mgriffiths Posted September 19, 2018 Share Posted September 19, 2018 So I just recently learned that the billing department at my current employer has been downcoding almost 2/3 of my patient visits - and it is completely arbitrary. Patient's who are billed based on time (i.e. 40+min for a 99215) down-coded, while a single narcotic refill appointment left alone... I mentioned this to the clinic administrator who stated she would look into it - and basically billing was going far beyond their pay grade to downgrade billing to pre-empt the insurance company from downgrading themselves. For a bit of background one of the major insurers in our area is downcoding based on diagnosis only and not actually auditing the visit - completely illegal and it's being taken higher and higher within the state AG. Getting back to me...normally I wouldn't give a rip about this - the company can do what it wants - except that approximately 1/3rd of my income is RVU based bonuses (another issue entirely). Just for the month of August I have calculated that I lost approximately $1200 in bonuses, and who knows how long this has been going on. I am currently waiting to hear what they are going to do about the lost income, but I have a feeling that it is going to be a "oh, this was a mistake, but hurt the clinic's income too so it's all even." Something I'm curious about is whether I am the only provider this has been happening to or is it all 32 providers we have...because that could be HUGE $$$$$ lost!!! I am posting this for two reasons: 1. if anyone has thoughts on next steps: try to claw my money back, let it go, dealbreaker and start polishing the resume? 2. this was ONLY caught because I keep track of my RVUs and the number of patients I see per month. My RVU/patient visit has been dropping significantly over the last 3-4 months which I initially attributed to other causes, but as it kept happening I looked further...REVIEW YOUR NUMBERS PEOPLE!!! Quote Link to comment Share on other sites More sharing options...
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