Chart requests by payers – Ophthalmic Professional

Who is looking and why?

Certainly, the notion of getting a request for a moderate number of charts from a payer would not raise much consternation today. Technicians are usually responsible for helping to input information into charts. They may also gather charts and supporting documentation to review before sending to the provider for final review, after which they are sent to the requester. But, techs should also be concerned about some important issues related to these chart requests — even if they do seem “routine.”

Knowing whether the request is valid should be the first consideration. Never forget that some people may try to steal practice and patient information — particularly via electronic methodology (although mail scams are still a threat). We often hear of smart people who click on links or respond to “phishing” scams and expose private information or protected health information. Everyone in the office (including technicians) should be able to recognize when “something doesn’t seem right” and how to react. Everyone who looks at mail needs to become familiar with the various parties selected by the government to do these chart reviews since they are not household names.1 Otherwise, an official correspondence might seem like just another piece of junk mail and get discarded.

The entities that ask have a variety of reasons for the requests for documentation. Some of these are far more problematic for your office than others. Proceed to the article see the list of the significant requesters.

This article was published in Ophthalmic Professional’s Coding column, and written by Corcoran’s Senior Consultant, Paul Larson, MBA, MMSC, COMT, COE, CPC, CPMA. To view the entire article in Ophthalmic Professional, click on the link below:

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