Question

Susan has just been informed that an audit was conducted by an insurance company, and through data mining tools it was determined that multiple visits for various providers were exactly the same.

A number of issues went through Susan’s mind:

Copy/paste functionality; cloning of notes; altering of notes; preprinted templates, and on and on. Each could lead to issues in patient safety, compliance as well as fraud and abuse.

In your opinion:

• How would you suggest that Susan goes about resolving this issue?

• Outline a plan that would help Susan monitor and mitigate this from happening again.

Answer 1

To resolve the above mentioned issue, First of all Susan should contact the office manager, who should then review the records for Susan under the specific appointment dates in question. If the notes are in fact the exact same without any attempt at creating an updated note, the office manager should then contact the provider who saw Susan to edit their notes with updated information. Following that, the office manager should have the provider resubmit the updated note to Susan's insurance company.

The plan that would help Susan to monitor and mitigate it from happening again is that he must request for a copy of her medical records as they exist currently, review the provider notes in question and confirm the insurance company audit is correct. Finally, Susan can request a copy of the provider's note after each appointment to confirm the appropriate updates have been made.