A medical service provider would then file a claim and receive higher reimbursement for these unnecessary services or procedures. Keep doors closed to help save information from being overheard. In the meantime, please feel free to drop us a note at, State Professional Counselor Licensure Boards, State School Counselor Certification/Licensure Agencies, Mental Health, Professional Counseling and Emergency Preparedness, Medicare Mental Health Workforce Coalition, how to enable JavaScript in your web browser, Other Important Information Related to Ethics, Social Media: 10 Tips for Professional Counselors, ACA Statement on Publicly Diagnosing the Mental State of an Individual, OTHER IMPORTANT INFORMATION RELATED TO ETHICAL & PROFESSIONAL STANDARDS, ACA STATEMENT ON PUBLICLY DIAGNOSING THE MENTAL STATE OF AN INDIVIDUAL, 6101 Stevenson Ave, Suite 600. Professionalism is crucial when interacting with patients, insurance companies, coworkers, and anyone else you may come in contact with. Please send an email request to consult@counseling.org to schedule a consultation. As discussed above, a therapist is required to maintain client confidentiality. If you found this page useful, please click "Like"! Yet, sometimes duplicate charges are intentionally made. Any concerns related to your specific treatment options should be discussed with your primary physician or other licensed medical professional. The term double-billing says it all. If you are a healthcare service provider, double billing might seem easy to fix because it would only impact your revenue. 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. In fact, over 411,000 seniors faced double billing for their medicare premiums in September 2019. As an official document, revisions to the Code are considered on a 5-year review cycle with public comment from members and key stakeholders considered as part of the review . In his case it was A.5.a. Under coding occurs when the codes used in a medical bill dont entirely capture all the medical services or procedures performed. Welcome to the Michigan Board of Counseling website! If you feel your therapist is behaving unethically, the first thing to consider is bringing it up in session. Please login or register first to view this content. For example, a doctor provided a brief and simple medical service. The definition of double billing is pretty straight forward. This is not a topic that is well taught in our PA programs. Use common sense and aim to treat others with grace and dignity. How the Process Works. Brandon is a certified Legal Malpractice Specialist and his practice focuses on the handling of legal malpractice claims and fee disputes. They both have different codes. Double billing is not uncommon in the medical field. A healthcare provider submits a request for a wheelchair but it is not needed by the patient and was also never received by him. Your best friend was treated yesterday in your place of work. This means that the treatments were only administered based on profit. Preference for any patient or insurance company should not get in the way of your decision-making. 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. . Hopefully, we managed to impart a few useful tips on how to avoid and detect unethical medical billing practices. In a sense, unbundling can also be called fragmentation because rather than billing the patient with one code, they would fragment it into multiple codes, which then leads to higher reimbursements or payments. This means it is always the counselor's responsibility to prevent these relationships. In most cases, physicians who believe a colleague is incompetent or unethical have an obligation to report clinical authorities. A physicians first step should be to protect patients health and safety. A consumer complaint can be filed with the Indiana Professional Licensing Agency or directly to its ultimate home, the Indiana Attorney General. "It is considered unethical for a doctor of . Ethical Counselors vs. the Unethical Counselors, WA. However, the bill of the patients tells a different story. Practices like these often goes unnoticed because patients are not familiar with these codes and it can vary even down to the minor details. (,VJ2'Cy7 \eQC:^ A~_06wB!~%3Qu4ZK"K-2Zrd^>n8y&Upl5rpJJ,@Vt/(,$r&b~Q For our regular blog readers, there are a few good online resources on dealing with situations involving medical billing errors. It is very worthy to note that the healthcare providers do not only commit this type of heinous fraud but at times partner up with the patients to conduct such malpractice. 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? 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. In episode 106 of the Counselling Tutor Podcast, Ken Kelly and Rory Lees-Oakes discuss the use of assessment tools in counselling.In 'Practice Matters', Rory then looks at the various forms of unethical behaviour in counselling.Finally, the presenters talk about the different levels of counselling training, and how to choose which level is right for you. The supervisor believes it is their ethical responsibility to report the breach to your employer. This could also be a form of fraudulent billing and phantom charges since the medications were not necessary. Look at all of the details of the statements you receive from a doctor's office. Violations can result in write ups and loss of employment. Inactive status will require a renewal fee of $100 and 10 hours of CEU's. All inactive licenses must be renewed every two years. In turn, it would just create more problems and even burden the healthcare system in the long-run. In their case study, the authors cite the AOA Code of Ethics doctors of optometry should "conduct themselves as exemplary citizens and professionals with honesty, integrity, fairness, kindness and compassion"as well as the Standards of Professional Conduct. Implementing time tracking software that encourages accurate time billing and . As we previously mentioned in our Anti-Kickback Statute article, referrals and kickbacks are generally illegal when it comes to healthcare programs. This vicious cycle brings higher revenue and premiums into the picture which makes the situation worse. They report and you are fired. (2014). This material may not be published, broadcast, rewritten or redistributed in any form without prior authorization. Naturally, intentional fraud has the most serious consequences. Finally, if your therapist is not helping you or is instead actually re-traumatizing you, you've spotted an unethical therapist. This, in turn, would result in more scrutiny and eventually damage the trust between the insurance company and the healthcare provider. How would you feel if a "little birdie" just told an acquaintance of yours that you are a recovering drug addict? 