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Are we sure the documentation isn't coming as required from the insurance companies? I know many Drs and especially nurses who CYA on all their documentation o
by bearjaws 4y ago
Are we sure the documentation isn't coming as required from the insurance companies?
I know many Drs and especially nurses who CYA on all their documentation otherwise insurance will try to pin them on an adverse reaction.
- nradov 4y agoPayers in general (not just insurance companies) require high levels of documentation both to prevent fraud and to increase care quality. Most healthcare providers are highly ethical and only act in their patients' best interest. But there are always a minority of bad actors who will try to boost revenue by submitting claims for procedures that weren't medically necessary, or weren't performed at all. So the system needs checks for that in order to hold down costs for everyone, and prevent iatrogenic harm. You will also find many cases where even good providers let things slip through the cracks and fail to give some patients the appropriate level of care. For example, diabetics should generally receive annual foot exams, eye exams, and hemoglobin A1c tests. If the payer doesn't see evidence of those in the EHR then they can prompt the doctor to resolve that care quality gap.