Metzinger Associates, a billing consulting company, allegedly devised and implemented a scheme for maximizing reimbursement. The Metzinger group used improper coding methods, which included up-coding, unbundling and rebundling, to obtain a higher amount of reimbursement, and provided these services to their clients.
In order to avoid criminal liability, the owners of Metzinger agreed to cooperate with the government in the civil and criminal prosecution of their clients. In addition to providing the government with a list of their clients, they also provided 250 consulting hours to the government and provided the government with documents, records, computer runs, and other information with regard to other consultants, doctors, coding and billing techniques.
Billing companies can be very useful in running an efficient practice; but, if your billing and coding company is providing you with methods of billing and coding that sound too good to be true, watch out!
When negotiating with a billing company, ask what they do to stay in compliance. Find out if they use a Compliance Manual. Billing companies that provide coding services should have extensive policies in place to ensure proper coding.
Ask how they pay their employees. Make sure that there are no financial incentives to employees to up-code or un-bundle claims.
If you have any questions with regard to the above or with respect to any other legal heath care issues, feel free to FAX your questions to Deborah A. Green, Esq., at 954-971-3787 or call 954-971-7778 or email [email protected]. She will answer those questions which are of interest to the broadest audience, in future columns.
Ms. Green has been a practicing attorney since 1977. She is admitted to the practice of law in the State of New York and Florida and is a member of the American Health Lawyers Association, the New York State Bar Association Health Care System Design Committee, the New York State Bar Association Health Care Providers Committee, the American Bar Association Health Law Section and the Florida Bar Health Law Section. She has formed numerous multi-discipline practices throughout the country.
Because this column is being presented to you by an attorney, it would not be complete without a disclaimer. This column is provided subject to and governed expressly by the terms of this disclaimer. This column is provided for educational purposes only. The accuracy or timeliness of the information presented herein is not warranted. The information presented herein is not intended to be advice as to a specific fact pattern with which you may be presented. Accordingly, please note that the information contained herein is not being presented as legal advice with respect to any matter and that no attorney-client relationship is hereby established.