Author Topic: NY based billing company billing for NJ Provider?  (Read 11003 times)

QueenAlicia

  • Sr. Member
  • ****
  • Posts: 347
Re: NY based billing company billing for NJ Provider?
« Reply #30 on: January 24, 2013, 04:48:49 PM »
I ask for a schedule with my clients.  I know that it is not always foolproof  ::) but it does help me to determine whether or not the patient was seen.  If I am using the clients software I compare the patient visits to the schedule and I ask them for access to it but I tell them that I do not touch it and that it is just for reference.  Sometimes there is no way of knowing at all times but by taking extra measures you can avoid an incident.

Also, for those that do no believe as a medical billing company you can be held responsible, I encourage you to go to the OIG website to do some research.  There are plenty of examples there.

Christy

  • Sr. Member
  • ****
  • Posts: 278
Re: NY based billing company billing for NJ Provider?
« Reply #31 on: January 24, 2013, 04:51:17 PM »
yes, but how do you recieve the actual CPT codes/charges?

QueenAlicia

  • Sr. Member
  • ****
  • Posts: 347
Re: NY based billing company billing for NJ Provider?
« Reply #32 on: January 24, 2013, 04:53:24 PM »
The same way as you stated, by day sheet or super bill. Some send by fax and I have clients that email them to me to a specific email.

PMRNC

  • Hero Member
  • *****
  • Posts: 4217
    • One Stop Resources & Networking for Medical Billers
Re: NY based billing company billing for NJ Provider?
« Reply #33 on: January 24, 2013, 05:03:02 PM »
OF course with certain claims it will come down to the doctors documentation.. AS medical billers (and I hate using that term) we are expected to KNOW certain things and if things DO come to question it is UP to us to find the error and even if suspecting an error, fraud, or abuse we are supposed to take action. IF indeed there is a compliance plan in place it tells you that along with the OIG's regs.   I had a client one time that went on vacation.. he left his biofeedback tech there to send me superbills. Only problem is, that MY client was to OVERSEE all services (biofeedback) rendered and was required to be ON site. When I looked at my clients email that he was going "on vacation" it was MY job to KNOW that the biofeedback tech was NOT to perform services while he was off site. When superbills were sent to me.. that was my cue.  IT WAS MY JOB TO KNOW!!    long story short. I dismissed client as per my clause in my contract and I also collected a whistle blowers fee from Medicare.   I did NOT automatically make the complaint, I first contacted my client, told him the law, and his response.. "Oh no one has to know" just bill it.   had it not been for that I would have HELD the charges and with my knowledge let the provider know that I could NOT knowingly submit these charges. Maybe a complaint could have been avoided.    Bottom line. .it was MY job to know it.   
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Christy

  • Sr. Member
  • ****
  • Posts: 278
Re: NY based billing company billing for NJ Provider?
« Reply #34 on: January 24, 2013, 05:03:11 PM »
This question is not specifically for you, Queen Alicia  ;D, but just in general to those of us who recieve logs/superbills.....how do you KNOW if a code is fradulent?...it seems like you do need to trust the doc, unless you require notes.....

Christy

  • Sr. Member
  • ****
  • Posts: 278
Re: NY based billing company billing for NJ Provider?
« Reply #35 on: January 24, 2013, 05:04:46 PM »
Linda- I thoroughly agree with everything you said...great example! :)

I wish there was a "like" button on here  ;)

PMRNC

  • Hero Member
  • *****
  • Posts: 4217
    • One Stop Resources & Networking for Medical Billers
Re: NY based billing company billing for NJ Provider?
« Reply #36 on: January 24, 2013, 05:07:32 PM »
Quote
This question is not specifically for you, Queen Alicia  ;D, but just in general to those of us who receive logs/superbills.....how do you KNOW if a code is fradulent?...it seems like you do need to trust the doc, unless you require notes.....

And yes indeed.. this is where I think this person is being a bit ignorant.. Of course we are NOT mind readers, nor are many of us coders privy to the provider's documentation. However there are MANY things we are expected to look for that are obvious.. if it's blind faith.. "Bill this and keep your mouth shut" certainly we are being irresponsible, no excuses.  For something we are SUPPOSED to know however, the laws and regs in place are NOT going to protect us.  It's not as complicated as it sounds if you are well educated in this business. IF YOU are supposed to know.. and YOU know it's not right.. your libel. period.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Christy

