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Question 1) As an inpatient coder, you have been instructed by your coding supervisor to code all debridements as excisional

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Question 1) As an inpatient coder, you have been instructed by your coding supervisor to code all debridements as excisional. You are not comfortable with this practice and tried to discuss it with her, but she stated that you are to follow her instructions and not issue queries. You went to the HIM director, who only half-listened to your concerns, saying that the coding supervisor must have a good reason for the instruction. The other coders are following her instructions without question. You are reluctant to get into trouble for not following the instructions and equally worried that the coding supervisor will retaliate against you in some manner if you report this practice. Please number your answers.  (Competency V.3,  level 5)

1. Assess and provide a minimum of three options you have in this situation.
2. Appraise the impact of the False Claim Act as it relates to this situation.

 

Question 2: You are the new practice manager for Cypress Pediatric Care, a pediatric primary care group owned by Dr. Brad Pitt, that serves a large Medicaid population. As you review policies, you find that all referrals for speech-language pathology services are made to Children’s Speech and Languages Services of Valley View (CSLSVV), which is one of the three area businesses that supply those services to children. As it happens, your son has had services provided by CSLSVV, and you know that the business is owned by Dr. Brad Pitt’s sister, Dr. Sherry Watt. Please number your answers. (Competency V.3, level 4)

1. What could this discovery mean for Dr. Brad Pitt? Apply the appropriate federal statute.
2. Upon further investigation, you find that a monthly deposit is being made from CSLSVV into the pediatric group’s account. What could be inferred from this transaction and the federal statute would apply?
3. Could the term “safe harbor” have any relevance in this scenario? Justify your answer.