Results 1 to 3 of 3

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
    Location
    Columbia, MO
    Posts
    12,911
    Default
    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
    Default
    That's what I figured. Thanks Debra!!

Similar Threads

  1. Replies: 2
    Last Post: 12-13-2016, 01:56 PM
  2. Changing the provider on claims
    By megs22 in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 12-09-2014, 01:38 PM
  3. Insurance changing a provider's claim
    By amadams in forum Compliance General Discussion
    Replies: 3
    Last Post: 10-10-2014, 05:37 PM
  4. Medicare Charges for family member of provider
    By Ltoth in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 01-08-2009, 12:19 AM
  5. Changing CPT Codes/Provider permission
    By epilcher in forum Medical Coding General Discussion
    Replies: 0
    Last Post: 06-13-2008, 06:36 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.