  • Sr. Member
  • ****
  • Posts: 278
Re: NY based billing company billing for NJ Provider?
« Reply #37 on: January 24, 2013, 05:08:44 PM »
sounds great to me, Linda! :-*

galinafl26

  • Newbie
  • *
  • Posts: 28
Re: NY based billing company billing for NJ Provider?
« Reply #38 on: January 24, 2013, 06:03:30 PM »
You can go on and on and on and on and have this continue for another 40 pages, I said whatever I had to say, if you don't want to hear it or you don't agree that's your problem. You obviously don't have a clue what you are doing for saying what you are saying. I don't care what you did on facebook or who you asked to participate. Why don't you contact OPMC and let them tell you who is responsible the biller or the doctor. I am not going to address anything you said anymore. I've said everything clearly, you choose not to want to hear it because that's more convenient for you. You want to make this complicated, go ahead. This business is not so complicated, you make yourself sound like you know it all when by far you don't. You don't know everything. I don't believe anything you say either here because according to you, there are not cheap doctors, and you never met a cheap doctor. My husband and I was actually lauphing at one of your responses how you told someone that you never met a cheap doctor. And you want me to believe that a biller is responsible for  billing whatever was given to you by a doctor?? come on, Please!!! I got your point, you got mine. NO reason to go on and on...

PMRNC

  • Hero Member
  • *****
  • Posts: 4217
    • One Stop Resources & Networking for Medical Billers
Re: NY based billing company billing for NJ Provider?
« Reply #39 on: January 24, 2013, 07:43:58 PM »
Yes I was "lauphing" myself.  ::) :o ;D.   As was everyone else.   Bet you do his billing!

OPMC???     Did you miss key words? Medical Conduct? You think calling there will help you determine professional liability for administrative issues? You are more delusional than I thought!
« Last Edit: January 24, 2013, 07:48:54 PM by PMRNC »
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

galinafl26

  • Newbie
  • *
  • Posts: 28
Re: NY based billing company billing for NJ Provider?
« Reply #40 on: January 24, 2013, 07:48:03 PM »
Yes, I do a lot of cheap doctors billing!  At least I don't have doctor's who are doing fraud and I don't have to worry about dropping a dr! I'll stick to cheap over someone who does fraud. Thank you.

RichardP

  • Hero Member
  • *****
  • Posts: 688
Re: NY based billing company billing for NJ Provider?
« Reply #41 on: January 24, 2013, 07:59:32 PM »
[edit]  I see that several other comments have posted while I was typing this.  Those new comments are not addressed in what is written below - but it appears I covered some of the same issues that are raised in the new comments. [/edit]

In the back and forth, a number of different issues have been raised.  Bear with me for a moment.  You are both dancing around an issue that I have with EMRs and Practice Management Systems - the lack of a paper trail for audit purposes.  Consider this scenario I faced when asked to use G.E.'s Centricity system.  It is a totally paperless system, and the EMR can pass billing info to the PM side electronically - but there is no way to return the electronic fee slip back to the EMR from the PM.

Doctor is diligent and puts all relevant info into EMR.  Signs off (which locks that DOS) and forwards the electronic fee slip to the PM side.  Biller receives the electronic fee slip and sees that some codes are wrong and need to be changed, and some other codes are missing and need to be added.  Biller cannot return the electronic fee slip to the EMR.  Doctor cannot go back into DOS for that patient and make the necessary changes.  So, what does the biller do?  Puts in a call to the doctor.  Doctor calls back while driving home after work.  "Yeah, change the wrong codes to the correct codes, and add the codes I forgot to put on the electronic fee slip.  I'll add an addendum to the patients account in the morning."  Biller makes the changes the doctor authorized and sends the data off to the clearinghouse.  Doctor forgets to add the addendum to the DOS for that patient.  Account gets audited at some later time.  And there is the stark evidence:  biller billed for things that cannot be supported by the data in the patient's electronic chart in the EMR.  Fraud.  Biller is found guilty and hung out to dry.

It was on this basis I turned down the doctor's group that was using Centricity.  There is no way to protect the biller from the situation I just described.  Now, consider what we do with our current setup, using the same criteria as above.

Doctor is diligent and checks off all relevant codes on the paper fee slip.  Sends paper fee slip to us.  We receive the paper fee slip and see that some codes are wrong and need to be changed, and some other codes are missing and need to be added.  We return paper fee slip to doctor, with our comments attached.  At his leisure, doctor makes the necessary changes and returns the paper fee slip to us.  We type the codes into the PM system and send it off to the clearinghouse.  We return the paper fee slip, with the doctors changes written on it in his handwriting, to the doctor, who puts it into the patients chart.  Account gets audited at some later time.  And there is the stark evidence:  the only things biller billed for are things that can be supported by the data in the patient's chart.  No fraud.  Biller passes the audit.
-----------

With regards to the posts above:

1.  galinafla26 said only that she had one client who resisted her efforts to educate him.  So she left him alone.  I did not see where she stated that she does not provide feedback to any of her clients.

