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Thread: Legal question

  1. #1
    Join Date
    Apr 2007

    Default Legal question

    AAPC: Back to School
    I have a billing client who is in the middle of an insurance audit. I have since been reviewing all level 5 services before billing - with his permission. Almost all have not met criteria (he tends to bill all pre-op clearance exams and new patient exams as a level 5). I give detailed feedback on each along with the appropriate CPT code. Recently, he has been wanting me to bill "as is", even though I have advised him that these services do not meet documentation guidelines. Can I have him sign something stating that he has been advised on the appropriate coding, refused the advise and accepts full responsibility for these claims?

    This situation is making me very uncomfortable. We are considering dropping him as a client.

  2. #2
    Join Date
    Apr 2007

    Thumbs down

    Ethically it is wrong even if you have him sign anything. If you look at the AAPC Code of Ethics, it is written out for you in black and white.

    I would drop him as a client.

    What he is doing is committing fraud because you have provided him the education and he still chooses to code a level 5.
    Last edited by AHVC; 04-26-2010 at 02:21 PM.
    Ali Coleman ~ CFE, CPC, CEMC
    Defense Health Agency
    TRICARE/Department of Defense
    Health Care Fraud Specialist

  3. #3

    Default Legal question

    You need to drop this client immediatley; because you have provided the education and corrected the claims you have knowledge that he is over coding and if you continue to bill (not by abstraction) there is culpability here.


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