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Thread: Billers changing coding before bill goes out!

  1. #1

    Default Billers changing coding before bill goes out!

    AAPC: Back to School
    Recently I started working for a physician billing group. I found out that the billing staff is changing my coding if the bill does not pass through the software scrubber.

    Evidently they are looking back through older bills that DID pass and gathering those codes, then asking the physician if they can use them. I do not see the new codes before the bill goes out. There is one biller that is familiar with coding but not technically hired as a coder and is not certified. The other employee does billing and to my knowledge no coding.

    I really needs some fast and solid guidance on these issues before I speak with the manager next week.

    1. What is my liability in this situation? I am not electronically signing this work nor seeing this before it goes out.
    2. Is this leading the physicians to certain diagnoese that are known to 'pass' for payment? What ramifactions and inherent here and what guidelines can I quote regarding this.
    3. Shouldn't these cases come back to ME for review and query of the physicians?
    4. Am I correct to be concerned about this process?

    Please help me right away with any commentary, suggestions and information that will help me when I present this to management. I am VERY uncomfortable with this situation and I feel they are treading on thin ice at best.

    HELP and thanks in advance.


  2. #2
    Join Date
    Apr 2007

    Default Coding

    In the practice I work for, all bills pass through me before they go to billing for posting. I code them based on documentation and then they go down.

    I believe that by the BILLING staff changing to codes without being able to support them with documentation from the chart, you are setting yourself up for an unfavorable audit. What you need to stress to the manager is all code selection is based on what is documented in the chart. If the doctor is verbally giving the okay to billing staff to change the codes, but these codes are not supported by the documentation in the chart, they will not hold up against and audit.

    If there are problems with codes you select and they do not pass through the claims scrubber without error, then you should receive the feedback and query the physician. That way, in the future, you will catch these errors before they go to billing and reduce any possible denials. If they do not go back to YOU for correction, and you coded them originally, the same mistakes will continue to happen and you will not have the opportunity to properly educate yourself and the clinician on the denial problems.

    Let me know if this helps.

    Heather Winters, CPC, CFPC

  3. #3


    I had a very similar situation a few weeks ago. I gathered as much information as I could and took it to my supervisor. When she advised me to let things go on the way they were, I contacted someone higher up in the company. Come to find out, I was correct. When the legal department was consulted, they agreed with me. Things in the office have recently changed. I couldn't know something was going on and not say anything. I take my job very seriously and do not want to jeopardize my certification. Good luck!!

  4. #4


    Thank heaven I am not alone in this area. The whole system raised red flags the moment I was able to evaluate the process. I have contacted and been interviewed by the Compliance Officer who is also doing an investigation. It will go to legal counsel if need be.

    Your replies will allow me to clarify my stand and present it in a sound manner.

    Much appreciated!

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