Wiki Need Advice

[ercoder65]

I am in a quandry and I need some advice. I have coded now for over 3 years. I worked for a great little hospital initially in my coding career, but left when the threat of layoffs loomed. I took a job as a coder in an Orthopedic Center. My supervisor is handling coding, billing and MRI's. She knows nothing about coding. She won't take advice at all, and has us code in a way I feel uncomfortable in doing. For instance, she has me code for an Ortho's Inpatient visit in the hospital, using these blurbs which just say who the patient saw and what level he is charging (1,2,or 3); there is absolutely no documentation anywhere that I can verify this charge being billed. Another problem I see is when a surgeon has a PA assisting. We code off the surgeons OP report, and all he says is so-and-so PA assisted me. There is no documentation anywhere from the PA explaining how he assisted. I know she is inept because she recently came into the coding department witha transmittal from Wellmark BCBS saying they've stopped accetping V-codes, but after reading the transmittal, all BCBS states is that they want 'appropriate' V-codes being used [properly using 1st listed, secondary, and some are 1st and 2nd]. After explaining this to her, well, lets put it this way, I have one foot out the door. I don't know what to do or what I can do, if anything. Any professional advice would be greatly appreciated.

TIA


Richard

 

[fredabrinson]

Difficult place to be

Hey Richard,

We can all sit here and give you advice on what to do, myself included, but it is not "us" in your position, so please remember that as we, myself included, give any advice! I really do not know what it would be like to be in that position, but like you, I know I would be extremely uncomfortable.

To start, I would go to the website of your RAC contractor, and print the information on what your RAC will be auditing. I would also look at other regions RAC contractors as well. As you know, RACs will be looking at all Medicare providers, not just hospitals as was the primary focus in the demonstration project. Medicaid also has their own contracted auditors. And there is always the OIG, CERTs and others I can't even remember! The bottomline is that everything providers are submitting on claims can be looked at. Most of these contractors are doing data mining, so providers will not know their claims data is being looked at, but just know that it is. Providers can be requested to refund money received based on this, without the medical records ever being requested. If your supervisor and physicians do not know about these programs, that's where I would start. Educate them on what all providers are facing, and it is more vital then ever that our coding and billing is correct.

On your inpatient coding, the physicians should be documenting in the medical record at the hospital, as I sure you know since you have worked in a hospital! You could request a copy of your physician's progress notes and audit that documentation against what you are being "required" to code. If you see a problem between the documentation and the code billed, write up an audit report on your findings and submit it to your supervisor and if you are comfortable with this, include the physician involved as well. Documenting your findings and putting it in writing can be powerful in presenting your concerns.

I know this is easy for me to say, but again I am not in your shoes and I don't know the relationship you have with your physicians. I would not want any advice you might take to get you into any trouble. Everything you do has to be your decision.

Please feel free to call me at 912-819-8964 if you would like to talk. Again, I've never been in your situation but I have worked for physicians and hospitals for the past 30 (yikes, has it really been that long!) years.

Good luck to you!!!

 

[ercoder65]

Freda,

Thanks for your advice. I wish I can just up and go, but unfortunately (As you know) the economy isn't so great so jobs are scarce right now. All I know is I feel like I am doing something I shouldn't and have no control over any of it! I may take you up on that call..........thanks again!

Rich