By Jackie Miller, RHIA, CCS-P, CPC, PCS
A physician practice biller who was concerned about possible inappropriate billing practices at a local hospital contacted a coding consultant. One of the biller's physicians saw a patient in the hospital's outpatient clinic, and the biller was horrified to discover that the hospital had submitted an Evaluation and Management (E/M) code to Medicare for the clinic visit. She explained to the consultant that this was clearly fraudulent billing because only physicians can use E/M codes, and she questioned whether it would be appropriate for her to turn in the hospital to the Office of Inspector General.
Not a Member?