Wiki Over-reads

[pulin391]

I work for a small Cardiology group. It has recently come to my attention that a cardiothoracic surgeon is performing over-reads for our procedures and the insurance is paying them before us. Is this right? Did the cardiothoracic surgeon find a loophole? If there is anyone out there that knows of some kind of rule or article which I can be directed to, it would be a great help. This Dr. is overreading chest xrays, angiograms, tee's and billing for them. But our Dr. performed the procedure and dictated them. Please help!!

 

[jerseygirl66]

If your physician's name is on the official report, you have a basis for appeal with the carrier. You will need to fax or send the report to the carrier. This is something you should bring up with your office manager and/or physicians and let them deal with the surgeon(s). If you let them know it is affecting THEIR money, I'll bet they will take care of it right quickly.

 

[pulin391]

Our physician is on the official report. We were planning on filing an appeal until we started finding more and more with the similar situation. My manager is aware of this situation and has advised our dr's. But do you know of any written rule in regards to this? We shouldn't have to appeal anything because its our money to start with. This sounds like the surgeon is fraudulenty billing for interpretations that were not done by him/her. I do understand that the surgeon needs these interp's to perform surgery, but it doesn't mean he can bill for them. Thanks for the initial response. I did'nt think anybody would answer my question.