10-16-18 NAMAS Webinar Compliance Manuals

Post here your questions regarding auditing ,coding, documentation, and compliance. Also, join in on the conversation- help your fellow auditors and compliance professionals in the industry.

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Fri Oct 19, 2018 8:44 am

These questions have been answered by the webinar presenter, Jesse Overbay, JD.

Question 1: If the provider refuses to change a level of service on a note. Are the coders held liable or will this fall back on the physician?

Answer 1: This one is not as simple as it seems. If a provider is refusing to change a level of service, the biller/coder may have some responsibility to change it. If the provider is ordering or threatening the biller/coder not to change it, the biller/coder wouldn't be as culpable. Typically, the responsibility lies with the provider but there have been instances where the biller/coder either changed the code (to something fraudulent) and was found liable.

Question 2: Is 5 charts a year sufficient for auditing a practice of 26 docs?

Answer 2: The OIG's recommendation on "baseline audits" are 10-20 charts per provider.
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