Wiki Compliance Issue

[JRalston]

A physician recently moved his practice to another office locally. The physician contracted with our billing office for an additional couple of months after the move to post insurance payments received for charges billed from our office. During this process, the new office would provide me with eobs that often times had payments for both my office and theirs. These eobs revealed that the new office bills Medicare at one rate and all other payers are billed with higher amounts for the same CPT codes. Who should I report this to?

Thanks!

 

[thomas7331]

I thinks it's always best to try to follow your 'chain of command' for these issues, if there is one. So I would start with the compliance officer in your organization, if there is one, or your manager or supervisor. If not, then I would discuss it with the physician since that's who your contract is with and also who is potentially liable if there is a violation. He or she may be able to take the issue to the compliance officer at the new office, or put you in touch with the responsible party there to discuss it with you. I wouldn't jump to any conclusions about wrong-doing without giving them a chance to review and investigate first - there could be any number of reasons why you're seeing this on the EOBs.