Monday, December 10, 2012

They'll Come Knocking



Behind all the anxiety of new CPT codes-- because change is hard-- there is not just the angst of more paperwork, or the question of whether gathering specific data distracts from the work of caring for the individual patients.  We wonder whether the burden of new billing systems and more documenting for the sake of being able to code like "real doctors" will actually translate to higher reimbursements.   More than that, though, there is the fear, which lately does not go unspoken: the fear of doing it wrong and being accused of insurance fraud.  Our presenter at a CPT training seminar warned that down-coding is just as fraudulent as  up-coding, and my feeling is that we should accurately code the work we do within the confines of the very complex Evaluation and Management schedule, such that our services do get higher reimbursement --- it's difficult to follow but it's either about collecting the right number of bullet points in each category or it's about spending more than 50% of time counseling and coordinating care.  Funny, now psychiatrists have to talk more than they listen.   Yet everyone I've spoken to says they code low because they don't want to draw attention to their work and don't want to be accused of fraud.  I suggested that this is wrong when the doctor is paid a salary and so the hospital collects lower fees.  I also think it's wrong when the doctor is out-of-network and the patient's reimbursement, from their health insurance company with those very high premiums and very low reimbursement for expensive psychiatric services, depends on the code. 

 Some docs are just trying to ignore the upcoming changes, especially those in small private practices.  Insurance companies don't typically audit charts of solo practioners who are not in their networks.  It's likely rare that Medicare does either, unless perhaps something looks fishy?  So some say, "they won't bother me."  Others say, they're coding low to stay off the radar, and at least 2 docs I know are opting out of Medicare, because Medicare audits are scary with their $10,000 per claim fines.  (Am I right about this?)

Emailed to me today, with the actually title, "They'll Come Knocking":

Subscribe to Compliance Watch to Steel Against Investigations and Unnecessary Penalties 
Do you know the new definition of fraud? Are you up to snuff on changes to CPT codes? Big changes are on the horizon. Are you ready for how they will affect your day-to-day and business practices? To survive in our new healthcare environment, staying current on mandates and preparing adequately for investigations and audits is crucial.

Of course this company is selling their services and they are doing it through scare techniques, but still.