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Changing provider charges

  1. #1
    Default Changing provider charges
    Medical Coding Books
    I apologize up front because I'm sure this has been covered before, however I can't find the threads.
    If a company has a policy that providers do their own codes for billing, and you come across procedures not documented, you then inform the provider to append the note. Provider doesn't, or won't. Now you have a note that doesn't justify the charge. Please tell me that my only choice in this scenario isn't just to resign. I obviously can't send in a claim that isn't warranted, but aren't we somehow protected, legally, in this situation?
    Any help is greatly appreciated.

  2. #2
    Columbia, MO
    If it is not documented and you cannot obtain the document then you cannot submit the code. There is no protection for you to knowingly submit a claim that is not supported by the chart note. I do not understand why a provider would not want to document a procedure and yet mandate you bill for one. That is openly requesting that you submit a fraudulent claim. Submit the claim with only what you can support. Your codes on the claim do not need to match those submitted by the provider, however you must match the narrative in the chart note itself. If you cannot do this then you either risk the consequences or resign.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    That's what I figured. Thanks Debra!!

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