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Properly coded clinical reports are one of the cornerstones of an effective healthcare practice, and that’s why it’s often one of the most substantial parts of compliance training for institutions. In the best of circumstances, every report is clear, coding is straightforward, and there’s no need for additional clarity — but this is often not the case.

This is where a physician query can come in handy, even if many medical professionals get uncomfortable dealing with them. Learn more about physician queries here.

What Is a Physician Query?

A physician query is a request made by a coder for additional information from the physician. They’re typically used to determine the best way of coding some nuanced aspect of clinical care for insurance purposes, which can sometimes lead to friction between clinicians and the medical coders if mismanaged.

Physician queries are a critical way for coders to provide a clearer picture of any documentation related to a health record. Yet, they must be done correctly, not only for clarity, but to maintain consistency with an organization and compliance with governing entities. Here are just some of the reasons why a physician query is essential to accurate coding:

  • Determining illness severity and risk of mortality
  • Managing denials and reducing the need for audits
  • Tracking cases and diagnoses

Additionally, the life of a physician query doesn’t end once the communication between a coder and physician stops. Queries must be tracked so that accurate documentation can be recorded and referenced if needed.

Why Do Physician Queries Matter?

Medical coding ensures that a healthcare institution can get fairly compensated for the care they provide. With healthcare costs on the rise and insurance companies becoming increasingly strict about what requirements must be met before paying providers, it’s become more important than ever to document all aspects surrounding a diagnosis in order to receive compensation.

It’s not unusual for a physician to view a query as a challenge to their clinical judgment, but that is often a misunderstanding that can be cleared up fairly easily.

When a Physician Query is Necessary

These situations require additional explanation because they can change how a patient is treated when it comes time to bill for the treatment they received from the clinician.

Under no circumstance is a coder’s query a challenge to the physician’s judgment. Treating patients can be a unique situation with various pressures that sometimes result in imprecise documentation of the symptoms that led to a diagnosis. Here are four situations where further clarity regarding treatment would be needed from a physician:

  • Diagnosis performed without primary clinical validation
  • Unspecific clinical indicators
  • Conflicting or inconsistent information regarding treatment
  • Diagnostics or treatments that do not align with a particular condition

If a coder requests additional information, physicians sometimes respond with a detailed clinical description to defend the position, resulting in lost time and increased frustration as two members of the organization work to fulfill their respective roles.

How to Query a Physician

There are multiple components to creating a straightforward and compliant physician query. All queries to physicians should contain the following information:

  • Provider name
  • Site name
  • Member name
  • Member DOB
  • Date of Service

In addition to the above information, queries should be clear and concise, with instructions on how to resolve any pending questions about coding. Physician queries should also be coordinated with providers, with agreed-upon timing and structure for any pending inquiries. 

MedTrainer provides an all-in-one software solution for healthcare practices and facilities. Whether your organization is looking for a way to track training and compliance initiatives or perform exclusion checks and accreditation, MedTrainer has the tools you need to succeed.  For more information about handling physician queries or to learn more about credentialing solutions that cover them, contact the MedTrainer team today!