In today’s fragile economy, there is no room for mistakes, and that rings even truer when it comes to coding and billing. One of the biggest questions heard in the coding world is, Who is liable for coding mistakes—the coder or the provider?
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Explore This IssueOctober 2010
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Most often, the financial and legal responsibility will fall on the provider. He or she has responsibility for what is billed under his or her unique provider number and signature because the provider has signified that everything on the claim is accurate and has been reviewed and authenticated. A physician’s signature on a claim also attests that the medical services provided were necessary and reasonable to submit to a payor, therefore accumulating the accountability. It is for these reasons that the provider is usually the one that is fined for fraud and abuse. Do coders need to pay if it is their wrongdoing or mistake?
There is a level of liability that should be applied to anyone who knowingly submits a claim that is erroneous—this includes coders, billers, and physicians. The False Claims Act (FCA) imposes liability on any “persons” who knowingly submit false claims to the government for payment.
The FCA is used as an enforcement tool for the submission of false claims; providers and their staff should be mindful of the monetary penalties as well as civil penalties for fraudulent claims. Right now, private payors only fine providers and not ancillary staff. However the law applies to everyone. Although there is no record of levy against coders, this doesn’t mean that it is impossible.
Compliance in coding and billing is the responsibility of everyone—whether in a private practice or a hospital. Anyone in charge of preparing, computing, or submitting claims to a payor should be mindful of the guidelines as well as the legal responsibility of claims submission. No one should be ignorant of the rules!
Providers and their staff should protect themselves from coding errors and fines and code all claims from the documentation. Coders should feel empowered to ask about anything that is questionable before billing to payors.
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Compliance, coding, and billing training, including maintenance and upgrades of electronic medical records, should be provided to staff. Additionally, self-audits of claims should be done at least two times a year to find trends or errors that need correction.
Finally, there should be an official policy and procedure for employees in every physician practice. This document should be available for employees to refer to in case a question arises. The old saying that “prevention is better than cure” can be applied to paying unnecessary penalties for errors that can be prevented. Coding compliance should be not a choice but a reality.
The ACR certified coders are available to assist physician practices with audits and coding compliance. For additional information, contact Melesia Tillman, CPC, CRHC, CHA, at firstname.lastname@example.org or (404) 633-3777, ext 820.