If one of our doctors admits a patient and another doctor within our practice sees the patient on a subsequent day and discharges the patient, which doctor should each day be billed under? Should we bill all dates under the admitting physician or does each day have to be billed with the doctor that signed off on the progress note for that day (even if they are in the same practice, same Tax ID #)?
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Tag Archives: doctor
New Doctor Credentialing
I have a new doctor and she starting seeing patients. How do I bill her claims when she is still credentialing with insurance? Do most insurances backdate? Should I hold claims and not bill them? They are denying through the clearinghouse. I would appreciate any feedback – Thanks, Karrie
Stuart Doctor Charged in Twenty-Six Count Federal Health Care Fraud Indictment
A specialist has been accused of submitting social insurance misrepresentation out of her training in Stuart, Florida. The U.S. Lawyer for the Southern District of Florida, Shimon R. Richmond, Special Agent in Charge, U.S. Division of Health and Human Services, Office of Inspector General (HHS-OIG), Miami Regional Office, Robert F. Lasky, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office, and Pam Bondi, Florida Attorney General (Florida Medicaid Fraud Control Unit), made the declaration.
The post Stuart Doctor Charged in Twenty-Six Count Federal Health Care Fraud Indictment appeared first on The Coding Network.
Southeastern Connecticut Doctor Settles under the False Claims Act for Nearly 100K
John H. Durham, United States Attorney for the District of Connecticut, today declared that HELAR CAMPOS, MD, a doctor with a training in New London and Norwich, has gone into a common settlement with the administration in which he will pay $ 99,912 to determine charges that he abused the False Claims Act.
The post Southeastern Connecticut Doctor Settles under the False Claims Act for Nearly 100K appeared first on The Coding Network.
New York Doctor Imprisoned For $30M Scheme
Dr. Ewald Antoine pleaded guilty to healthcare fraud, as well as several other crimes. According to the indictment, Dr. Antoine posed as the owner of two clinics in Brooklyn, falsely claiming he examined and treated hundreds of patients there.
The post New York Doctor Imprisoned For $ 30M Scheme appeared first on The Coding Network.
What code to use after 90972 for follow-up services with same doctor
I am seeking guidance on which code to use the day(s) after 90792 for a follow-up with the same doctor that did the 90792. We were once instructed to use 90791 for the follow-up and now that I’ve helped my supervisor to understand that this is not appropriate, I’m having a hard time figuring out exactly which code would be appropriate. I was thinking 9923*. The patients are usually in outpatient/ inpatient care for substance abuse at a facility and we are billing as a doctors group. Any guidance would be greatly appreciated.
Lab Billing in Doctor Office setting
Hello all,
Just had a quick question in regards to billing out labs in a doctor office (11) setting.
We use Quest Diagnostics as a lab and one of our providers needed some extensive tests done on a patient. However, the issue lies with the CPT codes being reported/billed being denied.
What was billed out:
Code:
36415 - venipuncture
87081 - C Dif w/ Reflex
83993 - Calprotectin, stool
87045, 87046, 87427 - Sal/Shig/Campy Culture and Shiga toxin test.Now my issue is that 87081 has a CCI conflict with 87045 and 87046. Is there a modifier I might be able to use to have this reprocessed or should I not bill the less expensive test?
Thank you!
36556 nun-tunneled central venous catheter billed twice by different specialty Doctor
Need your help, please! 36556 billed twice on the same day by two different specialty Doctors, denied as duplicate, do you think a modifier is needed?
New York Doctor Sentenced To 13 Years In Prison For Multi-million Dollar Health Care Fraud
A New York surgeon who practiced at hospitals in Brooklyn and Long Island was sentenced today to 156 months in prison for his role in a scheme that involved the submission of millions of dollars in false and fraudulent claims to Medicare.
Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, U.S. Attorney Richard P. Donoghue of the Eastern District of New York, Assistant Director in Charge William F. Sweeney Jr. of the FBI’s New York Field Office and Special Agent in Charge Scott Lampert of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Office of Investigations made the announcement.
Syed Imran Ahmed M.D., 51, of Glen Head, New York, was sentenced by U.S. District Judge Dora L. Irizarry of the Eastern District of New York, who also ordered Ahmed to pay $ 7,266,008.95 in restitution, to forfeit $ 7,266,008.95, and to pay a $ 20,000 fine. Ahmed was convicted in July 2016 after an 11-day trial of one count of health care fraud, three counts of making false statements related to health care matters and two counts of money laundering.
“Medicare is a crucial program for many of the most vulnerable people in our society – American seniors and those with disabilities,” said Acting Assistant Attorney General Cronan. “In this case, Syed Ahmed put his own greed ahead of the trust we put in our medical professionals, draining over $ 7 million in precious funding from our Medicare program. His conviction and the sentence imposed in this case demonstrate the Department of Justice’s unwavering commitment to protecting public funds and the integrity of our health care system.”
“Dr. Syed Ahmed treated Medicare like a personal piggy bank, stealing over $ 7.2 million by making fraudulent claims for medical procedures he never performed,” stated U.S. Attorney Donoghue. “Dr. Ahmed will now pay the price for violating the trust that Medicare places in doctors. His 13-year prison sentence and the heavy payments imposed should send a powerful message of deterrence to other medical professionals who would seek to defraud vital taxpayer-funded programs like Medicare for personal enrichment. This Office, together with our law enforcement partners, will remain vigilant in rooting out health care fraud.”
“Health care fraud is often billed as a victimless crime, but that couldn’t be further from the truth,” said Assistant Director in Charge Sweeney. “Someone is always left to foot the bill. Insurers, the insured, and others are the ones who pay the price. Those who employ these schemes will most certainly be brought to justice, as we’ve proven here today.”
“The fraud scheme that Dr. Ahmed engaged in was motivated by pure greed,” said Special Agent in Charge Lampert. “HHS OIG and our law enforcement partners will continue to aggressively pursue all those who seek to unlawfully enrich themselves by victimizing participants of the Medicare program.”
According to evidence presented at trial, Ahmed, a surgeon who practiced at Kingsbrook Jewish Medical Center and Wyckoff Heights Medical Center in Brooklyn, Franklin Hospital in Valley Stream, and Mercy Medical Center in Rockville Centre, New York, billed the Medicare program for incision-and-drainage and wound debridement procedures that he did not perform. Ahmed wrote out lists of phony surgeries and sent the lists to his billing company in Michigan with instructions that they be billed to Medicare. Ahmed also directed that the surgeries be billed as though they had taken place in an operating room so as to increase the payout for the fraudulent scheme, the evidence showed.
The evidence introduced at trial showed that Medicare paid over $ 7 million to Ahmed for fraudulent claims.
The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of New York. Trial Attorney Debra Jaroslawicz of the Fraud Section, Assistant U.S. Attorney F. Turner Buford, formerly a Fraud Section trial attorney, and Senior Litigation Counsel Patricia Notopoulos of the Eastern District of New York are prosecuting the case.
The Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 3,500 defendants who have collectively billed the Medicare program for more than $ 12.5 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
The post New York Doctor Sentenced To 13 Years In Prison For Multi-million Dollar Health Care Fraud appeared first on The Coding Network.
Sample Contracts between Doctor and Coder
Hello, I am planning to code for a private doctor, does anyone have a sample of the contract that I can see or where to find one? I would want to include something about privacy, HIPAA, pay rate, confidentiality, etc. Please help asap. Thank you.