical record as an auditing tool for medical charges. This is my entire entire.
Audit for errors + ensure proper coding = controlling your costs
Most patients are intimidated when I first mention auditing an EOB or understanding coding, but patients are ultimately responsible to make sure the billing is correct. When you receive the statement from the doctor’s office or the EOB from your insurance, you should check to see if it is correct (Did you see the doctor on the date on the EOB? Did you receive the service(s) indicated?), and the best method to check the financial record is comparing to copies of your medical record.
Medical records are the only relied on documentation of what actually occurred between the health care provider and patient. The charges reflected on the health care providers’ bill comes directly out of the medical record. The records must reflect answers to: 'why' the patient was seen, and 'what' was done as a result of the encounter in the form of codes. The 'why' is translated into a diagnosis code utilizing guidelines found in the International Classification of Diseases Version 9 (ICD-9), though next year, and October 1, 2015 the entire industry is scheduled to upgrade to Version 10 (ICD-10). The professional health care provider answers the question of 'what' was done with Current Procedural Terms (CPT). These ICD-9 and CPT codes are submitted to your insurance and ultimately determine charges to the patient. Keeping medical records provides an important window to the past and as the baseline for all of your healthcare costs, you should always request copies for your files. Whether you audit the medical and financial records yourself or ask someone for help, your copies of the medical record will enable the answers to be found and your costs to be accurate.
This is the article found in US News & World Report:
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