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.
Richard, I understand what you are saying.... some billers do that and some don't. I have a doctor in New York who I tried to give him that advice and he kindly asked me to never tell him any advice and how to do things, he's set on his old way and he wants to do things the way he is used to saying so in this case, it is a data entry account, where he only wants me to bill whatever he writes on the super bill.
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.
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.
HI I AM BILLING FOR AN OBGYN AND HE PERFORMED TOTAL ABDOMINAL HYSTERECTOMY (58150) AND ALSO EXPLATORY LAPAROSCOPY (59000) HOW DO I BILL THEM TOGETHER AND GET PAID FOR BOTH. WHAT MODIFIER WOULD I ADD?HE ALSO DID AN INITIAL HOSPITAL EXAM (99222)THANKS EVERYONE!GAYLE
my contract also states that I collect a percentage of full practice revenue however this particular doctor doesn't go crazy collection copayment or deductibles. Again, I can't get my question answered. Do I run an aging report based on whatever was posting to invoice my doctor?
Hello everyone. I am trying to find out different ways and the best ways to advertise your billing company. I just moved to Florida from New York and looking for best ways to advertise to physicians. I mostly do Ob/gyn billing. I was thinking maybe going to an Ob/Gyn conference and setting up a booth. Does anyone know what works the best?
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.
She goes on and on and about having compliance plans, and how she know everything when by far a lot of her information is not true. She's more concerned about compliance plans thinking she's going to Wow the doctor by saying she has a compliance plan and that % is not allowed in their state. I mean come on!!!!!!
The funny part of this all, is that one of the practices that I took over in NY, where according to Linda % billing is not allowed, went through a lawsuit. They TRIED to sue the biller stating the biller wasen't billing whatever they were told to bill therefore it resulted in insurance audit and overpayment. Blah, blah, blah.. First of all, no one even mentioned the fact that % billing wasen't allowed in NY.
You would think that the judge would know if it's allowed or not.
The word % billing did not even come up. That's first, second of all, the biller had proof that whatever was given to him to bill on a superbill was billed out on a daily basis. The biller kept all superbills and provided evidence in court that he was billing whatever was given to him by the doctor. As Richard stated, there's no law stating that the biller is supposed to check notes to make sure the doctor is billing the correct codes. And guess what happened in court?? The biller was found not guilty and as per the judge, his exact words were "you are the doctor, you need to know what is going on in your practice, you cannot blame the biller for billing what you gave him to bill" Case close! Done deal! The doctor should know better to document properly.
Here's the deal, if you have any knowledge and you should if you are doing medical billing if you suspect a problem and do nothing to correct it and just bill it you're liable. It's not simple data entry as many people like to believe.
If you decide you don't believe Linda go to the OIG site and see who has been busted lately.
1. Can anyone provide a link to a situation where a billing entity was taken to court and found guilty of any charge other than for billing charges that the doctor did not ask them to bill?
2. Can anyone provide a link to a situation where a billing entity was taken to court and found guilty of the charge of billing what the doctor told them to bill (per the quote from Linda at the top of this post)?
3. Based on what I have been able to find (and I realize I haven't found everything), the biggest risk to the biller is billing for charges that cannot be found in the patient's chart. If I can't guarantee that changes are going to be placed into the chart when I bill for them, I'm not going to bill for the changes. That is not just an ethical consideration, it is a legal one as well, because I can be prosecuted.
4. The second biggest risk to billers is being found guilty of collusion with a doctor with the intention of defrauding the paying party. Again, this is not just an ethical consideration, because I can be prosecuted if I am proved guilty of collaboration with the intent to defraud.
5. The category that seems to be in contention here is what risk there is to a biller who has no intention to defraud when they bill only for what the doctor gives them. The main point of this category is the question asked of the biller by the court in the quote from Linda at the top of this post: Did you know it was wrong?With all due respect, I think that is a red herring. The court has no interest in proving what a biller knows. They only have an interest in proving collusion with intent to defraud. The only way a biller will be found guilty by the court is if it is proved that the biller colluded with the doctor in an attempt to defraud a paying party.
6. There is no legal requirement for a biller to check the patient's chart before billing for the charges the doctor gives them. The biller is allowed to rely on the expertise of the doctor, and it is the doctor that will be held legally responsible if anything is amiss. There may be an ethical obligation for the biller to refuse and/or resign if the doctor is intentionally asking the biller to bill falsely, and the biller knows it. But there is not a legal obligation. The doctor will be held liable in this case, not the biller - assuming that the court finds no evidence that the biller intended to collaborate with the doctor to defraud a payer. The OIG statement that the suggestion to resign in such a case does not carry a legal obligation to do so, it is just a recommendation, bears this out.
For Linda to imply that a "yes" answer to the question "did you know it was wrong" will result in a penalty for the biller is misleading. (What can the court do to you if your ethics allow you to answer no to that question?) The only thing that will result in a penalty for the biller is if the court proves that the biller colluded with the doctor in an attempt to defraud the paying party.
Again, if I am wrong, provide links to the results of court cases that show a biller was found guilty when the court did not prove the biller was guilty of collusion with intent to defraud. (I'm not asking for links to cases where the biller was found guilty of billing for charges the doctor did not give him. That is a separate legal issue.)
My, my, my.... so argumentative..... It really takes away from the information that you're trying to convey... don't really need all the caps and italics
Seriously, I don't have time nor desire to read all the b.s. you wrote. I have way too many clients to read your garbage.
Instead of calling people ignorant and stupid you should be probably doing follow up or patient's statements just like I've been doing all day. This conversation was done for me and I am not going to continue with this. You want to pop a vein, go ahead, no one is listening to you anyway and I am not reading your b.s. anyway. I do read what Richard is saying and to me he makes more sense than you do. You must be a pretty shitty biller if you are afraid of your own shadow and have million and one protection plans, compliance plans insurances coverage, you name it and work with shitty doctors who will sue your butt incase you do one tiny mistake. Sad, why don't you find normal doctors where you feel comfortable working with. Think with your head who you are calling ignorant. Have you heard yourself speak? Do you even listen to yourself? I threw up listening to you on youtube. If I were you, I would hide and not speak at all.
I am not going to continue with this