Luckily I have a wonderful SAM right now who is helping us begin to address a potential problem for all
docs having CCM claims generated in their name.
CURRENTLY ECW USES EVERY SINGLE ICD CODE FROM A PATIENT’S PROBLEM LIST AND INSERTS IT INTO THE CLAIM
I am a very very conscientious doc and live and breathe my patient care 24/7.
I have a wonderful support team. That being said, there is no way we could work on every chronic condition on every patient every month.
I AM SCARED TO DEATH RIGHT NOW.
UNINTENTIONAL FRAUD is still FRAUD.
I CAN SEE THE RAC AUDITORS SALIVATING ONCE THEY GET WIND OF THIS.
If my practice manager and biller hadn’t been sitting at a table working on charts at the same time as me and asked,
“Why are you submitting 11 diagnoses on this CCM claim?” NEITHER ONE OF US WOULD HAVE EVER KNOWN.
For now either the biller and/or myself need to do extra work each month. Either I have to create an encounter that lists ONLY THE CODES I ACTUALLY WORKED ON (from the CARE PLAN) and/or the BILLER has to go back into the patient’s care plan and whittle the codes down to the ones on the CARE PLAN.
