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Physicians coding/billing

  1. Question Physicians coding/billing
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    Does anybody know if there are any compliance standards that steer physicians in private practice away from doing there own coding of office & surgical procedures?
    Does CMS have standards of conduct or the OIG ? Thanks for any imput.

  2. #2
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    Quote Originally Posted by seslinger View Post
    Does anybody know if there are any compliance standards that steer physicians in private practice away from doing there own coding of office & surgical procedures?
    Does CMS have standards of conduct or the OIG ? Thanks for any imput.
    Not really - physicians are ultimately responsible for the codes that are submitted, whether they're correct or not. The problem is, most physicians don't know all of the rules in code selection, or don't have time to make sure that their documentation meets the requirements of the codes that they're selecting. The purpose of having a professional coder is to delegate the task of coding to someone who can be trusted to do it right, and maximize their reimbursement, while minimizing their risk in an audit. The OIG is the governing authority, and CMS makes the rules.

    You can advise the doctor that the OIG doesn't often distinguish between honest mistakes and attempts to collect improper reimbursement through fraudulent activities; they can assess the maximum fine of $11,000 plus 3 times the amount improperly paid for EACH claim that is incorrect, in the event of an audit. If the doctor still prefers to do their own coding, I would strongly recommend that they have an internal or external audit conducted to assess their level of billing compliance. It's too risky to cross your fingers and hope for the best. Hope that helps!

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    Yes thank you..

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