Mr. Jones, A Patient Of Dr. Brown's Arrives For His Annual Wellness Exam

1439 Words Nov 23rd, 2015 6 Pages
Imagine the following scenario: Mr. Jones, a patient of Dr. Brown’s arrives for his annual wellness exam. Mr. Jones feels great, with no complaints. When he sees Dr. Brown, Dr. Brown spends 15 minutes reviewing his last office note. He listens to Mr. Jones’ heart and lungs, checks his ears, eyes, nose, and throat, palpates his abdomen, and looks at his extremities for swelling. Everything looks fine. Reimbursement for annual wellness visit has a typically billable value of 50 dollars. However, Dr. Brown documents Mr. Jones office visit as an extended visit, not an annual wellness; that visit now billable value of more than 100 dollars. The medical coder submits the bill as documented. This is up coding.
Up coding, has serious
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During this period, $900 million was reclaimed from Healthcare providers in overpayments. Interestingly enough, another $32 million was returned to providers as result of determining underpayments (Recovery Audit Program, 2015). Yes, it’s a real thing. At times, (obviously far fewer times) a provider may actually not charge enough for a service or procedure. Since the physician agrees on the prices for reimbursement that CMS sets, they cannot take less; they have agreed upon predetermined amount. Also, keep in mind that these numbers only reflect Medicare and Medicaid patients. Imagine the size of the number if the audits included non-qualifying patients as well. After an overwhelmingly, successful first year congress determined safeguards needed to be maintained, permanently. In 2006 the program instituted under section 302 of the Tax Relief and Health Care Act of 2006 (Recovery Audit Program, 2015). The program may appear to be successful but according to CMS website and estimated 48 billion is lost because of improper payments, a third
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