2.  The OIG has guidelines for billing companies.  In those guidelines, the OIG states that the guidelines do not carry the force of law.  They are only recommendations.  And in those guidelines is the recommendation for a biller to dismiss a client when the biller knows that the client is billing fraudulently.  Since that recommendation does not carry the force of law, it suggests that billers cannot be legally held liable for following a doctor's direction to bill fraudulently.  If any one can provide links to cases that refute this, I would be interested in seeing them.  I don't want someone's opinion.  I want court opinion, if it exists.

3.  When lawsuits are filed, as many entities are named in the lawsuit as can be.  Being named in a lawsuit is no guarantee that any judgement is going to go against the named party.  A lawsuit against a doctor can also name the biller as a defendant.  That does not mean the biller will be found guilty of anything.

4.  I am not aware of any state regulation that requires a biller to go through the patient's chart and make certain that all charges the doctor has given them to bill are supported by the information in the chart.  The biller can only bill what the doctor gives them.  Therefore, without a requirement that the biller verify that all charges are supported by the chart, any difficiencies are the responsibility of the doctor, not the biller - regardless of who is named in the lawsuit.  It cannot possibly be any other way.

5.  Where a biller can be held legally liable is in the case of fraud - where the biller has submitted for payment charges that the doctor did not give them.  In Point 4 above, the biller cannot be held liable for deficiencies if all he has done is bill what the doctor gave him - for the reason stated there.  In this Point 5, the biller can be held liable for deficiencies that arise when they bill for things the doctor did not give them - because they are billing for charges that the doctor did not give them.  That is the distinction between these two Points 4 & 5 - the distinction between when a biller can be held liable and all other times when he will not be held liable.

I welcome links to any court cases where the decision contradicts what I have said here.

6.  As we move towards the paperless office of electronic data collection and billing, we are losing the very valuable paper audit trail.  Since the most likely case for billers being prosecuted is billing for charges the doctor did not give them, and since the scenario I presented above with Centricity is a very real situation right now, and is getting worse - I see the paperless office as shutting the mouths of those billers who wish to educate their doctors on how to legally bill for all monies they possibly can.  There is just too much chance with electronic billing that the changes the doctor authorizes will not/can not be added to the patient's electronic chart - which leaves the biller open to the one thing they can be prosecuted for with no questions asked: billing for charges that cannot be found in the patient's chart for that date of service.

In a paperless office setting, where it is impossible to leave a paper audit trail, the only way to guarantee that this scenario won't happen is to say nothing back to the doctor and bill only for what he gives us - no matter how deficient the coding from the doctor may be.  That scenario is not useful to anybody.
« Last Edit: January 24, 2013, 08:26:59 PM by RichardP »

galinafl26

  • Newbie
  • *
  • Posts: 28
Re: NY based billing company billing for NJ Provider?
« Reply #42 on: January 24, 2013, 08:21:37 PM »
Richard, you couldn't of said it better!!! I wish everyone understood this! This is exactly what I was talking about. They are goin on and on about billet being liable and I ve been saying all along what you just said. Bravo!!!!!!!!!

dekenn

  • Jr. Member
  • **
  • Posts: 77
Re: NY based billing company billing for NJ Provider?
« Reply #43 on: January 25, 2013, 08:49:13 AM »
Florida Statute:

 The basis for the final order appears in F.S. 458.331(1), which sets forth a list of acts or omissions for which the board may take disciplinary action against a physician's license. The list includes 458.331(1)(i), which prohibits "paying or receiving any commission,
bonus, kickback, or rebate, or engaging in any split-fee arrangement in any form whatsoever with a physician, organization, agency, or person, either directly or indirectly, for patients referred to providers of health care goods and services . . ."This is an article From the Florida State Bar in regards to Illegal fee splitting and cites a perfect example. 


This refers to a physician "splitting a fee", or giving kickbacks to someone else for referring patients to him. This doesn't sound like it has anything to do with paying for services on a percentage basis, as long as the biller is not referring him the patients.  Fee splitting does not necessarily mean the same as being paid on a percentage basis.

dekenn

  • Jr. Member
  • **
  • Posts: 77
Re: NY based billing company billing for NJ Provider?
« Reply #44 on: January 25, 2013, 08:58:50 AM »
Found this on the internet, in relation to payment to billing services:

This is from the laws regarding payment and billing of EMS Services in Mount Laurel Township, which is in New Jersey:
http://ecode360.com/12597358

"The professional medical billing service shall be responsible for the initial billing and two follow-up billings. Costs associated with the professional medical billing service shall be based solely on a percent of reimbursement collections as provided in its contract with the Township of Mount Laurel. "

I would imagine that the attorneys for the Township know the laws about "percentage of collections" and "fee-splitting".  Linda, I think you're confused about what "fee-splitting" really means.