Insurance requires 6 month physician visit...

[faithmd 14]

Not in your case, Renee, in mine.

Never

add anything unless you write a separately

dated and signed note. The patient, a third-party

payer, or a plaintiff’s attorney may have obtained

a copy of the patient’s original records. The entry

date for ink or type can be accurately determined

retrospectively, and any alteration after the fact

will seriously compromise the defense of your case.

Nope, it ISN'T fraud. It was MY MD writing in HER own office notes adding LATE ENTRIES to her OWN notes.

Looking at your quote below, it does not apply in this case. I am the patient, I sat there with her and had my journal with me of what I did each month and what we had discussed, it just hadn't made it into the record. By writing the date and time and "Late Entry" or "Late Addendum" it is just fine to add to a note. No third party payor had been sent copies of the records yet (because we were making sure what was needed in there was there BEFORE sending them to the third party payor). And what attorney? What defense of what case? I wouldn't be suing my PCP for anything relating to my weight loss visits.

From the American Health Information Management Association (ahima.org), THE authority (in the US) on medical documentation (thedoctors.com is a medical malpractice insurance company website):

Handling Omissions in Documentation

At times it will be necessary to make an entry that is late (out of sequence) or provide additional documentation to supplement entries previously written.

1. Making a Late Entry When a pertinent entry was missed or not written in a timely manner, a late entry should be used to record the information in the medical record.
   

• Identify the new entry as a "late entry"
  
• Enter the current date and time – do not try to give the appearance that the entry was made on a previous date or an earlier time.
  
• Identify or refer to the date and incident for which late entry is written
  
• If the late entry is used to document an omission, validate the source of additional information as much as possible (where did you get information to write late entry). For example, use of supporting documentation on other facility worksheets or forms.
  
• When using late entries document as soon as possible. There is not a time limit to writing a late entry, however, the more time that passes the less reliable the entry becomes.

1. Entering an Addendum An addendum is another type of late entry that is used to provide additional information in conjunction with a previous entry. With this type of correction, a previous note has been made and the addendum provides additional information to address a specific situation or incident. With an addendum, additional information is provided, but would not be used to document information that was forgotten or written in error. When making an addendum --
   
   • Document the current date and time.
     
   • Write "addendum" and state the reason for the addendum referring back to the original entry.
     
   • Identify any sources of information used to support the addendum.
     
   • When writing an addendum, complete it as soon after the original note as possible.

[*]Entering a Clarification Another type of late entry is the use of a clarification note. A clarification is written to avoid incorrect interpretation of information that has been previously documented. For example, after reading an entry there is a concern that the entry could be misinterpreted. To make a clarification entry –

• Document the current date and time.
  
• Write "clarification", state the reason and refer back to the entry being clarified.
  
• Identify any sources of information used to support the clarification.
  
• When writing a clarification note, complete it as soon after the original entry as possible.

[tanderson 3]

Faith, I stand corrected, however, the fact that your physician is "adding" forgotten notes would not be accepted by most insurance companies as acceptable proof of a medically supervised diet.

[faithmd 14]

I appreciate your point, tanderson. I do.

I guess my frustration came (when we were sitting there writing all of this in for an hour) was that I made it a point to discuss all of this at each and every visit. I made it a point to mention when I started walking three days a week for thirty minutes. I mentioned when I cut the simple carbs out of my diet. I discussed when I started logging my food. She simply didn't include that in her notes. So adding late entries to me was simply righting an error.

But again, you do have a good point. And certainly "creating" entries would seem somewhat...wrong. Though I also see the other side of it, if I've been fat for years and each year at my visit with my PCP we work on it, I know that I've met the insurance's basic requirements. I also see where writing something that never happened is very risky.

[nursekathy2u 0]

I got out of the 12 month requirement. I have no idea how but my obgyn wrote a letter stating that he had been seeing me for 13 years and the I have had battled my weight that entire time. While I was going through the process of submitting it to my insurance and getting all my tests I created 9 months of visits that my dr was willing to sign off on and if push came to shove I would have waited until I got 12 months worth. It didnt. I was approved 1st time through. I started from my last yearly physical and had seen him a few times for some other issues and we filled in the other months and he signed them. Good Luck.

I responded to the highlighted areas above. She said she "created" 9 months of "visits" and her doctor signed off on them even though she had only seen him a few times. No where in that post does it say that the information was never submitted to the insurance company. I could only assume from the post that the records for 9 months worth of visits were submitted and she was approved without having to finish the 12 months. If that had been the case.. stated exactly as above.. that would have indeed been insurance fraud. After her clarification as to what the notes actually were.. even if they HAD been submitted to the insurance company it would not have been considered fraudulent. The first post was misleading, or perhaps I just interpreted it wrong.

