Posted by Cairo on January 21, 2005, at 19:32:36
In reply to Psychiatrists (and others) please read, posted by Jakeman on January 20, 2005, at 23:54:03
Intentional overcoding/billing is fraud. Unintentional overcoding/billing should still be brought to the attention of your insurance company. If a records review reveals that he overcoded and his records cannot back up the level of code that he used, then he may be required to pay back the insurance company. Ask your insurer what they would advise you do about getting your money back from the Pdoc. At the very least, they may seriously talk to him about his status as a provider for their company.
Either way, notify your insurance company IN WRITING. Keep copies of the receipts you received at each session, cancelled checks, billing notices, etc. You will need a paper trail to confirm your claims.
You can also ask your insurance company to provide you with a list of billing codes and what services they entail. Usually there is a checklist of what must be done and documented. If documentation does not take place (eg. he did it but didn't note it), then it didn't take place as far as the insurance company is concerned.
Too many doctors are not familiar with what is entailed for higher level coding, but they sure are familiar with reimbursement rates for higher codes. Buyer beware.
Cairo
poster:Cairo
thread:445031
URL: http://www.dr-bob.org/babble/20050119/msgs/445425.html