We have a provider(Hospital) that routinely upcodes Emergency room E&M codes using 99285. Documentation clearly does not support the billing of the code and the provider refuses to lower the code or the charges. The provider in turn bills the patient for the charges since we, the auto insurance company won't pay for the services/treatment where documentation isn't supporting the billing. How can this be handled appropriately? We don't want the patient balance billed for a service that wasn't rendered. Is there an organization where a formal complaint can be filed?
-
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 ER E&M upcoding
- Thread starter Lisa Cato
- Start date
mitchellde
True Blue
to bill for services not provided is fraud, check with you states attorney generals office or if you have a state board of healing arts or the equivalent.