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Billing can be complicated, but ultimately, if he is the provider of the services, he should bill only for what he is actually providing, nothing more, nothing less. Most insurance companies adhere to Medicare guidelines, so he could consider seeking additional training or consult his practice association for further guidance. While many workplaces offer these trainings, it is also the practitioner’s responsibility to educate themselves.
I have worked in several jobs where I was instructed to perform billing in a certain manner, even when it was not appropriate. For example, I was asked to bill a specific evaluation code despite the patient not meeting the required level of complexity. Ultimately, the services were provided under my license, and I had to make decisions based on what I believed was justified and ethical.
Chief
Thanks for sharing your perspective. All the board says is that you learn on the job how the codes work. They did not share any additional insight.
If you’re a Billing coder and you’re not sure if you’re trained correctly, you need to speak to whoever does training in your area. This sounds like a small office and somebody trained your friend to code for billing. If you’re not coding accurately, that can be a big issue, especially if in his prior office compliance was discussed and known about and trained and in this new office it’s not, that’s a huge red flag.