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Physician Law Current news, updates, & useful tips relating to legal issues affecting physicians & non-institutional providers in their personal & professional lives

Don’t Ignore Billing and Coding Rules

Posted in Fraud and Abuse

Many physicians were once content (and a few still are) to let their coders select their codes for billing purposes.  At a time when enforcement authorities have some heavy-duty technological weapons for identifying improper billing, physicians can no longer avoid learning the billing rules applicable to their services.  Consider this recent settlement related to the improper use of Modifier 25

We all know that billing and coding rules are complicated but learning them is not nearly as difficult as, say, getting though medical school.  Ultimately, if your name is on the claim, you are responsible for the other information on the claim as well.  Does your documentation support your codes?  Do your diagnosis codes support your procedure codes?  Are the modifiers correct?  If you’re a physician and you don’t know the answers to these questions, take the time to learn this stuff.  Everyone makes mistakes but disregarding rules that you should know could ultimately be deemed abusive or even fraudulent billing.