Health care providers are responsible for documenting and authenticating legible, complete, and timely patient records in accordance with federal regulations and accrediting agency standards. The provider is also responsible for correcting or altering errors in patient record documentation. A patient record documents health care services provided to a patient and includes patient demographic data, documentation to support diagnoses and justify treatment provided, and the results of treatment provided.

A commercial health insurance company reviewed patient records as part of the claims payment process and then denied payment for submitted procedures and services totaling $7,000. The insurance company's denial letters stated that documentation about denied procedures and services were not found in the patient record. What action should the provider's office take?

Answer rating: 100% (QA)

When an insurance company denies payment for procedures and services due to insufficient documentation in the patient record the providers office shou... View the full answer