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Opinions Please!

  1. #1
    Location
    Columbia, MO
    Posts
    12,965
    Default Opinions Please!
    Medical Coding Books
    To all fellow coders,
    I have a situation that has me extremely bothered and I want to know what you would do.
    A really close acquantance of mine works for a billing service that it is well known I have no respect for their work ethic. (a story for another time)
    The background you need here is she is untrained as a coder and has no medical experience at all. They have put her in the position of "coder". They usually just take whatever codes are given by the physician office and pass them thru to the payer with no review at all.
    So she is relaying to me how she is bored with her job, and I said that it did not surprise me being as how it is a data entry type of function they have her doing with no decision making on her part, who wouldn't be bored. But then she said no that is not true she makes coding decisions every day, such as if a claim comes thru and she knows the diagnosis is not payable then she changes it to something on the "list" with no med record review, AND if the codes come thru as a global encounter and she sees it is even one day past the global then she changes it to a 99213, again with no record review. The physician office is never told of these changes either. When I tried to tell her that she cannot do that she just shrugged her shoulders and said "well, I do it."
    I am just appalled by this attitude and she is not the only one in this office that does this. It bothers me greatly when our profession is trivialized in this manner, and it makes it very hard for providers in general to trust us to do what is correct.
    So honestly am I upset over nothing ? How do you feel about this and should something be done?

    Debra A. Mitchell, MSPH, CPC-H

  2. #2
    Default
    This type of unprofessional and unethical behavior aka reimbursement trumps compliance plucks my last nerve. It certainly helps to explain why I have not received a correct EOB in over 10 years.

    Can you give the provider a heads up? I suspect said billing company's compliance department is nonexistent or a joke at best. Since your acquaintance doesn't seem willing to code accurately how will she look in an orange jumpsuit?

  3. Default
    Quote Originally Posted by mitchellde View Post
    To all fellow coders,
    I have a situation that has me extremely bothered and I want to know what you would do.
    A really close acquantance of mine works for a billing service that it is well known I have no respect for their work ethic. (a story for another time)
    The background you need here is she is untrained as a coder and has no medical experience at all. They have put her in the position of "coder". They usually just take whatever codes are given by the physician office and pass them thru to the payer with no review at all.
    So she is relaying to me how she is bored with her job, and I said that it did not surprise me being as how it is a data entry type of function they have her doing with no decision making on her part, who wouldn't be bored. But then she said no that is not true she makes coding decisions every day, such as if a claim comes thru and she knows the diagnosis is not payable then she changes it to something on the "list" with no med record review, AND if the codes come thru as a global encounter and she sees it is even one day past the global then she changes it to a 99213, again with no record review. The physician office is never told of these changes either. When I tried to tell her that she cannot do that she just shrugged her shoulders and said "well, I do it."
    I am just appalled by this attitude and she is not the only one in this office that does this. It bothers me greatly when our profession is trivialized in this manner, and it makes it very hard for providers in general to trust us to do what is correct.
    So honestly am I upset over nothing ? How do you feel about this and should something be done?
    Three letters come to mind for me... OIG

  4. #4
    Default
    I have 3 better letters eadun2000.
    RAC

    I worked for a company like that for a brief time.
    The owner went to prison for Bank Fraud.

  5. #5
    Location
    Phoenix, AZ
    Posts
    620
    Default
    WOW, that's horrible. Is she not aware of the consequences or just really doesn't care? Truly appalling!
    Cyndi Allen, CPC, CIRCC
    2015 Local Chapter President, Casa Grande, AZ

  6. #6
    Location
    Columbia, MO
    Posts
    12,965
    Default
    Honestly none of them feel the consequences apply to them. I have tried to educate them, and I have talked to the owner. They all feel the same way, the provider is responsible not them! I was there during contract negotiations with one client and they were told that the "coders" would look over all documentation and would verify all codes prior to submission. I was horrified when this was not the case and I immediately quit. They have 1 certified coder in the lot and she does nothing to improve things they have another that says she is certified but has never produced a certificate and is not in the member database. They have 12 "coders" total. Oh and there is no compliance department at all. They have over 100 clients. I have reported them twice to the OIG but there has never been and investigation that I am aware of. I also know that they take the 36415 codes and convert them to 99211 charges everytime, and they change all preventive codes to 99215 charges. I just had to know how others feel out there. It is good to know I am not the only one that feels this way. I have sent yet another complaint to the OIG and since she has clients in other states I am hopeful that something can be done. I just feel it will continue and I feel like there is something else I should do.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Everett, WA
    Posts
    887
    Default
    Debra, it's these very same issues that terrified and continues to haunt when I entered this profession a few years ago. At times I felt the course did such a good job of "scaring" us with fraud and abuse scenarios that I felt "paralyzed" on how to proceed navigating thru the jungles of compliancy. As a result we're always in network and research mode to locate supportive back-up references/guidelines.

    How can you educate and inform folks who don't want to know? This must be a very troubling journey for you to endure. Less experienced coders might falter in your shoes, but on a more positive note my guess is you're just THE RIGHT PERSON for the job. Please know that we who post and watch the forums are using this as an important educational experience to learn more from what these types of jobs may entail. Surely, you are doing what you've been trained to do and your steps have been wisely calculated. Please keep us informed. You could have chosen not to ask for help on the public forum but I'm so glad you did. ---Suzanne E. Byrum CPC

  8. #8
    Default
    Debra,

    Did you identify yourself to the OIG for further questioning? I wonder if the agency is swamped with complaints or looking for bigger fish to fry.

  9. #9
    Location
    Columbia, MO
    Posts
    12,965
    Default
    I did identify myself but no contact as of yet. I keep hoping there will be an investigation. Thank you all for letting me know you feel the same way as I do. At some point an investigator will decide this must be looked into.

    Debra A. Mitchell, MSPH, CPC-H

  10. #10
    Location
    Milwaukee WI
    Posts
    4,466
    Default Journalist
    Do you have an investigative journalist on your newspaper who would LOVE to be in the running for a Pulitzer?

    Or ... the next time you contact the OIG, do it in writing with a copy to your Congressman. Don't forget to mention that you've alerted them to this issue previously.

    This kind of blatant fraud is at least half the reason for the continuing rise in the cost of healthcare.

    ARRRGH!

    (going off to take some "blood pressure medication" ... a/k/a chocolate)

    F Tessa Bartels, CPC, CEMC

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