Unethical medical practices are rampant in all aspects of healthcare. Unfortunately, it does not exclude physicians. Some entire practices are involved in fraudulent practices. If I were the billing specialist in a practice and was in charge of the billing, and found that the charges did not match the procedures, I would investigate the patients’ medical records and try to decipher what was happening.
These are two discussion post read and answer back with 150 words each separately post about what you think about it.
1. Unethical medical practices are rampant in all aspects of healthcare. Unfortunately, it does not exclude physicians. Some entire practices are involved in fraudulent practices. If I were the billing specialist in a practice and was in charge of the billing, and found that the charges did not match the procedures, I would investigate the patients’ medical records and try to decipher what was happening.
It could possibly be an error on the part of the doctor while completing his dictation. Many times they are not aware of all the procedure codes and it could be a mistake. Most likely it is not, it would be up to me as the billing specialist to ensure that financial integrity is maintained. My hope would be that the physician was not actively participating in fraudulent practices. I would then go to the physician and inform him that there were charges entered incorrectly. Once we have discussed the incorrectness of the medical records, I would enter the charge in a manner that was in line with the medical billing practice act.
Each state has statues that govern the practice of medicine in that state. These are called medical practice acts and are meant to protect the health and safety of the general public. (Bonnie F. Fremgen, 2011).
In the event the physician was not receptive to the proper billing and coding procedures, then it would be my duty to turn the information over to the proper authorities. That is known as being a whistle blower. There are laws that protect whistleblowers, and it can be risky to rat out your boss. Often times people don’t want to turn them in under pressure of being fired. But of you are ethical and have morals, stick to your guns.
Bonnie F. Fremgen, P. (2011). Medical Law and Ethics. New York: Pearson.2. In processing the billing statements for patients and found some charges that had
never done. It’s best to go in person and talk to an employer/physician about the
charges that had billed. They might be unaware or look into the treatment record and
there should be a note in the file concerning those minor procedures and compare
those files. Be an advocate for the patient and to avoid any further complaints to the
media and insurance companies. If notice a fraud from an employer/physician, be
proactive and protect yourself from becoming a potential victim. If unable to resolve the
billing issue with an employer/physician, call the hotline number or report the issue to the
state’s insurance. Make sure you have your facts, bills, and other evidence of potential
fraud readily available when make a report.
Health care providers must establish standards of conduct that are above reproach
and ensure that those standards are clearly articulated and adhered to services should
be billed in accordance with these established guidelines and to ensure the
appropriateness bundling of services and accurate reimbursement. (Yuspeh, Whalen,
Cecelic, & Clifton, 1999).
Multiple codes that are frequently billed in conjunction with furnishing a single
service. For consideration of coding changes which may include consolidation of
individual services into bundle codes for payment under the physician fee schedule.
Services cannot be examined for absolute accuracy, only for relative precision. If identify
some component of the calculation used to generate that is incorrect, it is impossible to
know whether this is a systemic error or an issue with an individual code. Furthermore, consumers already face a challenge when attempting to evaluate providers. (Medicare
program, 2010).ReferencesMedicare program; payment policies under the physician fee schedule and other revisions to part B for CY 2011. (2010). (). Lanham: Federal Information & News Dispatch, Inc. Retrieved from ttp://search.proquest.com/docview (Links to an external site.)/814556329?accountid=41759Yuspeh, A., Whalen, K., Cecelic, J., Clifton, S., & al, e. (1999). Above reproach: Developing a comprehensive ethics and compliance program / commentaries /reply. Frontiers of Health Services Management, 16(2), 3-38. Retrieved from
http://search.proquest.com (Links to an external site.) /docview/203888955?accountid=41759
Edited by Yvonne Nazarene Vingua on May 9 at 4:42pm