Wiki Billing Question

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Metroderm

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I've recently moved to a new practice to do billing.
As I do the job, I feel very uncomfortable for what they asked me to do.
My job is to check patient's benefit In and Out of network.
We have two doctors, but only one of the doctor is in-network.
So when patient has a good out of network benefit or already met their deductible,
doctor will bill under non par doctor. Of course, checks will be sent to the patient and that is my job to chase after.
They don't ask, nor inform patient before they billing out of network.
I tried to talk to the doctor, but doctor thinks that I'm over reacting.
I would like to know what all other billers think about this situation.
Please kindly share your thoughts.

Thank you.
 
It's probably not illegal but it's pretty underhanded behavior. I've seen offices do this to patients (or know there is an in-network provider in the office and make the appt for a non network provider). Personally I'd spend every minute looking for a new job and quit the minute I found one. As a patient, if I figured out this had happened I'd file a formal complaint.
I'd also ask a lawyer what I need to do to cover myself because if they end up having an issue after you leave, don't think they won't throw you under the bus as the person no longer working there.
 
michellepilcher said:
It's probably not illegal but it's pretty underhanded behavior. I've seen offices do this to patients (or know there is an in-network provider in the office and make the appt for a non network provider). Personally I'd spend every minute looking for a new job and quit the minute I found one. As a patient, if I figured out this had happened I'd file a formal complaint.
I'd also ask a lawyer what I need to do to cover myself because if they end up having an issue after you leave, don't think they won't throw you under the bus as the person no longer working there.
Click to expand...

Thank you for you reply.
I thought this was illegal because they are billing under the provider who did not see the patient just to get more money.
That's why I have to understand clearly before I decide to quit this job.
 
what you just said... you absolutely cannot do. You cannot bill under one physician the work of a different physician. That would be in a way incident to billing and you can never do that with physicians to physician. You really absolutely need to not do this.
 
Yes, when I first read your question I also interpreted it that they were scheduling people based on their coverage.


Billing for a different provider than the provider of service is a violation of the False Claims Act and your company can be fined almost $11,000 per claim! So contrary to what your provider thinks, this is a VERY big deal.
 
cgaston said:
Yes, when I first read your question I also interpreted it that they were scheduling people based on their coverage.


Billing for a different provider than the provider of service is a violation of the False Claims Act and your company can be fined almost $11,000 per claim! So contrary to what your provider thinks, this is a VERY big deal.
Click to expand...

Thank you for confirming this.
 
Agreed!! I thought you were initially saying it was a scheduling thing based on their insurance but now that's it made clear that the claims are being billed under the provider that did not see the patient...I'd leave sooner than later. Not worth having your name tied to that.

Good luck...sorry you were put into that situation.
 
jhendrix08 said:
Agreed!! I thought you were initially saying it was a scheduling thing based on their insurance but now that's it made clear that the claims are being billed under the provider that did not see the patient...I'd leave sooner than later. Not worth having your name tied to that.

Good luck...sorry you were put into that situation.
Click to expand...

Thank you! I'm looking now. I'm very uncomfortable here.
 
hopefully you personally are not submitting claims in this manner no matter what the consequences at work are. Also the general rule is if you know something is going on and it is wrong then you have the responsibility to report this action to the appropriate agency. certainly the insurance company needs to know and maybe others such as the attorney general for your state. You cannot continue to comply with this activity. you are in a bad situation and I feel for you.
 
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