Your office is being audited by the government for claims submitted to Medicare for the last year. The setup of the office is the following: there is a head biller named Mary, a front desk person named Jane, a scribe named Miley, and a doctor named Dr Bob. Mary oversees claims and spot checks claims but Jane takes the superbill or fee sheet and actually enters the claims into the computer where they are submitted to Medicare. Dr Bob exams the patients with Jane who records the exam findings. Jane also circles diagnoses on the super bill and selects CPT codes after the exam is finished. Patient X was examined 6 months ago. The level of billing for that exam is being questioned by Medicare. The patient was in for a blepharitis follow up without dilation. Blepharitis was circled on the super bill and Miley also circled a 92014 (comprehensive eye code). Jane brought the super bill to the front desk and Jane entered the information into the computer. Before it was submitted with a batch of other claims, Mary also looked at it and approved it for submission. Who is the most responsible for this inaccurately submitted claim?
No matter how many people Dr Bob employs to ensure the accuracy of claims' submission, it is he who is responsible for the accuracy of the claim. It is this writer's opinion that the physician should always select diagnoses and CPT codes submitted to Medicare. Only the physician has his or her best interests most in mind when ensuring the accuracy of the claim.