This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. However, this is your job. (H) Counselors, social workers and marriage and family therapists shall be aware of and adhere to divisions (H)(1) and (H)(2) of section 3109.051 of the Revised Code. We still highly recommend you to seek guidance from a law professional. Give two examples of unethical billing practices that you, as a paraprofessional, are likely to encounter and how you would deal with those situations. Yet, sometimes duplicate charges are intentionally made. These tools come with significant legal and ethical risks for counselors as well as counselor educators and supervisors.Rules from HIPAA and HITECH are discussed in relation to counselor practice.Guidelines for electronic records and communication are suggested. Each code represents a specific procedure or service performed for patients. By doing this, the organization can receive money for services never provided. The definition of double billing is pretty straight forward. Claims submitted by healthcare service providers are often not consistent with the date of service it was rendered. Billing abuses are by no means limited to excesses at our largest firms. People who might require those certain services or procedures in real life may find great difficult to receive or obtain them when needed because the resources have been depleted or drained completely. In the realm of audiology, it is considered unethical for an audiologist to dispense hearing aids to a patient whose audiogram indicates that no reasonable benefits can be expected from amplification. Like upcoding, unbundling is also difficult to detect without whistleblowers (e.g. Given that there are thousands of billing codes and not everyone has the ability to interpret their billing statement, we have listed a few practical tips that would help you. That includes standards on informed consent, competence to practice, confidentiality, doing no harm, and on how terminations, interruption of service and payment arrangements are handled. Perhaps an argument can be made for reporting to your employer. %PDF-1.5 % Medical equipment fraud is one of the most common types of illegal billing practices. Book a consultation with Khouri Law today! Difficult situations can arise in any counseling setting, and when they do, counselors are expected to engage in a carefully considered ethical decision-making process, as recommended by the2014 ACA Code of Ethics. Ethical Considerations for Group Counseling Group counseling can be an effective form of practice with several intuitive benefits. Unethical Billing Practices. The Federal Bureau of Investigation has defined unbundling as a practice of submitting bills in a fragmented fashion in order to maximize the reimbursement for various tests or procedures that are required to be billed together at a reduced cost. However, attorney overbilling is unethical. Express your concern. Ethical considerations Confidentiality As a medical billing specialist, you have access to very private patient information. The American Counseling Association is pleased to help members with inquiries on ethical practice, career counseling and advice regarding the profession. This, in turn, could lead to higher premiums and even worse, patients losing trust and veering away from any medical services or procedures. While our offices are closed right now - we are happy to chat with you M-F: 8:30am 5:30pm ET. Think about a patient who has to navigate the red tape of improperly or unethically applied medical billing codes. Of course, humans are prone to make mistakes, especially due to the complicated billing process. As we previously mentioned in our Anti-Kickback Statute article, referrals and kickbacks are generally illegal when it comes to healthcare programs. Your use of this website constitutes acceptance of Haymarket Medias Privacy Policy and Terms & Conditions. The obligation to report incompetent or unethical conduct that may put patients at risk is recognized in both the ethical standards of the profession and in law, and physicians should be able to report such conduct without fear or loss of favor. If you are a healthcare service provider, double billing might seem easy to fix because it would only impact your revenue. However, those who intentionally double bill or more for the same medical procedure might face criminal and civil penalties. That seems like a huge amount, doesnt it? 2QU?re#&cUss=4]YMAukR1_}. Whether you are a healthcare beneficiary or a healthcare service provider, this would help you ensure that every billing statement you received or generated is always accurate and free from any errors. x[YZ~_jI<0)# Y>glr. You know she has minimal health insurance and will be paying most of the expenses out-of-pocket. **The information included within this blog is not intended to be legal advice and may not be used as legal advice. Read out your bill carefully and avoid getting scammed by these fraudulent people. If you are on the front lines and in direct contact with patients, face your computer screen away from the view of other patients and turn any paper documents face down. The most fraudulent practice in medical billing is called phantom charges and the worst part is that it is the most established one as well because it is the quickest and easiest to be carried out. There are no time limitations applied to these complaints, although reporting this behavior as soon as possible is recommended. The next time you generate or read a medical billing statement, you would know what to avoid or look out for. This would help ensure that the expectation for making ethical decisions in the workplace and commitment to integrity during the coding process is always reflected in the employees work. This is one of the most far-fetched types of misrepresentation as often to save extra money, different clinics or health care facilities hire unqualified, unprofessional, and totally untrained staff to conduct medical services and procedures. Going back to the same example that we use in bundling, the Duke University Health System, Inc. also settled an alleged claim for billing the government for services provided by physician assistants (PAs) during coronary artery bypass surgeries when the PAs were acting as surgical assistants (along with graduate medical trainees), which is not allowed under government regulations. Another aspect of under coding is that this practice does not give any kind of benefit to the coding professionals or the medical practitioner. If you violate them, legal action can take place in the form of sanctions and fines. As a result, in-person fraud rates for counterfeit cards have plunged. He is a current member of the State Bar of California's Committee on Professional Responsibility and Conduct (COPRAC) and is a member and the immediate past chair of the Los Angeles County Bar Association's Committee on Professional Responsibility and Ethics. Like every other sector, this world also has its black sheep, its malpractices, and other unethical means of practice. Cite the American Counseling Association, the American Psychological Association, or the National Association of Social Workers code of ethics to support your solutions. An unethical therapist might not be licensed to practice in your area, or be unclear or misleading about the costs of treatment. Patient information must be protected from the eyes of unauthorized individuals. Life happens and emergencies happen where meeting at 2:30 every Wednesday may be difficult. NaviNet ( www.navinetclaims.com) is a web-based service that, for a flat yearly fee, will walk you through billing and set up and submit your claims electronically. This, in turn, would result in more scrutiny and eventually damage the trust between the insurance company and the healthcare provider. Thanks for contacting the Membership Engagement Team at ACA. google_ad_client="ca-pub-2747199579955382";google_ad_slot="9869789507";google_ad_width=336;google_ad_height=280; Back from Ethics in Medical Billing to General Information This mission encompasses the maintenance of ethical conduct with respect to race, ethnicity, national origin, color, gender identity or expression, sexual orientation, age, marital status, political belief, religion, immigration status, and mental or physical disability. There are a lot of factors in the Rule defining what is reasonable, of course. It can also happen when a provider submits a claim for unnecessary services. Unethical practice if done intentionally is no less than a sin. 33 0 obj <> endobj Keep the company in your best interest. Its not enough that these patients may have just emerged from a stress-inducing visit to the doctor or hospital. (2014). Give two examples of unethical billing practices that you, as a paraprofessional, are likely to encounter and how you would deal with those situations. Second, join as many insurance/managed care companies that offer a fair fee as possible. In most cases, physicians who believe a colleague is incompetent or unethical have an obligation to report clinical authorities. There are a number of ways to aid in protecting information. Duplicate billing is where someone submits the same bill many times even though service or treatment occurred once. a practice of submitting bills in a fragmented fashion in order to maximize the reimbursement for various tests or procedures that are required to be billed together at a reduced cost. It says that the injection was administered at the clinic under the supervision of the doctor and this administration at the clinic has its own separate charges. This number was partly due to a glitch in Medicares system. In simple words, a medical practitioner is given payment by other service providers for every reference that they will make. Editors Note: Look for further articles and discussions with Jeff Nicholson on this topic in future articles on The Clinical Advisor. In addition, professional counselors should use all of the services available to them through their liability insurance provider. The name "upcoding" refers to the codes that are used to