Question Legal liability for physician coders

jmulis

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I have been informed by an executive high up in my organization that, as a physician coder billing under the provider's tax id number (not the facility's tax id), once I have educated the provider and documented my coding advice, I no longer have any legal liability for improper coding. I'm not being asked to code something that didn't take place but I am being asked to send through charges that don't follow coding guidelines. I don't believe this advice from a legal standpoint and I definitely don't believe it from the perspective of maintaining my credential but wondered if anyone has information supporting it.
 

RDK720

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If that is their company policy, ask them to put it in writing on the company letterhead.

It is fraudulent to bill for non rendered procedures. The procedure done should be reported even if it differs from the authorization received. It is the responsibility of the provider to select, at the best of their knowledge, the proper procedure to render prior to procedure. It does happen that complications may arise that causes a change in the type of procedure, and it will be up to the authorization department to do a retro auth and appeal.
 

jmulis

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I agree, it's not correct advice and I notice that no written direction has been provided for me. I'd never heard anything about the supposed differences in liability between a coder billing under the facility vs physician tax id and it sounded fishy.

If that is their company policy, ask them to put it in writing on the company letterhead.

It is fraudulent to bill for non rendered procedures. The procedure done should be reported even if it differs from the authorization received. It is the responsibility of the provider to select, at the best of their knowledge, the proper procedure to render prior to procedure. It does happen that complications may arise that causes a change in the type of procedure, and it will be up to the authorization department to do a retro auth and appeal.
 

jmulis

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I should add, the coding guideline I'm being asked to ignore is solely to get around the fact that a procedure wasn't pre-certed, so the physician gets paid for the one that was pre-certed and so the patient doesn't get billed for it.
 
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