As to Faithmd's question of "why do I care?"... Why shouldn't I care?? I am in the business... it affects me and my profession when other healthcare practioners lower the standards by doing stupid things. From the previous post it gives the impression that physicians can be manipulated into doing unethical things... some can be manipulated.. and that pisses me off. I am also in the weight loss surgery business as well as being a patient. I had to do my time on a diet before I could get approved.. I had to jump through hoops to get approved, why shouldnt every one else have to follow "the rules"?? I have had a patient ask me to bill her insurance now for surgery but do the surgery the following month. She was quitting her job and didn't want to pay to COBRA her insurance. We have had a patient try to use her sisters insurance because she didn't have any. And don't even get me started on the folks who are on medicare disability and want the taxpayers to pay for their surgery but they can't even tell you what their disability is. I had another patient on medicaid who actually owns a business but put it in his dogs name so his profits wouldn't exclude him from medicaid eligibility. I understand about truly disabled people. Some people are so obese that they truely could not possibly work due to joint pain, back pain, shortness of breath, limited mobility etc. I am in no way making reference to anyone who TRULY is disabled. Im talking about folks who want a free ride..... Now I am on a soap box that has nothing to do with the original post!!!

Anyway, as a weight loss surgery patient myself I understand how desperate people can get to have their surgery done. I was one of those people. I guess Im just a stickler for the rules.. If I have to follow them why doesnt everyone else??? Because life is just not fair I guess....

[nursekathy2u 0]

I appreciate your point, tanderson. I do.

I guess my frustration came (when we were sitting there writing all of this in for an hour) was that I made it a point to discuss all of this at each and every visit. I made it a point to mention when I started walking three days a week for thirty minutes. I mentioned when I cut the simple carbs out of my diet. I discussed when I started logging my food. She simply didn't include that in her notes. So adding late entries to me was simply righting an error.

That drives me crazy!!!!!!!!!!!! My patients will go religiously, every month and talk to the doctors about their diet and exercise and when we get the notes all it says is "patient here for weight check" I finally created a form for the patients to take to their doctor visits for the doctor to document on and give to them right then. That way the patient sees exactly what was documented and can get it corrected. I also give my patients diet and exercise logs to fill out and they have a place for the physician signature at the bottom. If all else fails I submit the office visit notes with "weight check" written on it and the logs with the docs signature on them to prove it was discussed at the visit. Then I write a letter to the insurance company and ask them not to penalized the patient for poor record keeping onthe physicians part. They always get approved with the logs with the signature on it.

[tanderson 3]

I guess my frustration came (when we were sitting there writing all of this in for an hour) was that I made it a point to discuss all of this at each and every visit. I made it a point to mention when I started walking three days a week for thirty minutes. I mentioned when I cut the simple carbs out of my diet. I discussed when I started logging my food. She simply didn't include that in her notes. So adding late entries to me was simply righting an error.

I feel your frustration. That happened to me as well. I had gone in to see my doctor for a weight check and another problem. I needed that visit as one of my monthly visits for insurance documentation purposes and because I had mentioned my other problem, my doctor totally focused on that. He did not document one thing about my weight check. When I got the chart notes, I called the office to tell them what happened and they REFUSED to have the doctor add on my weight info. So I had to make ANOTHER appointment to go in and have my weight info documented. Thank goodness that I still had a few days left in the month to do this...otherwise I would have had to start completely over on my documented weight loss.

[tink128 0]

Whats happens to those of us who do follow the rules and still get denied? I appeciate your wanting to stick to the rules but if most of us could be successful at losing weight on a 6 month plan we wouldnt need the surgery in the first place. I think this insurance company requirement is bogus! Perhaps that is why some people feel the need to get past that requirement. However in the end I do believe in doing things honestly thus the reason why I too jumped thru hoops for the surgery and was still denied. I am going thru it again and I will be thinking twice about how to handle that reqirement if it rears its ugly head again. However, I do thank you for your dedication to your profession!

[nursekathy2u 0]

Whats happens to those of us who do follow the rules and still get denied? I appeciate your wanting to stick to the rules but if most of us could be successful at losing weight on a 6 month plan we wouldnt need the surgery in the first place. I think this insurance company requirement is bogus! Perhaps that is why some people feel the need to get past that requirement. However in the end I do believe in doing things honestly thus the reason why I too jumped thru hoops for the surgery and was still denied. I am going thru it again and I will be thinking twice about how to handle that reqirement if it rears its ugly head again. However, I do thank you for your dedication to your profession!

