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PA Assist Documentation Requirements

  1. #11
    Default
    Medical Coding Books
    Many auditing companies will do a sample audit for free (usually up to 10 cases). That might be enough to convince them there is a problem and either go forward with a bigger audit or change their ways.

    Try The Coding Network http://www.codingnetwork.com/

    I really like Mark and the coders are great.

    Good luck,

    Laura, CPC, CPMA, CEMC

  2. #12
    Default
    Thanks Laura!

  3. #13
    Default Shot down again!
    Well, bad news. Had a coding meeting yesterday afternoon with my supervisor. I explained how the surgeons need to document why they needed a PA assist, and what the PA did while assisting. My supervisor then got upset and stated I was incorrect, that her 'contact' said all the surgeon has to do is state a PA was with him; I disagreed and it became a somewhat heated conversation. Anyway, at 9 this morning I have to go see HR, so I am expecting to be let go. This is a great example of a department being run by someone who is very ignorant of the importance of documentation. She says that the way she does it, all the claims get paid, and I replied just because they are paid doesn't mean your guidelines are compliant. SO, we'll see. I'll keep everyone posted. I appreciate all the information I received. I just wish I knew who I can go to listen to me? We don't even have a compliance officer at this place!

  4. #14
    Location
    North Carolina
    Posts
    3,126
    Default
    OMG! That is horrible! I'm rooting for you...

    Sincerely,

  5. #15
    Default That is called retaliation and it is illegal
    I would make sure they know that. Unfortunately you are already in that meeting as I am reading/responding.

    You can not kill the messenger no matter who you are. If they do anything to you, fire, threaten, intimidate, demote, etc.. you need to file suit against them. I'm not sure where you are but there are attorneys all over that deal with this. Generally the same ones that do the qui tam suits will handle this because they tend to go hand in hand. Do not take this, fight back!

    I know some attorneys in Ohio if that would help you in anyway. You could talk to them if nothing else and get a better idea where you stand.

    Laura, CPC, CPMA, CEMC

  6. #16
    Default Thanks for the support
    Laura and Rebecca,

    Thank you so much for your support. It does mean a great deal to me. Sometimes I feel there is nobody out there protecting me, and all we do, as coders, is try and follow guidelines and be compliant. I will reply to this thread after my interview, to let you gals know of the results. Thanks again!!


    Richard

  7. #17
    Default
    I'm just getting my ducks in a row, and while I know that nobody can give me a numerical percentage of risk that this Orthopedic Facility was taking by not documenting the PA assist part, can anyone give me a subjective idea of this risk via low, medium or high scale? I am trying to put facts together. Thanks!


    Rich

  8. #18
    Default
    Well if you are billing out services that are not supported by documentation you are at a high level of risk because you are basically commiting fraud. It would be no different than if they billed based on the header of the note which said "CABGx 3 and wedge resection lung" but there was no documentation of the wedge resection in the body of the op report.

    Having said that I thought I would post a link to another thread I started about this since there is some ortho references in it. I no longer have ortho, CVT is my big headache which explains my example!

    http://www.aapc.com/memberarea/forum...assist+surgery

    Also here is a link to a study by the OIG stresses the importance of increased controls over payments for services by NPP.

    http://oig.hhs.gov/oei/reports/oei-02-00-00290.pdf

    I am more than happy to back you and will help in any way I can.

    Laura, CPC, CPMA, CEMC

  9. #19
    Default Scared stiff!
    Okay,

    Here is what went down. Was called into the HR office at 9. They asked if everything was okay, and they said they'd hate to lose me. So, I asked if I can be candid and they said go ahead.............I did. I let them know how helpless we felt in the coding department because our supervisor wouldn't listen to our advice. I explained about documentation. I was surprised when the HR manager said she absolutely agreed with me; she did some coding way back when. Anyway, I felt it was a productive meeting. She asked if I planned on leaving and I said I am actively looking for a new job. She said not to go anywhere, and to give her 1 week to try and get something resolved.

    I then went back to my desk feeling somewhat better, but we'll see. HR then called in my co-worker friend to speak with her. Apparently she told themthe exact same thing I said, and said she didn't want me to leave. A few hours later, my supervisor and the HR department are in a long meeting. Now I didn't see this, but other co-workers said that after the meeting my supervisor looked very pissed off. SHe then went back to her office and closed the door(which she never does) for the rest of the day. What worries me, however, is another co-worker said she sa that the supervisor had her cronies(the ones that crawl up a boss' butt)in her office for a long time, and they all looked mad. I am wondering if now I have a bullseye on my back. STill trying to gather info on what I can do to protect myself; at least it sounds like HR may be on my side for having a valid point.

    I'll keep everyone posted on how this day goes!

    Rich

  10. #20
    Location
    North Carolina
    Posts
    3,126
    Default
    You're doing the right thing, Rich. Reminds me of a time when a former manager stated..."If it's paid, it's billable" . Needless to say I fought this tooth and nail because the code in question was absolutley, 100% not billable in the manner she wanted it billed. Long story short...we receive a kind letter from the carrier requesting a refund...I had the honor of presenting the letter to her...

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