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. Patients must be reassured that their best interests are kept in mind when a medical biller works on their submitted claim. Unethical Billing Since all these events were unnecessary, they could be legally considered phantom charges. xc```b``b`f`db@ !0X \(r 4MCH-{t&@gR `d```!is zvj00 ]dr For instance, a doctor supposedly provided a medical service that is simple and brief. Under coding is an unethical billing method that often goes unnoticed. This is often interpreted by authorities as attempting to avoid audits. As a rule of thumb, whenever you ask yourself "Is this perfectly ethical?" it probably isn't. APA Code: Two codes of ethics guide counselors for the practice of ethical counseling- General Code of Ethics, " Ethical Principles of Psychologists", can also be applied Changing information in a contract or . Instead of coding it as it is, they coded it as an extensive and specialized medical service. To file a complaint against a counselor who is an active ACA member, please review the Policies and Procedures for Processing Complaints of Ethical Violations. This would definitely result in more revenue and more payment. If, they're unwilling to correct it, then report them to your insurance company. This number was partly due to a glitch in Medicares system. Another aspect of under coding is that this practice does not give any kind of benefit to the coding professionals or the medical practitioner. Some patients are often billed for services that are not exactly consistent with what they receive. Inquiries are prioritized, and the ACA standard practice is to respond within three business days of receipt. :7"XjATAtQeu>(:Yi9H:[GZV?HOF=:oE98 :D1A"=7Bl%@N+E/Jz->Qj=Pt=z^derEu{,]+jO782QoyyA^9 Q"[v9+Y4;?Wb'R'6DCacsy@ "In fact, practicing with distance therapies actually raises the bar, because you . Take, for example, evaluation of speech fluency and speech evaluation complex. Be sure to check that all codes are accounted for, no additional codes are added, and all the fine details of billing are complete when submitting claims. The counselor is in a position of power over the client by virtue of the position. This means that the treatments were only for profit. To view previous risk management columns by Anne Marie "Nancy" Wheeler, J.D., as well as other resources, visit the ACA Risk Managementpage. Never belittle patients and show them respect, even when they make it hard. Copyright 2023 Haymarket Media, Inc. All Rights Reserved Give us a call today, and lets start a partnership that lasts a lifetime. *The information and topics discussed within this blog is intended to promote involvement in care. As a biller you are entrusted with medical information, collecting money, reliability, customer relations, etc. In this case, your best friend is now just another patient. This in turn has led to abuse, leading several healthcare professionals to recommend other medical procedures or services even when they are not needed. The health provider will be considered a partner in this scheme even if he hired someone or outsourced the medical billing of his organization. In most cases, physicians who believe a colleague is incompetent or unethical have an obligation to report clinical authorities. Normally, the maxim that "good work isn't cheap, and cheap work isn't good" rings true. Here lies the conflict of interest. In general, all of the standards of the APA ethics code apply, says Barnett. This unethical billing scheme is often due to oversight. The claims made by the service and aid providers are generally incoherent and inconsistent. Here is a list of unethical behaviors that often occur in mental health facilities: Neglecting to meet with clients during a set time. For example, a patient received treatment for Chlamydia a few years back and requests for this information to be concealed whenever possible. They may also report an incident (s) to the state licensing board or state medical society if there's an immediate threat to patients. So are 25% of medical tests and 11% of procedures. For example, evaluation of speech fluency and speech evaluation complex evaluation of speech fluency and speech evaluation complex may seem the same to a casual observer. It can also happen when a provider submits a claim for unnecessary services. Patients might be hesitant to receive any medical services from the same healthcare provider because they were double-billed before. If you violate them, legal action can take place in the form of sanctions and fines. A small slip of the tongue can get you into trouble, and cause serious problems for the patients. Instead of using one code to describe services provided, providers used several different codes to describe different parts of the service. 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. Billers are part of a team - everything you do directly reflects on that team. The protection of the public health, safety, and welfare and the best interest of the public shall be the primary guide in determining the appropriate professional conduct of all persons whose activities are regulated by the board. .i)2R, /N[\R%&x1^gmi 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. To avoid such circumstances and to educate the patients and the medical professionals, we have come up with some very common and general unethical medical billing practices that you should identify immediately after reading this article so that you can avoid such a situation and not end up in paying lengthy litigations and heavy fees. Keep any conversations regarding patient information as hushed as possible. This type of fraud occurs when the provider bills for equipment the patient never received. ACA has no affiliation with Martindale and does not endorse the attorneys listed on the companys website. If you find out that your healthcare provider has double-billed, you then you can politely ask them to rectify it if it occurs for the first time as it will impact your cash flow but if it is a practice of the medical practitioner to double charge it clients then he needs to be reported. And lets start a partnership that lasts a lifetime someone or outsourced the medical or! Action can take place in the way of your decision-making 2023 Haymarket Media, Inc. all Reserved. Capture all the medical field start a partnership that lasts a lifetime please send an email request to consult counseling.org! The patients tells a different story of using one code to describe different parts the. Quot ; it is, they & # x27 ; s responsibility to report authorities. Seem easy to fix because it would just create more problems and even burden the healthcare submits... 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