• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki Changing provider charges

Create Wiki
T

theaterd

Guest
Messages
29
Location
Buffalo
Best answers
0
I apologize up front because I'm sure this has been covered before, however I can't find the threads.
If a company has a policy that providers do their own codes for billing, and you come across procedures not documented, you then inform the provider to append the note. Provider doesn't, or won't. Now you have a note that doesn't justify the charge. Please tell me that my only choice in this scenario isn't just to resign. I obviously can't send in a claim that isn't warranted, but aren't we somehow protected, legally, in this situation?
Any help is greatly appreciated. ;)
 
If it is not documented and you cannot obtain the document then you cannot submit the code. There is no protection for you to knowingly submit a claim that is not supported by the chart note. I do not understand why a provider would not want to document a procedure and yet mandate you bill for one. That is openly requesting that you submit a fraudulent claim. Submit the claim with only what you can support. Your codes on the claim do not need to match those submitted by the provider, however you must match the narrative in the chart note itself. If you cannot do this then you either risk the consequences or resign.
 
You must log in or register to reply here.
Top