Author Topic: I FEEL LIKE MY BOSS IS BEING SCAMMED BY HER MEDICAL BILLER , WHAT IF IM WRONG  (Read 1094 times)

Msladyajw

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My boss hired a medical biller online , I keep seeing in the audit reports hundreds of claims being deleted. she performs anywhere from 1000 to 1500 either test or vaccines a month, she does not pay attention to the claims, Sometimes I think she is addicted to performing the services, (JK) Not only do I see claims deleted, But I check the claim number thinking maybe it was a duplicate, But I do not find any of the claim numbers in the system,

Also we use office Ally, If I export the claims I will find the same patient 4 sometimes 5 times BUT each time the patient will have a different patient id number, I have heard of fraud committed by the doctors up-billing and fraud of that type, But Is it possible that a medical biller from over seas could commit fraud against the employer? I was thinking since he knows she pays no attention is it possible he takes some of her claims and files them as his claims, This is covid testing anyone can get a npi and a clia waiver, Have I totally lost my mind

Michele

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It's really hard to say based on the information you've provided.  However, it does sound like it should be looked into further.  It is a big mistake when a provider doesn't pay attention to what's being done in the billing department.  They should have checks and balances to make sure billing is being done correctly.  You've definitely mentioned some things that would be concerning to me.  You didn't mention what your job title is?
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RichardP

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With regard to Office Ally:

If you do not keep track of some kind of identifier, it can be difficult to know whether a patient is in the O.A. database when they come in for a visit - particularly if they have not been in for a while.  The default position, particularly in a busy office, is to simply create a new patient record.  In doing so, you have instantly created a duplicate account.  And, unfortunately, spelling mistakes and/or typing in "Dan" while the original record has "Daniel", makes it almost impossible to find the "correct" original record.

Over time, in an office staffed with folks for whom it is easier to create a duplicate record than to find the original record, you are going to end up with a database that is full of duplicate, triplicate, fourthlicate, etc. patient records.

Three points you did not mention are 1) how long has the provider been using Office Ally; 2) were duplicate records deleted before the old database was imported into Office Ally at the start, and; 3) how long ago was this new biller hired?

I don't know of any way to figure this out in your situation (don't know how your Office Ally is set up), but I will mention it just to trigger some thoughts if you have not thought about this:  Office Ally only allows you to delete a record if there has been nothing placed into it regarding an office visit.  If something has been placed there, including I think just an appointment being recorded, Office Ally will not let you delete the record.  But it does give you a means of "hiding" the record.  It is still in the database, but it is not pulled up into anything you can see on-screen.  Office Ally also gives the user a means of unhiding records that have been hidden.  This, then, makes the hidden record become visible.

Office Ally also provides a means of merging records.  So, if I have 5 duplicate records, I can pick the record I want to keep (by account # or patient name) and Office Ally will merge the data in the other four records into that one record that I designated.

It is possible that the new biller knows all of these things about Office Ally and is simply cleaning up the database.  Remember, Office Ally won't let anyone, including this new biller, delete a record that has something in it.  So - the new biller is either hiding duplicate records (not the best solution unless someone is deceased), or they are merging duplicate records into one.

Hopefully this information will encourage you to approach what you think you see from a more-informed angle.  Billers CAN do many illegal things.  Office Ally makes it harder for that to happen.

RichardP

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It has been a while since I have "hidden" a patient record.  So I don't know if I am remembering incorrectly or if Office Ally has changed its options.

I used the word "hide" in my previous post.  Office Ally's word is "inactivate".  And there is also an option for "deceased".

Click on the "Manage Patients" tab.  At the right, upper part of page, is an item called "Select Actions".  Select "Change Patient(s) Status".  That is where you end up if you want to display a range of accounts that have been previously inactivated.  You first start by defining the range that you want (at the "Starts With" drop-down arrow) and the status that you want to display (under the "Status" drop-down arrow).

I don't know of any convenient way to specify a useful "range" other than to specify the entire database.  But be careful in doing this because you could undo a lot of legitimate work that the new biller did if they were in fact "inactivating" duplicate records rather than merging them.

Click on the "Manage Office" tab.  At the left, under the heading of "List Maintenance", you will find "Merge Patient Records" - but only if you have been granted permission to view those things by the database administrator.  You cannot use this to unmerge records, only to merge.  But at least you can check out how the routine works in Office Ally - if you have been given permission to view these things.

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