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Coding / Medical Billing

another issue to consider with off shoring - MT now coder

Posted: Jul 9th, 2016 - 8:56 am In Reply to: Speak up. A lot. Frequently. - They work for you

There are multiple rules with coding for Medicare or any senior advantage plans and you must check and verify both that the diagnosis is on their accepted list for a procedure as well as that the procedure meets medical necessity. If for instance a wart removal is billed, but a GY modifier is not attached (meaning the procedure is not medically necessary per their requirements) and you are audited, there can be big fines/penalties. If it is a frequent occurrence you face stiff penalties (False Claims Act) and you can lose your contract to treat Medicare or Medicaid patients. The inherent risks are huge with incorrect coding, which is why I think the profession is less likely to go the way of transcription. There are off shore contractors now, but there are also many auditors in US closely checking all codes to ensure accuracy. In many cases the hospital has then returned much if not all work to US because the amount of errors and the time/money to correct them didn't end up saving them anything.

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