Physician, Coder Issues

haven711

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I am wondering if any one knows where to find a document that you can have your physicians sign, stating that they are liable for any billing issues, such as fraud etc. I was told at a Medicaid conference you can have your physicians sign one. I only want one because I am told alot to just bill it even though I have proven medical necessity does not exist. Any information or help you can give would be great.
 

mitchellde

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you should consult with an attorney.. Liability cannot be assigned away. If you knowingly submit claims with false information, you are liable for those claims. if the provider documents false information then you are not liable for submitting a claim based on what was documented.
 

thomas7331

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I agree with Debra, and I think that having a physician sign a document is not the right path to take. Even if you can find a legally binding document, I would be surprised if your physician would agree to sign it, and just the act of asking them to do so would likely make any working relationship with them very difficult.

But in reading your original post, I don't believe that you, as a coder, would be liable for medical necessity issues - medical necessity is outside the scope of coder training, so I'm not sure what you mean in saying that you have 'proven medical necessity does not exist'. Only a physician or peer with clinical training can make a definitive determination about the medical necessity of a service provided to a patient, and performing medically unnecessary services is a medical practice issue, not a coding or billing issue. If a payer were ever to challenge medical necessity, it would be the physicians who would need to justify their decisions to the payer's medical directors, and would usually not involve a coder. As long as the claims you are billing are supported by documentation and you are not knowingly submitting claims for services not rendered or not supported by the medical records, I can't imagine that you would be held liable for this.
 
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Mayzoo

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I agree with Debra, and I think that having a physician sign a document is not the right path to take. Even if you can find a legally binding document, I would be surprised if your physician would agree to sign it, and just the act of asking them to do so would likely make any working relationship with them very difficult.

But in reading your original post, I don't believe that you, as a coder, would be liable for medical necessity issues - medical necessity is outside the scope of coder training, so I'm not sure what you mean in saying that you have 'proven medical necessity does not exist'. Only a physician or peer with clinical training can make a definitive determination about the medical necessity of a service provided to a patient, and performing medically unnecessary services is a medical practice issue, not a coding or billing issue. If a payer were ever to challenge medical necessity, it would be the physicians who would need to justify their decisions to the payer's medical directors, and would usually not involve a coder. As long as the claims you are billing are supported by documentation and you are not knowingly submitting claims for services not rendered or not supported by the medical records, I can't imagine that you would be held liable for this.

I am still new at this, but maybe she is referring to level of E/M visit? The doc maybe is wanting to up code the visit higher than the dxs qualify for?
 
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