Author Topic: Fraudulent Charting  (Read 2232 times)

trackhead

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Fraudulent Charting
« on: July 13, 2014, 06:55:59 PM »
Background:  I am an ER nurse with 17 years experience in ER, ICU, and flight medic.

History:  Went to ER for palpitations.

Physician:  Billed 99285

Problems: 
He charted he did a cranial nerve assessment that he didn't do.
He charted a skin assessment he never did. 
He charted a muskuloskeletal assessment that he did not do.
He billed for pulse oximetry (94760) when I had no respiratory complaints or abnormality.

Debate:  How can an ER physician charge 99285 for a visit when his charting did not meet requirements for doing so.  Sure, he charted it, but he didn't actually do it.  And how can he bill for 94760 without any respiratory complaint.

I sent the billing department my concerns with his fraudulent charting, haven't heard back yet.  This is commonplace in the ER, I see it literally every day.  Doc does a quick assessment, charts that he/she did a complete assessment when it never happened.  Problem is, patients don't realize this because they don't realize it.

kristin

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Re: Fraudulent Charting
« Reply #1 on: July 13, 2014, 08:45:34 PM »
I would take it higher than just the billing department. I would write the CEO of the hospital, and call/write my insurance company, sending everything certified. It could be intentional fraud, or it could be ignorance, but either way, it needs to be fixed.

My coworker just ran into a similar situation with a visit she had to the ER after an auto accident. The auto insurance paid everything but the 94760 that the ER doc billed, because the hospital billed it themselves also, and the insurance already paid them for it. The doctor didn't apply the PO, nor did he record the reading, the nurse did. So how does he think he can bill for it also? The end result is the insurance company is now demanding his chart.

I personally have spent tons of time calling various offices my husband and I have been to when I see something coded incorrectly...consults that weren't consults, 99212's being billed for nurses visits that don't qualify, you name it. It amazes me what gets billed out. And you are right, the average patient has no idea that the 99214 their doctor billed and insurance applied towards their deductible, that they now have to pay for out of pocket, should have a been a 99212. I imagine it is even worse with hospital billings.

One thing I have always told the doctors I bill for is to imagine that every patient is an insurance auditor/certified coder, and to keep that in mind before they go getting creative with their charges.

trackhead

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Re: Fraudulent Charting
« Reply #2 on: July 13, 2014, 09:54:18 PM »
It's interesting, I researched the increase of 99284-99285 charges and the concimittant decrease of lower acuity charges.  It's amazing at the increase in these two higher acuity charges.

Much of this can apparently be attributed to EMR that easily populate assessment parameters in physician charting.  Same thing for nurses charting.

Another common issue is critical care billing.  I guarantee you physicians charge for critical care for moderate sedation cases in the ER when they are only at the bedside for 5-10 minutes, yet they bill for far more time.  I overhear physicians talking about charting to meet critical care billing codes.   

I'm annoyed at the profession I support every day in the ER.  It's pathetic, and until you work on both sides of the billing/healthcare delivery, you have no idea the amount of excess charges involved in healthcare.

kristin

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Re: Fraudulent Charting
« Reply #3 on: July 13, 2014, 10:54:41 PM »
I was just complaining in another thread here the other day how EMR's do exactly what you are talking about (force upcoding), and it is one of the reasons I don't like them. Here is the screwed up part to me...it is the federal government basically forcing the healthcare industry to use EMR's/EHR's, or take penalties, yet it is also the federal government who is all about auditing the healthcare industry, between the OIG and RAC. And meanwhile, doctors are barely trained on proper coding and documentation. It is a mess!

Medical Billing Forum

Re: Fraudulent Charting
« Reply #3 on: July 13, 2014, 10:54:41 PM »