Can all of this be avoided by the billing company NOT doing the coding?Athena Health which has about 40,000 providers does not do any coding, the client does that. The billers are barred from changing any code. They don't have any problems managing thousands of clients, and here there are problems with managing a handful.I plan to follow the same principal.And why do the billing companies do the coding to begin with?In my research, I did not find even one single large company that did the coding.It is a dangerous area and I see no reason for the biller to do it. I think Linda's caution is well taken.
Edit: Linda - you posted as I was typing this. We are on the same page. /EditGary - you need to have any legal questions answered by a health-care attorney who is familiar with the regulations of your state. This link will help you find one if you don't already have one.http://lawyers.findlaw.com/lawyer/practice/health-health-care-lawDo you receive codes from your clients electronically, or do you receive them on paper and have your clerks type them into your billing system? Those logistics are going to govern what you can do, never mind what you should do. I turned down a client who uses G.E.s Centricity system for several reasons - and a major reason was this: the EMR part of that system sends codes electronically to the PM part with no way for the billers to send the codes back to the EMR part for corrections.You said: If something obviously wrong we do bill it.Wrong, as in incorrect (e.g., OB/Gyn codes for a heart procedure)? Or wrong, as in illegal?You said: We do bill Medicare patients for non-cover services without an ABN.Some relevant points to keep in mind. It is the doctor's responsibility, not yours, to use the ABN when necessary. The biller is not required to examine the patients chart before billing to see if it contains support for the codes submitted to you by the doctor. If you are receiving codes electronically, how can the ABN be included?You said: What is my exposure for a client who sends us mostly level 5 visits?What do you mean by exposure? Do you mean, can you be held legally liable for overuse of the Level 5 code? That would be a question for your health care attorney to answer specifically. But generally, do you have specific knowledge that your client is billing Level 5 for visits that are not Level 5? If your answer is yes, then I would strongly urge you to get a response from your health care attorney.If you are interested in further information, you might Google on "Level 5 visits". That will get you to links such as these two:http://www.medicalbillingandcoding.org/blog/leveling-up-to-level-5-visits-part-1-of-2-99205-coding-and-compliance/http://www.physicianspractice.com/level-5-part-ii
Some relevant points to keep in mind. It is the doctor's responsibility, not yours, to use the ABN when necessary. The biller is not required to examine the patients chart before billing to see if it contains support for the codes submitted to you by the doctor. If you are receiving codes electronically, how can the ABN be included?
gary - if you have not yet read through the two links I provided above re. Level 5 coding, it would benefit you to do so. Both links emphasize the point that there is nothing incorrect about coding at any particular level - so long as the documentation in the chart supports it.That would be the general answer to the question you just asked about abnormal E & M. But what do you mean by abnormal?