So do all health care providers commit some version of billing fraud? Just had an appeal denied because “their notes matched the billing code” but their notes are very clearly a lie. Not sure what to do next.

I went in for a new patient appointment July 2021 and was seen by the NP for 5-10 minutes max. Asked a few questions, took vitals, that was it.

I received a bill for ~$140 with CPT code 99203. After looking it up, it states that it is for a new patient appointment with 30-44 minutes of face time with the provider. There is another code that I should have been billed, 99202 for less time with the provider.

I called the provider’s office, and was told “I’m sorry you felt like it was only 5 minutes, her notes say she saw you for 45 minutes”. 45 minutes?! Are you serious? Then I found out they did the same thing with my husband’s new patient appointment bill – it’s not a one time thing.

I submitted an appeal through my insurance company and after 2 months, received a call saying that they did everything they could but the health records show that I spent 45 minutes with the NP. The insurance lady who looked into my appeal even told me “I know they’re lying, but I can’t do anything about it.” I also submitted a fraudulent billing claim but “their notes match their billing codes” so “no fraud was found”. Even though their notes are lies.

How are you supposed to fight this, when it’s their word against mine? The only thing I can think of is to ask the NP herself, but if she admits fault on one record, I’m sure it opens it up to questions about all the other things she bills.

I am less concerned about the money than I am about the principle. I can’t believe that this system is so messed up

submitted by /u/captainottothecorgi
[link] [comments]I went in for a new patient appointment July 2021 and was seen by the NP for 5-10 minutes max. Asked a few questions, took vitals, that was it. I received a bill for ~$140 with CPT code 99203. After looking it up, it states that it is for a new patient appointment with 30-44 minutes of face time with the provider. There is another code that I should have been billed, 99202 for less time with the provider. I called the provider’s office, and was told “I’m sorry you felt like it was only 5 minutes, her notes say she saw you for 45 minutes”. 45 minutes?! Are you serious? Then I found out they did the same thing with my husband’s new patient appointment bill – it’s not a one time thing. I submitted an appeal through my insurance company and after 2 months, received a call saying that they did everything they could but the health records show that I spent 45 minutes with the NP. The insurance lady who looked into my appeal even told me “I know they’re lying, but I can’t do anything about it.” I also submitted a fraudulent billing claim but “their notes match their billing codes” so “no fraud was found”. Even though their notes are lies. How are you supposed to fight this, when it’s their word against mine? The only thing I can think of is to ask the NP herself, but if she admits fault on one record, I’m sure it opens it up to questions about all the other things she bills. I am less concerned about the money than I am about the principle. I can’t believe that this system is so messed up submitted by /u/captainottothecorgi [link] [comments]Read Morer/HealthInsurance

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