A billing company should NEVER EVER change a code in order to get paid. They are supposed to be transferring the information provided by the healthcare provider into a format (claim) to submit to a carrier. If a change happens, it should be thoroughly documented on paper or in the patient's file within the billing program and it should have permission given from the provider or provider's staff. Otherwise, there shouldn't be a change.
Obviously, some things a biller can correct possibly, but again, there should be a notation. Changing a code though - Unh Unh. This is a huge risk for the biller and for the provider if the biller makes a change like that.
If it's an issue where denials are happening frequently, the biller should be getting with the provider's office to understand why they are happening and to find out if there is anything they can do to prevent the denials or if it is a case where it just flat isn't covered.
Even where the provider enters their own patient demographics and charges into the biller's system, changes should NOT be made without proper documentation on the reason(s) why.
As for percentage of collections - well that's a whole other subject and depending on the state you're in, it might be illegal.
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