seek reimbursement from public health programs. .i)2R, /N[\R%&x1^gmi Implementing time tracking software that encourages accurate time billing and . This means that the treatments were only administered based on profit. If the fault lays with the facility itself, while no criminal or civil penalties will be handed down, it will need to correct any violations that break the law. If you have to phone a patient and reach their voice mail, choose your words carefully - you never know who's going to hear the message. While this may look harmless, this can actually backfire in the long-run. Apart from the above-mentioned case scenario, the patients have the right to call their insurance company in order to come up with a solution if they are certain that they have been double charged. Billing activities that are absolutely not client-related is not ethical at all. Find out here. Copyright 2023 Haymarket Media, Inc. All Rights Reserved (,VJ2'Cy7 \eQC:^ A~_06wB!~%3Qu4ZK"K-2Zrd^>n8y&Upl5rpJJ,@Vt/(,$r&b~Q Healthcare professionals fully understand the difference between these two medical services; but for patients and nonmedical practitioners, both of these might just sound similar. Under coding occurs when the codes used in a medical bill dont entirely capture all the medical services or procedures performed. Go over some patient records from your own patient encounters with them and get some tips to understand what meets a level 3 for a new patient, what meets a level 4 for an established patient, and learn how to put in your record what would be the appropriate coding level. A. It can also include prosthetic limbs that patients never received. Under coding occurs when the codes used in a medical bill dont capture all the services or procedures performed. Now the question isnt whether the said unethical medical billing practices are intentional or unintentional, the question is can they be rectified before they make life difficult for both the patients and the job providers? %F?wWAl%a5 WGwSb:H6$"IfoK^ zDp5f+#%2)G3'Iw\3]g8e' 5*i=k You can check out this guide created by the Center for Medicare & Medicaid Services to know more about the coding and billing information. Instead of using one code to describe services provided, providers used several different codes to describe different parts of the service. At the least, it is easy to understand why you might feel betrayed. Expert Answer Having worked with several professionals for many years, we have noticed some of the most common unethical medical billing practices that health care providers tend to make. So although under coding seems like it isnt that big of a deal, it can lead to some serious consequences. 15. Method 1 Examining the Nature of the Patient-Therapist Relationship Download Article 1 If you are a patient, you should immediately contact your healthcare service provider and ask them to correct the mistakes in your bill. Insurance Fraud and Misrepresentation of Services in Billing in Psychotherapy, Counseling and Social Work. Since the billing and claiming process is not always smooth, there are bound to be few mistakes along the way. This increases the presumed cost of service, which means a greater reimbursement. Conclusion. Therefore, ethical billing practices in service organizations plays a big role. 34 0 obj <> endobj 36 0 obj <>/XObject<>>>/Contents 37 0 R/CropBox[ 0 0 612 792]/Rotate 0>> endobj 37 0 obj <>stream For instance, the patients might be paying overly priced bills for the medical service they got and on the other hand, the physician or the medical professionals most probably will be facing severe criminal charges against him for unethical practice or in severe cases end up in jail. In an effort to reduce the use of paper, effective January 1, 2022, licenses issued or . The similar codes end up translating to very different payment amounts, increasing reimbursement. 10% off all courses with 10% of sales going to support Frontline Workers Learn More. The AHIMA Standards of Ethical Coding should always be followed and implemented in the workplace. Other versions of this type of fraud can include billing for private bedrooms, scooters, and other motorized equipment. Know the laws concerning HIPAA. Harsh words against your employer may do more damage than you can imagine. Theyre also proactive and prepared for the changes and updates in medical billing codes and best practices in the healthcare industry. )Re&Jr*%3y}as}EY6-d.C !w2Yj[5KS m[-/g,ugT{^9HWJ4! We are nosey and like to gossip. Ethical billing questions often come down to a misunderstanding of the intent of the codes as well as a misunderstanding of the implementation of the codes by each payer. But let's assume that the unethical behavior had something to do with coding, one of the things that is brought up a lot in the medical billing and the practice management course, and it is addressed in the coding course as well, is the False Claims Act and that has one of the strongest whistleblower protection provisions in the USA. 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