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"Blind billing"

  1. #1
    Everett, WA
    Default "Blind billing"
    Medical Coding Books
    Lately I've come across a few fok who do medical billing for a living, and I was a little surprised to find out that they submit the charges as given to them and DO NOT have access to the chart notes. Modifiers for the most part aren't on the charge slips, so it is up to the biller to decide if they should be applied. How is that possible? And then I heard one say, well, if it's an office visit with a procedure you should always add modifier 25, and so on. Really? So, how can they work the AR from the back end if the chart notes are not available? And how can modifiers be appropriately assigned without access to medical records? All my training a few years ago tells me this is not the most compliant billing, and since I've only been doing this for going on 4 years now and with the same employer would like to know if this is really a common practice?

    Then I had another friend in the business who audits the back end, AFTER the charges have gone out and AFTER the insurance companies have paid, but this same process is not done ahead of time. Is this the norm too? I would really like to know, because it just seems backwards and I would like to know if this is just accepted medical practice from the past that is being carried forward to the present and will ultimately face a big shake-up. Please remember, I'm only a four-year-old, so this is still sinking in for me...

    Comments and thoughts, please!

    ---Suzanne E. Byrum CPC

  2. #2
    Weston, Florida
    Default Coding from encounter form/superbill
    Hi Suzanne!

    You are absolutely correct!! One should never code from a superbill. The description for mod 25 states "significant, separable......" What if the encounter dx was for a repair where the E/M is included, etc.? Or, what if the physician checked a high E/M level with minimum document which does not meet the criteria? Again you are correct!

    Maxine Segovia, CPC, CPC-CGSC

  3. #3
    Everett, WA
    Maxine, thanks for your reply. So the blind billing practices eventually will and should be affected by industry regulations going forward and make it a thing of the past? I guess this is still a very common practice, and frankly, I find it a little scarey!

    Hope this threat will capture additional comments.

  4. #4
    Honolulu, HI
    Default blind billing
    Unfortunately, it is a common practice, but with so many doctors actually contracting their billing to a TPA (such as my employer) we are not privy to the notes all the time. I get superbills with procedures marked, I have the charge entered and placed on hold. I request the notes from the provider to ensure proper coding, but well, you know, this isn't a perfect world and the doctor's do not want to send copies of the records out. As the medical world slowly transitions over to EMR/EHR, my life has gotten somewhat easier though. I say, down with the paper charts, electronic records do make my job a little less nerve racking

  5. Default
    It's my understanding that Coders are held accountable just as much as the Physician if a claim is taken to court on a fraud case. I certainly do not want to be held responsible for fraudulantly coding/billing a claim that I haven't even looked at the chartnote on! It's my reputation as a Coder on the line and I want it to be accurate. Our large Practice requires that no charges are sent out the door without the chartnote being read to make sure what we're billing out matches what the documentation says. AND it's a requirement that the provider electronically signed that chartnote before we release the claim. EMR makes life much easier in all this.


  6. #6
    I am glad to see this post. I am looking for information regarding this type of practice also. Our offices post off of encounter forms and it is just data entry clerks taking what the provider writes on the encounter. The data entry clerks know nothing about coding rules. The physicians do not code to the greatest specificity either (in most cases). I could go on for days with the issues we have!!

    I am looking for rules/regulations on assigning the correct ICD-9 codes and also ALL of the codes. In some cases our providers will write many dx and the data entry people have been told to only enter 4 of them because that is all that will go out on our electronic claims!

    Does anyone have web links or can they point me to documentation on the importance of correct ICD-9 coding?


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