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Outpatient Surgery E-Weekly

Contact Congress Over Drug Shortage Issues

A Kentucky congressman is urging surgical facilities to contact their members of Congress and request that they sign his letter demanding changes to...

N.J. Posts ASC Inspection Reports Online

State and federal inspection reports of New Jersey's ASCs are now available online, giving patients an opportunity to make more informed choices abo...

Are Opioids Necessary?

While it's not always practical, or even possible, to eliminate opioids from your post-op pain management regiment, reducing their use in favor of n...

Archive > May, 2006 Vol. VII, No. 5

Coding & Billing

Plan Now or Pay Later

Stephanie Ellis, RN, CPC

Stephanie Ellis, RN, CPC You wouldn't intentionally bill a procedure that doesn't have a CPT code with another code just to get paid. But if the authorities come to investigate such a claim, they wouldn't just take your word for it. They'd want to see your center's compliance plan, which can not only ward off billing and legal headaches and perhaps even criminal charges, but also reduce the likelihood of exclusion from Medicare and burdensome government-imposed regulations.

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Where trouble lies; Now put it into action; Does your plan have teeth?; Act, HIPAA; Anti-kickback Statute, False Claims Act, HIPAA; Appoint; CPT; Claims Act, HIPAA; False Claims Act, HIPAA; General; HIPAA; Harbor; Include; Inspector General; June; Medicare; Modifier; Safe Harbor; Statute, False Claims Act, HIPAA; abuse; action; actions; activities; activity; actual; address; affiliated; anonymous; anonymously; applicable; assessment; assign; auditing; audits; authorities; backbone; balances; basis; benefit; bill; billing; burdensome; business; butt; cancelled; carrying; case; center; claims; code; coding; committee; common; communication; compile; compliance; comply; comprise; condoned; conduct; corporate; correct; correcting; corrective; courtesy; coverage; covered; credit; criminal; current; date; define; descriptions; detect; detected; develop; disclose; discounts; documentation; effective; employees; enforced; engage; ensures; establish; establishes; ethical; event; evidence; exclusion; expected; facility; failure; favorably; federal; fines; fit; fosters; fraud; government; government-imposed; grouper; guidelines; headaches; health; healthcare; high-level; hotline; hurt; identify; ignorant; illegal; implement; implemented; implementing; important; improperly; includes; individual; insufficient; insurance; intentionally; internal; investigate; investigations; investigators; items; job; judge; lawyer; leash; legal; likelihood; lines; locked; lose; make; medical; mistakes; misusing; monitoring; net; non-covered; obey; occur; offense; offenses; office; officer; organization; oversee; participated; patient; payer; perform; performed; place; plan; policies; policy; potential; prevent; problems; procedure; program; prominent; promote; protect; protection; provider; put; questionable; ready; reasonable; record; reduce; refund; regular; regulations; reimbursement; related; reminding; renders; report; reviewing; risk; safety; scope; screening; sentencing; service; services; short; staff; standards; statements; stepped; steps; submission; support; surgical; suspected; system; target; tendency; terminated; timely; training; trouble; undercoding; unnecessary; versus; view; ward; willfully; word; write; written; wrongdoing

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