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diann

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I need some advice. I just started at a new office in Florida. I am supposed to become one of the billers once the existing employee leaves--bad situation from what I gather--and once the office changes to EMR and leaves current billing company (which current biller is being paid under). Here is the thing...I have been there almost 2 weeks and have noticed 1)injections done by nurses are being billed under 99212 2)almost every patient is being billed for 99214/99215 3)visits being billed are i.e. 99214 plus a wellness visit 4)there is patient information being thrown in the trash even though there is 2 shred boxes. I went to the doctor who hired me about my concerns and was told basically I didn't know anything (granted my background is mainly rural health and CAH) that the billing was ok because the billing company says its right and that they have always billed this way. On the patient info, they are supposed to be getting more shred boxes but nothing was said to any of the employees about not throwing the patient papers away. I do not feel comfortable with any of this! So far I have not done any billing other than checking charges are in. I know I should quit and maybe that is answering my own question...I like most of the people there and hate to see anything happen...but I also know that I will be run out of town since everyone loves these doctors and they are really nice people!
 
It's pretty common, in my experience, to come into a new work situation and find things that are not working as you feel they should be. You're right to take note of things that are potential problems but I'd recommend being patient and recognizing that positive change can take time. As the new person in the office, unless you were hired to overhaul the process, you can't expect that you'll be able to fix everything right away and without some resistance, but you can have a positive impact if you take your time, allow people to develop confidence in you and your work, and approach things in the right way and at the right time. My recommendation would be to take it slow - start by trying to develop relationships with key people like the providers and managers. Then start with the more important issues one at a time - for example the HIPAA issue of disposal of PHI. I'd try take the approach not of saying that the office is doing something wrong or that they might interpret as negative criticism, but rather that they're doing something that could potentially put them at risk and which you think they can improve for their own benefit. From there, move on to look at the possible upcoding issues, which could be a longer term project that requires audits and educations, but is potentially less serious. But just be realistic that you can't fix everything at once. When you're new, if you come across like you're stepping in and demanding change because you know better than everyone else (even if you really do), you'll just end up making enemies and undercut your own ability to be an agent for change, but if you try to work together with your new team you're more likely to succeed. You may or may not be able to get things changed to a point where you're comfortable, but I wouldn't quit yet - giving up won't let you accomplish any change, and you may just find a similar set of issues at your next job anyway. Hope this helps some
 
Yes, understandably so. If you're worried about that and want an additional layer of protection, keep a written record for yourself of conversations with everyone about any compliance issues, or even better, communicate your concerns in writing or by email so that you can have a printed copy in case you ever need it. I've you've done your due diligence by bringing concerns in good faith to the responsible persons, you are not likely to be held liable, and you should also be protected from any form of retaliation.
 
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