Oncology & Hematology Coding Alert

Here's one more reason for coders, billers and RCM professionals to understand what goes on in their practice's software systems (see related story on p. 89): A leading EHR and billing software provider has become the target of a lawsuit focused on alleged double-billing.

An alleged software glitch made the news earlier this month when a whistleblower's 2015 complaint was unsealed as part of an ongoing case. Geraldine Petrowski, who was part of the compliance team at Raleigh, NC-based Wake Med Health & Hospitals, alleges that Epic's billing software allowed the provider to bill for both anesthesia base units for a procedure as well as the times the procedures took, according to a November 3, 2017 article in Modern Healthcare.

Petrowski says she alerted Epic to the double-billing and overpayment problems, but the software vendor initially dismissed her concerns. Epic later corrected the problem at Wake Med. But Petrowski says she received a patient bill from MD Anderson Cancer Center that showed the same billing problem, suggesting Epic had fixed the glitch only at Wake Med and had allowed double billing to run rampant at other facilities.

The Department of Justice has declined to intervene in the False Claims Act case, according to Modern Healthcare. Epic denies any wrongdoing. "The plaintiff's assertions represent a fundamental misunderstanding of how claims software works," an Epic spokesperson told Fierce Healthcare.

To read the newly unsealed complaint, go to: https://docs.google.com/viewerng/viewer?url=https://s3.amazonaws.com/assets.fiercemarkets.net/public/004-Healthcare/external_Q42017/EPICamendedsuit_full.pdf.