# conflict of interest?



## mkm1517 (Aug 4, 2008)

Is it ethical to have 1 supervisor over coding and the same supervisor over billing?  Would this be a conflict of interest?  Thanks for your input!


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## dmaec (Aug 4, 2008)

I don't see an issue with it.  Don't we all have the same goals? (we should) Correct coding and billing of claims for correct reimbursement, right?. I've worked in places that have the same supervisor for both area's and in places that have different supervisors for each area.  Either way, "we" in the coding department always worked very closely with the billers.  Often needing their expertise and input on certain issues and visa/versa.
_{that's my opinion on the posted matter}_


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## thompsonsyl (Aug 4, 2008)

Hi,

I agree with Donna.  I don't see how it would be a conflict of interest.  What is your take on it....why do you think it is?  Maybe if you spell out your issue with it, we can look at it differently.


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## rthames052006 (Aug 4, 2008)

thompsonsyl said:


> Hi,
> 
> I agree with Donna.  I don't see how it would be a conflict of interest.  What is your take on it....why do you think it is?  Maybe if you spell out your issue with it, we can look at it differently.




I have always been a firm believer that billing and coding go hand in hand if you know both then the whole picture is complete. 

Just my 2 cents.


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## dclark7 (Aug 5, 2008)

I don't see any problems with having the same supervisor over both areas.  It probably is better with the same supervisor, as rthames said, the two go hand in hand.  The important thing is the accountability, as long as the supervisor is accountable to someone there shouldn't be any problem.


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## RebeccaWoodward* (Aug 5, 2008)

Personally speaking...I've known billing supervisors that simply had the title.  They may have known how to work the electronic time card or produce very pretty reports but they didn't have the "meat" of the business.  Althought I am bias, I think it's safe to say that coders can have an upper hand over the day to day billing supervisor.  We're expected to know Medicare regs and apply them to day to day situations.  We're expected to educate our providers on what constitutes legal and appropriate medical documentation.  I've argued with many "billing supervisors" who had no concept of medical necessity or bundling issues or coding and compliance....(I could go on for days). Now, that's not to say that a billing supervisor can't do the job.  I've also seen some who go over and beyond the call of duty and produce exceptional results.  If you can find a coder that can also oversee a billing department...you have the best of both worlds.


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## mkm1517 (Aug 6, 2008)

*Background info...*

Here's some background info for the basis of my question--
Several years ago there was a position that supervised both coding and billing.  When that person left, a coder said the position should be split into two separate positions because there could be a conflict of interest if the same person was over coding and billing.  So, the position was split into two and now both positions are open again and the higher-ups are looking into combining the positions into one again.  We are just researching to see if there is an actual argument here or not.  We certainly don't want to bring attention to ourselves if this is not a common practice.  I think it would only boil down to a conflict of interest if something happened (coding to acheive a higher payment, for example) in which there would be an investigation.   I appreciate your help!


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## RebeccaWoodward* (Aug 6, 2008)

Well... I don't know about how others feel but I feel that a CPC holding a role of a billing supervisor should be on the "up and up".  When we pursue to be CPC's, the AAPC expects very high standards.  We are accountable for our certification and our representation of the AAPC.  After all, if we misrepresent ourselfs for self gain, we could lose our certification.  As a CPC, we are not perfect but I feel we strive to provide legal and ethical information.  Normally, you can spot someone who has malice intentions.  Personally, I have never read or seen any documentation that would prohibit a CPC acting in both functions.  Many times, I have seen billing supervisors threatened by a CPC;  especially, when they authorize unjustified adjustments, create polices that are completely against AMA, CPT and CMS guidelines.  It's when the CPC intervenes and proves their case that many polices are implemented within that practice.  If anyone has an opposite opposite of mine, I would really like to hear your stand.

Respectfully,


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## thompsonsyl (Aug 6, 2008)

Hi,

I don't know of any legalities involved in having a Billing Supervisor oversee the Coding Dept as well.  In my opinion, I think it would be smart to look for/hire a Billing Supervisor who _*is*_ a certified coder.  She/He would have an in-depth knowledge of all aspects of the field, would understand the complete billing cycle, would be sensitive to compliance issues, etc.  I also think that a certified coder would not risk losing her/his credentials by doing something unscrupulous.  A certified coder who also has the authority to implement & enforce compliance standards within your practice would be a great thing.

Just my two cents worth....Good Luck!


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## rthames052006 (Aug 6, 2008)

rebeccawoodward said:


> Personally speaking...I've known billing supervisors that simply had the title.  They may have known how to work the electronic time card or produce very pretty reports but they didn't have the "meat" of the business.  Althought I am bias, I think it's safe to say that coders can have an upper hand over the day to day billing supervisor.  We're expected to know Medicare regs and apply them to day to day situations.  We're expected to educate our providers on what constitutes legal and appropriate medical documentation.  I've argued with many "billing supervisors" who had no concept of medical necessity or bundling issues or coding and compliance....(I could go on for days). Now, that's not to say that a billing supervisor can't do the job.  I've also seen some who go over and beyond the call of duty and produce exceptional results.  If you can find a coder that can also oversee a billing department...you have the best of both worlds.





Rebecca, 

I feel like the latter part of your response your talking about me, I am a coder and also a billing supervisor, I understand and agree with what you are saying.  My previous supervisor at my last place of employment was the beginning part of your response, but I was the one who made her "look good" I was responsible for running those "pretty reports" she had no clue and still doesn't, the office manager is now paying the accountants to do the monthly reports.

Just wanted to chime in.


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## RebeccaWoodward* (Aug 6, 2008)

Roxanne~

I'm glad you're in a better place.  We work too hard to be taken for granted.


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## twebber68 (Jun 7, 2009)

I don't think there is an ethical problem if you have the right person, but where I work I believe the task to try to do both effectively is too large for one person. We employee approximately 40 physicians in a multi-specialty clinic. 

I found this thread because I am one of two CPCs. (Yes, for all of the clinic) I am employed partly by the I.T. department and partly by the Billing department. My Billing supervisor is not a CPC. My fellow CPC and I have our desks in the I.T. department and are pretty much isolated from the billing department.

Problems come into play when we try to correct billing practices. We must first explain them to our Billing manager, who may or may not understand it. Then based on how it affects her "girls", or how many patient will complain, is how long it takes to actually implement the change? 

The other problem is that she's "too busy" to work on our issues. I am concerned that some of our major billing issues may never get resolved because of a Billing Manager's stalling. Since she has us so isolated, I'm sure she's going to say she didn't know anything about it!


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