Here's my post to your question from the Medicare Regulation thread....
I think that is truly ignorance at it's finest if you want my opinion!
I'd take that right up to one your head people... explain the differences in reimbursement, especially over a period of time... not to mention they are not properly coding!
I mean, how difficult can it truly be to check to see if a patient is new or not? and the fact their records aren't active for 3 years - normally <depending on state> the records are retained for at least 7 years.
I don't know where you could find literature on this... I can point you the direction of the difference between new and established, but you already know that... but billing an established patient every time regardless of new or not - quite frankly, that is insane. Sorry to be so blunt
Show them this >>>>>>>>>>
Why shouldn’t I undercode all my services just to be safe?
With all the talk about fraud and abuse, some physicians decide to play it safe and undercode their Medicare patient visits. Undercoding is a problem for every medical practice because it decreases earned revenue and establishes false utilization patterns. Utilization patterns are closely scrutinized by the government and by many payors. Most coding experts believe all inaccurate coding is bad coding. In some cases, undercoding can flag a physician as an outlier and lead to an investigation.
The first step to a health practice is to understand the guidelines. Many physicians undercode because of their lack of knowledge of the system. Learning to code should be an important part of every physician’s knowledge base.
I'm on a roll with this. Also, you might want to pull up the False Claims Act:
This prohibits:
Knowingly presenting, or causing to be presented to the Government a false claim for payment;
Knowingly making, using, or causing to be made or used, a false record or statement to get a false claim paid or approved by the government
In my opinion - by submitting "established patient codes" for every patient without regard to their "new status" is a false claim because it is making it easier for the claims to get pushed through and paid.
Any opinions on this?!!
