Coding > Coding

Help with Coding Requirements for 99334 and 94760

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Podiatrist:
I am going to do that today Kristin.  Thank you for that info, that actually seems very important to my "case" and the lawyer at this point as not advised of that but we have only had one meeting, it was suppose to be a 30 minute consult and we ended up going for 90 minutes.  And is this information they have to provide if I ask, can they withhold it?  I assume they will deny my request but is there a statute anyone knows of or a ethic etc that they have to provide it.

To add even more intrigue to this story, I found out yesterday when I called Medicaid as I had a sample of patients I wanted to actually see what the claims were....I found out I am not even enrolled in medicaid with this company and have no active enrollment paperwork.  I then called Caremore and Humana and found the same.  Medicaid and Caremore are the bulk of the patients I see.  I have no clue what they are doing and how they are billing for services.  Could be billing under another providers info????  I didn't have any claim numbers so none of the insurances could process my questions further.

I want to kind of clarify some comments I made as they could be taken wrong in a few posts.  I have worked for the company for just over 2 months now.  The codes they apply were different than other places I worked.  I read the language of the 99335/99335 and stupidly self-interpreted it and it states "....a problem focused interval history..."  I figured "oh, we see the patients every 61 days for nail care when medically necessary and so that is an interval history, yes 99334/99335 can be used.:  My instinct never quite liked my answer I guess as I reached out via email to the billing manager after a few weeks and she overly enthusiastically said I was doing everything correct and it was just an odd phone call....smart she didn't put it in writing in hindsight.  So that raised my suspicion more and then I started looking for answers and went to multiple forum sites before finding this one and finally getting people to answer.....so thank you everyone.  Anyways, point being I was billing as instructed for about 3 weeks before I stopped and it either has gone unnoticed or they aren't willing to challenge me now that I have changed course for the last 6 weeks.  But I assume I'm on the hook for the past bills, I feel I should ask them to resubmit any claims prior to me doing this? 

Also, the lawyer asked to not play all my cards with the company yet so I have not revealed obviously the lawyer but also that I have firm documentation from this site on their tactics being wrong and so I am "using" the information as my "own" but I definitely want to credit everyone on here for their expertise and information.  Thank you for everything.




 

Podiatrist:
Actually, now that I know that I am not enrolled on at least 3 insurance carriers I wonder if they have any reports for me?  I am still going to ask for the info you advised Kristen and there are some other insurances I have seen but just didn't have the time to call and check on.  Could get very interesting if I'm not enrolled in anything........

PMRNC:
I would ask for a full audit of all your billing/claims. Doesn't matter which carrier or whether contracted or not. I'd put your request in writing and date it with request for them to complete it within 10 days (seems reasonable).  One other thing to consider, even though you are employed by the group, as Kristen mentioned, your name goes out on claims where you rendered services. With that said you may want to clarify with the group the position of the billing company in regards to "coding".

This is just my opinion from doing this almost 30 years, and I've seen situations like this before, but whistleblower cases involving attorney's take forever. You should probably only worry about you right now and see if possibly you can get the group to "see the light". ;)

Podiatrist:
I don't like orange and definitely don't look good in it.

I am reaching out to them for the information on my billing/coding and to audit my claims.  We will see if they provide it/do it. 

My lawyer really isn't pushing for the whistleblower as it is time consuming and labor intensive but she is probably reaching out to the AG to file a complaint.  She  advised to keep trying to get policy in writing but I think they are starting to get a little scent of what I am doing.  She said to expect to get fired but I guess that could work in my favor in some manner, at least from a legal standpoint.

In the meantime....job hunting as quickly as possible.

Podiatrist:
Oh, and the company was asked to never return to a facility yesterday as many of the residents who are not their own POA anymore, signed consent to treat paperwork and other paperwork related to accepting hearing aids and glasses (I heard a few resident's who are legally blind were dispensed eyeglasses which will obviously do them no good and was not medically necessary)  Numerous families when they got the bills were confused as the designated POA was not informed of the need for these and word got out this happened to many people so the families all convened with the administrator at the facility and found that the consent forms were signed by "mom/dad" who has dementia/alzheimer's etc and therefore not there own POA.  So from top to bottom this place is a scam.  I can't believe they have made it 8 years without an audit/investigation, but it seems to all of a sudden be showing some cracks and it is probably only a matter of time.

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