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To what extent is my billing company responsible for wrong ICD-10 claims submissions?

 October 13, 2015
Question:

Jennifer,
Thank you for providing such a valuable forum to our community.  I own and operate a billing company.  My staff and I have done our best over past umpteenth months to educate our clients about ICD-10.  Apparently to no avail.  We are receiving claims submissions that are 70-80% incorrect, if I had to guess.  We offer claims scrubbing as a service, but we never take responsibility for code selection.  What exposure do I have if my clients tell me to "just submit". 

Thanks in advance, and please feel free to use for everyone's benefit!
VTY,
P
 
Answer:

P, thank you for the question.  This Q&A most certainly applies to both sides of the aisle - biller and practitioner alike.  First lets hit on potential exposure areas for submitting the wrong codes: denial, audit, recoupment, allegations of fraud or intentional conduct that may be tantamount to criminal (if government funds are involved).  So, we run the gambit here from fairly innocuous to "orange is the new black" exposure. 

Next question:  whose exposure is it?  As you say, you are only contracted to submit claims, not to do the coding.  Well, that is the key to our puzzle.  Where the billing company is not performing code selection and is not facilitating code selection and hasproper contractual protections and appropriate language documenting same in its service contract, I would feel very comfortable defending the position that the billing company's job is to submit whatever the client hands them.  On the flip side, where the exposure might come in, is you mention you performed training.  If you failed to properly document the materials you trained on, or if you trained on the wrong stuff, or if you failed to properly train or completely train, an argument may be made you took the responsibility on to train proper coding, and there, if you do not have enforceable contractual protections, you may have exposure.  

With the anticipated muck of ICD-10 implementation, tread carefully and go back to your service agreement to confirm what your responsibilities are.  Do not take on more than you are contractually protected for.  

To our healthcare providers still reading, please take the time to educate yourselves and your staff (even your biller who has been doing this forever - no one is immune from benefiting from a proper training or refresher course).  Your ARs are your practice's life blood.  Do not risk payment by failing to properly educate and implement ICD-10. 
 
Need help with your billing contract?  Contact me or check out www.healthcarepracticecompliance.com for our form as a starting point.  (HBMA members receive a 15% discount) 
 
Looking for HIPAA and compliance forms?  
Click here to visit our website.
Have a question or comment for Jennifer?
Contact Jennifer at Jennifer@Kirschenbaumesq.com or  at (516) 747-6700 x. 302.
Interested in having Jennifer speak at an event or
at a residency/fellowship program?
Contact Jennifer directly at (516) 747-6700 x. 302 or atJennifer@Kirschenbaumesq.com.
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Looking for HIPAA and compliance forms?  
Click here to visit our website.
Have a question or comment for Jennifer?
Contact Jennifer at Jennifer@Kirschenbaumesq.com or  at (516) 747-6700 x. 302.
Interested in having Jennifer speak at an event or
at a residency/fellowship program?
Contact Jennifer directly at (516) 747-6700 x. 302 or at Jennifer@Kirschenbaumesq.com
Click here to learn about
K&K's Prepaid Legal Audit/Investigation Defense Now!