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Legal Basis for Claiming Ownership of Billing Data?

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PMRNC:

--- Quote ---Assume paper charts and paper EOBs.  The legal record is the chart, not the electronic data in the billing software.
--- End quote ---
  --- Agree


--- Quote ---For a given patient and a given date of service, one can match what is in the chart with what is on the EOB for that date of service.  That would demonstrate whether the billing service billed appropriately.  If the physician has both the chart and the EOB, why would anybody need to come after the billing service
--- End quote ---
?

Well that is what ANY PM software having an audit trail would show.. Audit trail is ABSOLUTELY necessary for any PM system. It's one of the first things a billing company needs to know if a client has that within their PM system.. I want to know what was changed, entered, and who did it and when!! If any PM software does NOT have an audit trail.. do NOT consider them at all. Hang up the phone, don't waste your money.

I think what your asking Richard is really about "convenience" rather than "law" .. sure a provider would LIKE to have it all load nice and neat in a PM system they can just "open" .. tough cookies. :)


 Other than maybe it would be easier to check the ledger of the billing software rather than find the appropriate paper EOB.  But - since the billing software is not a legal record - how could that electronic ledger be used in any legal proceding in place of the actual EOB for that date of service?

And - rhetorical question for now - how does that scenario translate to the physician who is totally electronic and has no paper records?

RichardP:

--- Quote from: PMRNC on April 06, 2015, 05:45:02 PM ---I think what your asking Richard is really about "convenience" rather than "law" .. sure a provider would LIKE to have it all load nice and neat in a PM system they can just "open" .. tough cookies. :)
--- End quote ---

Linda - what you responded to was my response to Merry re. CMS or other insurance auditing a doctor and also wanting to look at the billing service.  That is an issue different from what a billing company legally owes a doctor who is switching billing services.  We switched subjects there for a minute.  It isn't clear to me, from what I read in your response, that you got that distinction.  If you did, then nevermind.

Merry:
To answer your question..why would CMS want to see.....
Because Dr claimed he gave the billing service codes xxxxx and the billing service billed yyyyy. But when the auditors saw the source docs at the billing service location they showed that the service billed what the Dr gave them. Dr lied. Stripped of billing govt carriers and probably commercials.

RichardP:
OK.  I think I get it.  In your example, we are not trying to prove what the billing service billed - because that can be determined by looking at the EOB.  We are trying to prove what codes the doctor actually gave the billing service - which can't be done by looking at the EOB (since billing might have changed the codes).  That can only be done by looking at what the doctor gave the billing service.

Merry:
yes Richard. Sorry that I wasn't clear.

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