Author Topic: when provider doesnt follow the rules  (Read 1149 times)


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when provider doesnt follow the rules
« on: May 18, 2010, 09:17:19 AM »
i work for a doctor who does all CPT coding and i then bill. there are instances when i know that coding is not correct (e.g. E&M codes or unreasonable unbundling), but even when i explain to the dr why those codes should be changed she disargees and wants me to enter those in as she said. for example she wants me to always bill E&M code with the procedure code when pt comes in solely for the in office procedure. she wants me to apply mod 25 to the E&M code although no E&M is done, only procedure. what can i do? i dont want her to get in trouble and audited. but i dont want to lose my job or be blamed of committing fraud.


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Re: when provider doesnt follow the rules
« Reply #1 on: May 20, 2010, 07:02:07 AM »
The law is clear in pointing out that if YOU Know there is fraud/abuse going on you become responsible and assume the SAME exact liability.
So if you cannot get this message across and they tell you to bill them out, you should not. Document your corrections and conversations and refuse to bill them out. You could point out that part of the law that would have you assume the liability once you submit the claims.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers