Wiki Can a companies negative audit affect CPC credential?

[LuckyLily]

I am in a situation to where the company I work for wants to approve all E/M's with out a CPC examining it. E/M's do go through a coding software, however doctors do not dictate well (no diagnosis, wrong time statements, not enough info....etc) and often times level of codes are different from what the program says. My question is, if I approve these dictations without going through them (my name is attached to them) and the company gets audited and find all of the defects, can my CPC certificate be affected?

Us coders are in a sticky situation and we would like your input.

Thank you.

 

[npricercm]

I am in a situation to where the company I work for wants to approve all E/M's with out a CPC examining it. E/M's do go through a coding software, however doctors do not dictate well (no diagnosis, wrong time statements, not enough info....etc) and often times level of codes are different from what the program says. My question is, if I approve these dictations without going through them (my name is attached to them) and the company gets audited and find all of the defects, can my CPC certificate be affected?

Us coders are in a sticky situation and we would like your input.

Thank you.

Do you have the policy directing you to approve these codes in written form? Do you have a compliance department? Who is wanting you to take this action?

 

[mitchellde]

If a claim goes out with codes not supported by the documentation and you are the coder of record for that claim then yes you are on the hook for that claim.

 

[npricercm]

If a claim goes out with codes not supported by the documentation and you are the coder of record for that claim then yes you are on the hook for that claim.

Would you please provide documentation that this can affect your credentials? If you are following the directions of management, then I'm not seeing how you would be "on the hook".
Thank you.

 

[mitchellde]

The AAPC has published numerous articles in the past with respect to coder liability. The sum of it all is that if you knowingly submit or cause to be submitted a claim for payment that contains incorrect/inaccurate information, then yes the coder is liable for any consequences of that including fines and penalties. If you know that you are suppose to verify the documentation and you fail to do this and the claim has codes not supported by the documentation then the coder is liable. The employer cannot exempt you from this liability. You need to conduct some research in this area to convince yourself.

 

[npricercm]

The AAPC has published numerous articles in the past with respect to coder liability. The sum of it all is that if you knowingly submit or cause to be submitted a claim for payment that contains incorrect/inaccurate information, then yes the coder is liable for any consequences of that including fines and penalties. If you know that you are suppose to verify the documentation and you fail to do this and the claim has codes not supported by the documentation then the coder is liable. The employer cannot exempt you from this liability. You need to conduct some research in this area to convince yourself.

I respectfully disagree with your interpretation of liability in this particular scenario.

 

[mitchellde]

This definition is not mine, it came from an attorney. I am only passing information along. You owe it to yourself to do some research and find out. But this not my interpretation or definition. I pulled this information from an article written by a health care attorney. There are several out there, in fact lots of information, regarding past investigations and the consequences.

 

[mitchellde]

Here is some info from some back issue of Coding edge plus some from AHIMA:
Understanding Liabilities
1. Medical coders are liable, or legally responsible, for the confidential patient information with which they work. Although medical coders do not work directly with patient care, they do provide services that affect patient information.
Incorrect Code Assignment
2. Coders are responsible for all codes submitted for billing, even if they are incorrect. In most cases, incorrect code assignment results in denied claims. However, circumstances exist for coders to be charged with fraud.
Incorrect Reimbursement
3. In some cases, incorrect code assignments can result in increased reimbursement. Submitting false billing claims can be viewed as a criminal activity and punished by law.
Privacy
4. A patient's health information is private and is protected against being shared in an unauthorized manner. A medical coder who shares or inadvertently releases patient information can incur civil penalties of $100 or more for each occurrence or criminal penalties, including jail time.
Security
5. It is the coder's responsibility to secure electronic patient information from the patients with which they work. The increased use of laptops containing patient medical information and the potential for theft create liability issues

References

* American Health Information Management Association (AHIMA)
* American Academy of Professional Coders (AAPC)