fraud

  1. A

    Wiki Releasing charges without first reviewing the note to support the E&M level chosen?

    I have a couple questions and would like the opinion of other coders/clinics. How many practices are releasing charges without first reviewing the note to make sure the E&M level chosen by the provider matches the documentation? How many coders are letting the Dr's choose the level of E&M and...
  2. B

    Wiki Not Billing Services and Not Billing in Chronological Order

    A patient has authorization for 23 visits which they have exceeded. My colleague, another CPC, believes we can submit claims for the highest reimbursement amount for these 23 visits. I believe we must submit claims in chronological order or we are committing fraud. Any thoughts with...
  3. H

    Wiki Physician, Coder Issues

    I am wondering if any one knows where to find a document that you can have your physicians sign, stating that they are liable for any billing issues, such as fraud etc. I was told at a Medicaid conference you can have your physicians sign one. I only want one because I am told alot to just bill...
  4. J

    Wiki Help understanding clarifications/queries

    Hello, all! I am a coder, and my wife is a PCP. We work for different health systems in our area. Recently she started to receive what can be compared to a CDI clarification for patients who are scheduled for an outpatient visit (they have not yet been seen). These are coming from people...
  5. K

    Wiki Is this fraud??? Help!!! :(

    This might belong in the coding forum, but I'm just going to post this here. So something has come up at my place of employment and I'm wondering if this could be insurance fraud. I'm certain it is, but I'm looking for other insight. I was reviewing some A/R and we have some really old unpaid...
  6. R

    Wiki Ethical Coding and Billing

    Question. I have noticed that a practice is billing incident to incorrectly. They are billing under the physicians numbers (thus receiving reimbursement at a higher rate). The NP and PAs are seeing new patients and the doctor has never seen the patient at all. I have brought this to their...
  7. V

    Wiki "L. spondylosis without radiculopathy" and "L. radiculopathy" coded together?

    "L. spondylosis without radiculopathy" and "L. radiculopathy" coded together? I do outpatient coding for a pain center and recently they've realized that certain procedures aren't being covered if the diagnosis includes "...spondylosis with radiculopathy." So the doctor has begun listing the...
  8. K

    Wiki Residential Treatment and DCS Contracts

    I work for a mental health facility that has a contract with DCS as a residential treatment facility. We have a building for Level 2 and Level 3 patients. If they are in the state's custody, Level 3 clients' services are only billed to DCS. If they have private insurance, Level 3 client's...
  9. A

    Wiki HELP!!! Billing E/M without finishing note

    Help! I need answers or at least confirmation! I recently started a new position in a new company. The one physician owner is requesting that we bill out his E/M services without him signing off on the note. I have told him that I absolutely refused, due to guidelines. However, it was brought...
  10. C

    Wiki Changing fee schedule billing different cost same day???

    Hello, I am trying to confirm information regarding a recent fee schedule change we've had in our office. We have two coders in our office who are coding and billing claims on different dates of service between 10/1/15 to current 3/2/16. On 2/15/16 we updated our fee schedule to reflect...
  11. N

    Wiki Dilema: EMR templates documents things that were not done

    I am facing a ethical dilema here at work. The family physicians use a template for their office visits. The templates are pre-loaded with ROS and exam documentation, and it is up to the physician to edit such. The problem? The physicians do NOT edit. The office visit documentation for an...
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