~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This message is from PedTalk! To reply to the group, use "" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ First I want to thank Dr. Michael Sachs for re-introducing the issue of the Coding and Documentation Guidelines. I finally got a hard copy of the 50+ page document, plus there are also requirements for ordering certain lab tests(another 50 or so pages). The problem with going to HCFA is that you cannot download the document for printing without going nuts trying to reformat it. It has lots of charts that don't come back out well in the download process. If anyone wants a copy of this call my office and I will have my AA send a copy for reimbursement of the direct cost of printing at Kinko's and priority mail ($3.00) to send it. I think the whole thing comes to about $17.00. Problem is, you have to read this guys and gals. You cannot lay a hand over it and expect it to osmotically filter in. The wages of sin in this case is prosecution under HIPAA ( Kennedy and Kassenbaum Bill) and whats worse is that BOTH upcoding and downcoding is now subject to hefty fines. Where one could be prosecuted of double damages between the difference of the payment of the appropriate code ( per documentation ) and the listed code plus $2000 per level, the increase is now $10,000 per level, plus treble damages, per incident. For example: You billed 99214, but your documentation reflects 99212: 99214 allows $78.00 ( example only ) 99212 allows $37.00 ( example only ) difference in dollars= $41.00 x 3 = $123.00 plus $30,000 fine. total for (this visit only) infraction is $30,123. Plus, the Act also allows for prosecution as it did before on a "known or should have known basis" and also prosecutes for "deliberate acts of ignorance in the truth or falsity of the information or acts in reckless disregard of the truth or falsity of the information." According to Grant Steffan, M.D., Medicare Medical director for Colorado, in a written newsletter to physicians, he states, "A physician who chooses not to read or follow the [guidelines] may not be protected, because this could be considered deliberate ignorance. Similarly, a physician who ignores repeated notices from a carrier that they are consistently billing a wrong code many not be protected, because this could be considered reckless disregard." Having done physician advocacy work for years and practice management and consulting for many years, I strongly urge you to read and digest these materials, no matter how you obtain them. Review them with your staff and code your own visits. Remember that there is a master/servant responsibility for anything your staff does regarding your billing. Set up an office policy that any notices of aberrances in coding or denied claims for documentation be brought immediately to your attention. Have your biller write up any incidents on an incident report and also document corrective actions taken in a Continuous Quality Improvement format. Keep the file current. If the feds ever comes a-knockin' the file may mitigate any charges of intentional fraud or abuse. One last thing... the documents I have state that the 1999 CPT codebook will have these guidelines and new E&M definition changes because they did not make it into the 1998 book in time for print deadline, however, they will be enforced against the update, not the current CPT book, so that closes that loophole. I am fearful for the implication on innocent doctors who may be subject to what I call "federal brutality" as this Administration seeks to win back public popularity through programs such as "Operation Restore Trust", and that many will suffer scrutiny because these guidelines and new mandates and the HIPAA Act was not taken seriously enough. I know that there are many resources here on pedtalk to ask questions, Chip, myself, and others who have taken the time to digest these weighty documents. We are here as resources on pedtalk. Speaking for myself, I am not here to market my services as informercials. If you need help, ask and I am sure we will all do our best to answer whatever questions you pose on this subject. If we don't know the answers we can get them so that the information is shared with everyone. I make good money as a consultant, I have also been treated well by physicians all over the country, and I know what good most of you do for humankind, as dedicated stewards of our health, our happiness, and our quality of life. You have to keep taking care of patients, we administrator-heads will keep focused on the non-clinical and together we can make it good for everyody. My participation on Pedtalk is one of voluntary service - with the attitude that we are all angels with but one wing, and we can only fly if we embrace one another. Having been involved in expert witness defense of physicians for fraud and abuse, I urge you to please digest this E&M guideline document and its compendia and ask questions- there are no stupid questions here... this is really serious @#$%^!!!