Medical Auditing Practice Exam

Which document should accompany a coding appeal to a payer?

1. Practice overhead calculations

2. Patient satisfaction reports

3. Documentation copies

4. Clinical trial results

The correct answer is: Documentation copies

When preparing a coding appeal to a payer, it is vital to include documentation copies that support the claim being appealed. This documentation serves as evidence to substantiate the coding decisions made, demonstrating that the services provided were medically necessary, appropriately coded, and compliant with payer guidelines. The documentation may include details such as the patient’s medical records, notes from the healthcare provider, and any relevant test results that clarify the context of the services rendered. By providing this comprehensive evidence, the appeal presents a clear and compelling case to the payer, increasing the chances of a successful outcome. Other documents, like practice overhead calculations, patient satisfaction reports, and clinical trial results, do not offer the direct supporting evidence required for coding appeals. Instead, they are often unrelated to the specific details of the claim in question and would not aid in clarifying or supporting the coding choices made during the patient's treatment.