Wiki Coders Being Fined for Mistakes

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michelled

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Has anyone ever heard of or experienced coders being fined for mistakes, or physicians or facilities recouping losses for sloppy coding?

Any information or help is appreciated. Thanks!
 
Yes I have heard of this. There was an instance reported in "The Coding Edge" a few years back, also Decision Health had a couple of articles on this same subject citing cases where coders were fined heavily. I ahve had participants come to me at seminars to report that they have been fined and it is not pleasant. This is why coders should always code from the documentation and follow the coding guidelines.
 
Thanks for your reply!

It seems pretty harsh. Do you know of anyone who has experienced this firsthand? I'd like to find out the monetary penalties and any statics on how often this happens.

I'm wondering what the legalities of it are.

Michelle Dick
 
I cannot give you names from individuals that told me this in confidence. The article in "The Coding Edge" revealed a $1.2 million dollar penalty that was assessed to the coder and the physician. The dollar amount from the Decision Health article was not revealed. I have read others thru other resources that state penalties in the millions. Is it legal? To fine a coder for not doing her job? Of course it is legal, as a coder you should not append any code to a claim that is not supported by the documentation. If you make a mistake then it is just that a mistake. If on a regular basis you assign the wrong codes because maybe you code from memory or you use a cheat sheet or you code from a superbill, then you are responsible for that code and it was not a mistake it was intentionally applied.
 
It seems like the coder should be fired, especially if it happens more than once, rather than fined. Do you know what issue of Coding Edge the article is in.

Thanks again!
 
It was several years back possibly arounfd 03 or 04 and I think it was a winter issue. These were not interoffice audits these were payer audits. So fines and penalties will be assed all the way around.
 
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