Tink.. Why did you get denied?? Maybe I can give you some tips... Many times people get denied due to the way their surgeon submitted the information. I see that all the time. Also, on the diets, most insurance companies won't deny you if you don't lose weight. Believe me.. very few people lose any weight on the diets. I think the insurance company wants to see that you are comitted to the surgery and able to stick to a follow up schedule since that will be required after surgery. I also think they use it as a cooling off period.. maybe if they make you wait you will change your mind. Then there is always the assumption that fat people are lazy. Maybe they figure they will never have to approve us because we are too lazy to go to the effort of doing the diet. (If you can't tell I think the diet requirement is bogus too.) I think you should be required to have been on diets in the past though.. Surgery should be used as a last resort, not a first one. You would be surprised how many men ask for bands when they have never tried to lose the weight before. And the thing that sucks is that they will lose more weight, faster than us women!!!!! With or without the band.

[Kimmie 0]

I hear ya girl!!!

[tink128 0]

Tink.. Why did you get denied?? Maybe I can give you some tips... Many times people get denied due to the way their surgeon submitted the information. I see that all the time. Also, on the diets, most insurance companies won't deny you if you don't lose weight. Believe me.. very few people lose any weight on the diets. I think the insurance company wants to see that you are comitted to the surgery and able to stick to a follow up schedule since that will be required after surgery. I also think they use it as a cooling off period.. maybe if they make you wait you will change your mind. Then there is always the assumption that fat people are lazy. Maybe they figure they will never have to approve us because we are too lazy to go to the effort of doing the diet. (If you can't tell I think the diet requirement is bogus too.) I think you should be required to have been on diets in the past though.. Surgery should be used as a last resort, not a first one. You would be surprised how many men ask for bands when they have never tried to lose the weight before. And the thing that sucks is that they will lose more weight, faster than us women!!!!! With or without the band.

I was denied because 3 years ago GHI PPO did not allow any type of gastric surgery for weight loss except a gastric bypass. I even went thru the appeal process and was denied again. Dr Kwon was my Dr and he is a leading guy in the area of ins approval for the lap band in the upstate NY area so I know I was with the best. Now I have GHI HMO and I know they approve the surgery so hopefully the last 12 months of documented dieting with my OBGYN will suffice. I have an intake/seminar appt on the 14th so I will again be in the process of getting approved. I have tried 8 years of dieting, pills, antidepressants, getting prayed over,etc etc etc just like pretty much everyone else who has now decided this surgery is the last hope. Thank you for the info I will be taking it into the appt next week!

[rms78645 0]

I too think this should be a last resort, not a first. I think that dieting should have been attempted. My niece has seen what I have gone through and now she wants gastric. She has never dieted, never exercised and doesnt want to have to work so she doesnt want the band. It makes me crazy! I have tried and tried to get her to see that nothing will keep the weight off without working at it. But one of my best friends was banded 2 years ago and she doesnt think that having dieted should be a pre requisite. She thinks that she wasted all those years dieting to no avail. I see that point too I guess.

[rms78645 0]

I too think this should be a last resort, not a first. I think that dieting should have been attempted. My niece has seen what I have gone through and now she wants gastric. She has never dieted, never exercised and doesnt want to have to work so she doesnt want the band. It makes me crazy! I have tried and tried to get her to see that nothing will keep the weight off without working at it. But one of my best friends was banded 2 years ago and she doesnt think that having dieted should be a pre requisite. She thinks that she wasted all those years dieting to no avail. I see that point too I guess.

[chimboree26 24]

has anyone gotten out of this by your MD writing a letter to the insurance company....basically stating that you've been under his/her care for years...

Thanks for your input!

Kimmie, any word yet? And when you say 6 months physician visits, are you meaning just a weight loss history or 6 months of a supervised diet? My insurance (Carefirst/BCBS) asked for 6 months of weight loss history. They said medical records, logs from Jenny Craig, Curves, WW, etc. could be provided. I sent a year's worth of medical records that documented my wt history, and included notes where I discussed wt. loss efforts w/my doc. I also provided my contract/receipts from the gym and from Curves. I also included a log where I tried the Sonoma Diet, Suddenly Slim, etc.

This was enough info b/c I was approved.

Let us know what happens.

[Kimmie 0]

No word yet...tho I don't think my MD submitted my letter yet. Supposedly WW and all that won't count for this. I do have about 9 months of that though..maybe I should make copies and send it in with the letter. It can't hurt that's for sure!

[musicalmomma 1]

Nevermind...I see the issue was resolved....didn't see the second page Best of luck to you Kimmie