All the doctors better learn the proper coding than learn about the latest medical development.
If your medical center brings consultants and gives Mandatory presentations on Optimizing E &M codes,so that the center can earn more money.Be very very careful. learn your E& M criteria well.
if you are accused of wrongly putting a code or the billing and coding department jacks up the code without your knowledge, you are a goner.and you are History!
For example a physician who has not performed a physical exam but spent more than 20 minutes talking to the patient coded for 99213 and this was sited as evidence against him in a complaint by a patient that he molested her.
the medical Board members and even his own lawyer had absolutely no correct idea about the Nuances of e&m coding. the layer after reading the review of systems stating there was no lump in the breast or discharge from the nipple assumed a breast examination was performed.
After criticizing the work of the pathologists, the contracted reviewer offered to have her own group perform the pathology services at The Hospital. All four pathologists, with a combined 50 years of practice without regulatory complaints, now faced dozens of administrative complaints from the State of Florida and have had to pay many thousands of dollars in legal defense while trying to keep their licenses. The State of Florida had become the enforcer for a multibillion dollar corporation.
the following is the saga of a couple of pathologists who coded for 88307 billing code
and how it was used by the hospital administration and FBI/
Six months later, an “emergency” suspension (ESO) of a pathologist’s medical license occurred because of 16 placentas he had examined more than two years earlier. “Expert” witnesses were paid to say he did not examine the placentas well enough, and therefore could not justify an 88307 billing code, for which the fee was $44, rather than about $30 for the next lower code. No patients were harmed, and no doctors or patients complained about this alleged $200 oversight. The pathologist was informed that his license would be reinstated if he dropped his lawsuit against The Hospital.
The arrest occurred outside the pathologist’s home. A nice lady came to his door and informed his mother-in-law that his car, parked in front, had a flat. When he went to inspect it, half-a-dozen agents with Kevlar vests and drawn guns appeared out of nowhere, put him in handcuffs, and took him downtown. He was released by a judge about three hours later on a $250,000 “own recognizance” bond, to return to Florida to face charges. Each one of the 48 “late” placenta reports cited since 1996, for which he received at most $44 each, could land him 10 years in prison, according to the indictment. That adds up to 480 years. The indictments clearly stated that because the placenta reports were reported after the babies were discharged, the work was medically unnecessary, and billing for them was fraud. By now the federal government and the lawyers had financially exhausted both pathologists. They pleaded nolo contendere to one count of “felony tardy placenta report,” and both are now on probation. The amount of “fraud” admitted was $44. The price of the investigation to taxpayers was millions of dollars. The price paid by the patients of The Hospital is incalculable: it includes lawyers’ fees, as well as the increased prices and lowered quality that result from monopoly control of a service
The underlying problem is that the agencies entrusted with protecting the public may be in collusion with the very same corporations from which the public needs protection. This is called the “public-private partnership” these days. Previously, it was called “fascism.”
If your medical center brings consultants and gives Mandatory presentations on Optimizing E &M codes,so that the center can earn more money.Be very very careful. learn your E& M criteria well.
if you are accused of wrongly putting a code or the billing and coding department jacks up the code without your knowledge, you are a goner.and you are History!
For example a physician who has not performed a physical exam but spent more than 20 minutes talking to the patient coded for 99213 and this was sited as evidence against him in a complaint by a patient that he molested her.
the medical Board members and even his own lawyer had absolutely no correct idea about the Nuances of e&m coding. the layer after reading the review of systems stating there was no lump in the breast or discharge from the nipple assumed a breast examination was performed.
After criticizing the work of the pathologists, the contracted reviewer offered to have her own group perform the pathology services at The Hospital. All four pathologists, with a combined 50 years of practice without regulatory complaints, now faced dozens of administrative complaints from the State of Florida and have had to pay many thousands of dollars in legal defense while trying to keep their licenses. The State of Florida had become the enforcer for a multibillion dollar corporation.
the following is the saga of a couple of pathologists who coded for 88307 billing code
and how it was used by the hospital administration and FBI/
Six months later, an “emergency” suspension (ESO) of a pathologist’s medical license occurred because of 16 placentas he had examined more than two years earlier. “Expert” witnesses were paid to say he did not examine the placentas well enough, and therefore could not justify an 88307 billing code, for which the fee was $44, rather than about $30 for the next lower code. No patients were harmed, and no doctors or patients complained about this alleged $200 oversight. The pathologist was informed that his license would be reinstated if he dropped his lawsuit against The Hospital.
The arrest occurred outside the pathologist’s home. A nice lady came to his door and informed his mother-in-law that his car, parked in front, had a flat. When he went to inspect it, half-a-dozen agents with Kevlar vests and drawn guns appeared out of nowhere, put him in handcuffs, and took him downtown. He was released by a judge about three hours later on a $250,000 “own recognizance” bond, to return to Florida to face charges. Each one of the 48 “late” placenta reports cited since 1996, for which he received at most $44 each, could land him 10 years in prison, according to the indictment. That adds up to 480 years. The indictments clearly stated that because the placenta reports were reported after the babies were discharged, the work was medically unnecessary, and billing for them was fraud. By now the federal government and the lawyers had financially exhausted both pathologists. They pleaded nolo contendere to one count of “felony tardy placenta report,” and both are now on probation. The amount of “fraud” admitted was $44. The price of the investigation to taxpayers was millions of dollars. The price paid by the patients of The Hospital is incalculable: it includes lawyers’ fees, as well as the increased prices and lowered quality that result from monopoly control of a service
The underlying problem is that the agencies entrusted with protecting the public may be in collusion with the very same corporations from which the public needs protection. This is called the “public-private partnership” these days. Previously, it was called “fascism.”
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