Results 1 to 6 of 6

Coders Being Fined for Mistakes

  1. Default Coders Being Fined for Mistakes
    Medical Coding Books
    Has anyone ever heard of or experienced coders being fined for mistakes, or physicians or facilities recouping losses for sloppy coding?

    Any information or help is appreciated. Thanks!

  2. #2
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Yes I have heard of this. There was an instance reported in "The Coding Edge" a few years back, also Decision Health had a couple of articles on this same subject citing cases where coders were fined heavily. I ahve had participants come to me at seminars to report that they have been fined and it is not pleasant. This is why coders should always code from the documentation and follow the coding guidelines.

    Debra A. Mitchell, MSPH, CPC-H

  3. Default
    Thanks for your reply!

    It seems pretty harsh. Do you know of anyone who has experienced this firsthand? I'd like to find out the monetary penalties and any statics on how often this happens.

    I'm wondering what the legalities of it are.

    Michelle Dick

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
    Default
    I cannot give you names from individuals that told me this in confidence. The article in "The Coding Edge" revealed a $1.2 million dollar penalty that was assessed to the coder and the physician. The dollar amount from the Decision Health article was not revealed. I have read others thru other resources that state penalties in the millions. Is it legal? To fine a coder for not doing her job? Of course it is legal, as a coder you should not append any code to a claim that is not supported by the documentation. If you make a mistake then it is just that a mistake. If on a regular basis you assign the wrong codes because maybe you code from memory or you use a cheat sheet or you code from a superbill, then you are responsible for that code and it was not a mistake it was intentionally applied.

    Debra A. Mitchell, MSPH, CPC-H

  5. Default
    It seems like the coder should be fired, especially if it happens more than once, rather than fined. Do you know what issue of Coding Edge the article is in.

    Thanks again!

  6. #6
    Location
    Columbia, MO
    Posts
    12,531
    Default
    It was several years back possibly arounfd 03 or 04 and I think it was a winter issue. These were not interoffice audits these were payer audits. So fines and penalties will be assed all the way around.

    Debra A. Mitchell, MSPH, CPC-H

Similar Threads

  1. Replies: 4
    Last Post: 04-09-2012, 02:54 PM
  2. I had to share this great reference with new coders and multispecialty coders
    By nrichard in forum Employment General Discussion
    Replies: 6
    Last Post: 11-13-2011, 02:01 PM
  3. billing for mistakes made during surgery
    By ashlipickerill222 in forum General Surgery
    Replies: 3
    Last Post: 07-10-2008, 02:42 PM

Tags for this Thread

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.