Medical Billing Forum

General Category => General Questions => Topic started by: pattil88 on November 11, 2010, 11:02:45 AM

Title: Compliance Programs and Medical Billing Companies
Post by: pattil88 on November 11, 2010, 11:02:45 AM
Hi Everyone:
I'm new to this site - just opened and incorporated my own medical billing business here in Georgia. I just finished writing up our company compliance plan (ugh.......) but a question I have for the group is this - I wanted to distinguish "billing services" and "billing AND coding" services. (OIG recommends that these should be part of the compliance plan in addition to tying this into the business contract.) Do any of you formally stipultate what constitutes your "billing" services and your "coding" services and specify these items in your compliance plan and business contracts?

Thanks to everyone that participates in this site....very helpful info!
Title: Re: Compliance Programs and Medical Billing Companies
Post by: PMRNC on November 11, 2010, 06:00:39 PM
Since I don't code, I don't really go into coding services beyond identifying obvious coding errors and that when I have a question it gets returned to the provider for proper coding or clarification with documentation. If you are a CPC you will want to cover coding services as thoroughly as you do billing and include information about your Errors/Omissions, If you are not a CPC but still doing a coding, you will want to define your coding services and assume liability within your compliance plan., you will want to cover such things as what will your company do if coding errors are found, etc.
Title: Re: Compliance Programs and Medical Billing Companies
Post by: pattil88 on November 11, 2010, 06:39:19 PM
Thanks Linda - when I have done consulting work with practices in my past life, I found it interesting some providers allowed changing CPT codes, some allowed only adding modifiers with their CPT codes (usually payor specific) and some allowed only ICD-9 diagnosis code changes, particularly adding 4th/5th digits if the dx code(s) they were submitting were invalid.  I've always made a "rule of thumb" to never change a CPT code without the provider's permission/sign off and only after reviewing their documentation. You also bring up a very good point regarding the liability issue - it's one thing to make an innocent data entry keying error....and another to bill service(s) that you know or feel as a coder are going to be questionable with the payor. I just want to make sure my contracts define what the provider is responsible for and, acting on their behalf, what my liabilities are as a billing company. This is something I'm going to have my attorney evaluate in regard to any business contracts before they're signed. Of course, communication with the provider are key to any of these issues, but I want to make sure these are spelled out in any contract/compliance plan before any questionable scenarios arise. Thanks again!