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The Case of the Bad Billing Doc

A beloved doctor is terrible at billing and coding, and her bad habits are now rubbing off on the rest of the team.

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DENISE, THE BILLING specialist, saw Chrissy, one of the opticians, heading towards her with an agitated look on her face.

“Do you have a minute? Because I can’t even with this doctor’s coding,” Chrissy said.

ABOUT REAL DEAL

Real Deal scenarios are inspired by true stories but are changed to sharpen the dilemmas involved and should not be confused with real people or places. Responses are peer-sourced opinions and are not a substitute for professional legal advice. Please contact your attorney if you have any questions about an employee or customer situation in your own business.

ABOUT THE AUTHOR

Carissa Dunphy has been working in private practice optometry since 2008 and is the founder of Optician Now (opticiannow.com). Follow Carissa on Instagram and Facebook at @opticiannow.

As Denise considered the look on Chrissy’s face and her body language, she knew she didn’t really have a choice. “Sure. What do you need help with?”

She waved the chart in front of Denise and continued, “I’ve got glasses to bill for this patient and I’m being held up because Dr. Nozam didn’t enter any diagnostic codes in the chart. I saw that the patient is diabetic and that last year’s visit was billed to her medical insurance but there’s no notes on how today’s visit should be billed. The doc has left for the day and has the next two days off. I don’t want the glasses to be held up, but I also know it’s a pain to post insurance checks when one date of service is on two invoices.”

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Denise responded, “I see your dilemma and I appreciate your effort to do this correctly. Basically Dr. Nozam is just plain lazy at coding. The partners have brought this up with her several times and have explained how charting and coding is important and if it’s not done properly then the workload trickles down to others.”

“I’m glad it’s been addressed but I don’t think the doctor’s habits have improved,” said Chrissy.

“Well, in some cases I know the answer and just bill it,” Denise continued. “But it’s almost as though Dr. Nozam has shared with the other docs that I’ll just take care of it all, because they’re all becoming sloppier.”

Chrissy responded, “It sounds like you’re stuck between a rock and a hard place. She’s such a good doctor, she’s great with patients, she’s super smart, she’s fun to work with and she makes killer dishes at company potlucks, but I just don’t understand why we’re stuck on coding. It seems like such a simple thing!”

“Haha, she does make great appetizers!” Denise remembered why Chrissy had come over. “The lack of coding sure makes my job more difficult and I end up spending way more time on something that would only take the doctor a few seconds.”

“I wonder—if the partners knew how much of your time here was spent doing someone else’s job—if it would become more of a concern that they’d want to fix,” Chrissy questioned.

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Denise sighed, “I could totally get a ballpark of how many hours per month I spend doing this, multiply it by my hourly rate and give them an actual dollar amount that they spend paying me to complete doctor’s coding.
I’m sure they would prefer me to spend my time appealing denials, or anything more revenue generating than this!”

“I dare you!” Chrissy said, laughing. “That probably wouldn’t be the most delicate way to improve things.”

“Give me a few minutes to figure this one out. I’ll let you know when I’ve got everything ironed out and then you can process the glasses order.”

The Big Questions

  • Should the support staff continue to remind management that things need to be improved in the hope that it actually effects change?
  • Is it the biller’s duty — rather than the doctors’ — to assume liability for correct billing so it can be completed?
  • Should the chart be returned to the doctor’s desk until it is done correctly even though the patient order is delayed? What other solution would you propose?
Cheri J.
Madison Heights, MI

When people don’t have to deal with the consequences of their actions — or lack thereof — they have no reason to correct their actions. Complaining typically will not solve an issue. I suggest the paperwork be returned to the doctor for correction, asking permission for the doctor to be called on their cell next time they omit necessary coding information. She is smart, fun, a good doctor who is “great with the patients,” so once she has to deal with the consequences of her actions, she will most likely start remembering how important those details are.

Heather A.
Westminster, CO

They should strike. The staff should set a meeting with the practice owner, and everyone involved in billing and coding, and set rules and boundaries and explain the consequences if one of the rules is not followed properly. The biller’s duty is to make sure the claims are submitted promptly and in a timely manner with whichever codes are in place. It is not their responsibility to make sure the codes are correct before they are billed. It should also be their duty to mark down any extra time spent on unfinished charts as a separate fee from their set salary, as they are only responsible for the chart after it leaves the doctor’s hands. The chart can absolutely go back to the doctor’s desk until they are done. When patients begin complaining that their eyewear is taking too long, you can ask them to start writing reviews for the practice. Once the practice owner starts seeing reviews about delays that could have easily been prevented, that may be one way to stop the pattern.

Alex T.
Bays, NY

Show the doctor the way that other doctors in the practice code their exams. If previous exams were coded correctly, make a copy and show it to the offending doctor pre-exam.”

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Carissa Dunphy, ABOC, has been working in private practice optometry since 2008. She is the founder and editor-in-chief of Optician Now (opticiannow.com) and recently launched opticalgifts.com. Follow Carissa on Instagram, Facebook and Twitter at @opticiannow.

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