You Are an Auditor Reviewing a Spreadsheet That Shows All

Multiple Choice

You are an auditor reviewing a spreadsheet that shows all of the records for the year in which the patient was on a mechanical ventilator. You are reviewing these records because, in every case, the coder has assigned a procedure code indicating that the patient was on mechanical ventilation for over 96 hours. When queried, the coder remarked that the hospital gets a higher reimbursement for that code than for a lower number of hours. You should:

A) accept the coder's explanation, because it is up to the coder to decide what codes to assign to a case.
B) discuss the finding with the Health Information Management Director as a potential abuse or fraud issue.
C) change some of the procedure codes so at least some of them are under 96 hours.
D) ask the coder to re-review all of the records.