Quote:
Originally Posted by OrangeBlossomBaby
Hmmm indeed! So - maybe - just maybe - you should accept that I said this was all hypothetical, an example of what kind of error might be made, and not focus on the dollar amount because the dollar amount clearly doesn't apply in the situation.
Consider the POINT:
A set of codes can apply to similar procedures. A billing error isn't a dollar amount. It's a coded diagnoses, which has a base cost attached to it.
WHATEVER THAT COST MIGHT BE....
Someone put in the wrong code, which came with a higher base cost than the correct code.
The result was an overpayment with no red flags, because the procedure attached to the code was correct, therefore not causing any red flags to go up.
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In order to bill $90,000,000 over CONSISTENTLY over years, and never under, makes it unlikely to be an error, more like accepted practice. At least it would be in most circumstances.