The buck stops with you: MDs responsible for errors
September 1, 2000 3 minutes read
The buck stops with you: MDs responsible for errors
Make sure your staff are in compliance
It doesn’t matter who made the billing error; if your practice is audited, the physicians will be held responsible.
"Historically, too many doctors have thrown up their hands at billing violations by saying that they don’t do the billing. The federal government is saying that since doctors sign the claim form and they receive the money, they are being held responsible for any mistakes," says John Knapp, JD, a health care attorney with Cozen and O’Connor in Philadelphia.
Because the physician is the linchpin in the whole health care industry and nothing happens without a doctor’s say-so, the government says that the doctor is responsible when something goes wrong, Knapp adds.
"The OIG [Office of the Inspector General] is attempting to hold physicians responsible for knowing and complying with all elements of the law. It’s saying that it wants you to go through a process of understanding the law so it can presume that any violations were intentional," Knapp says.
That’s why Knapp advises physician groups to get started immediately on their compliance programs. The guidance the OIG issued in June — "Draft Compliance Program for Individual and Small Group Physician Practices" — makes it the responsibility of physicians to see that their employees get training and learn to code correctly.
The compliance guidance says that physicians have the obligation to get training for themselves and their staff, and that the training must be ongoing. This means that your practice must invest in training and education for all employees and keep your training up to date. And instead of throwing updates on billing developments from your Medi-care carrier in a drawer, read them, put them in a manual, and make sure your staff know they have to pay attention to them, Knapp says.
The regulations deal with the difference in fraudulent and erroneous claims and state that nobody will be punished for honest mistakes. The OIG recognizes that "the majority of physician practices are run by well-meaning people who want to comply with the law," he explains.
However, the guidance goes on to say that the OIG will presume you did know the rules and that if there is a repeated pattern of violations, the OIG will presume that they are intentional and it will be up for you to prove you are innocent, Knapp says.
Currently, the government finds fraud and abuse in the following manner: Medicare carriers are required by the Health Care Financing Administration to conduct sampling and audits of physician practices. The agency typically conducts random and analytical samplings. For instance, it may examine evaluation and management codes in a region and conduct a more intensive audit of doctors who have a higher proportion of 4 and 5 codes than their peers in that specialty.
Other ways your errors might be caught include:
Whistle-blowers: Unhappy employees may turn in physicians, particularly since they can make money.
Medicare recipients: Statements from the Medicare carriers include a toll-free telephone number to register complaints about physician billing practices. This has the effect of encouraging millions of Medicare recipients who may be un-happy with or confused by their billing to turn in their doctors.
With more and more electronic billing and the requirements of the Health Insurance Portability and Accountability Act, it’s going to be easier for the government computers to sort and sample items that are not in compliance, Knapp says.
Here are some ways to help your staff get training:
Look for training sessions on compliance issues built into continuing medical education sessions.
Bring a consultant into your practice to train your staff.
Find out if your billing company will provide training for your staff.
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