You recently started working at a primary care clinic, and the office manager agreed to provide on-the-job training in coding and billing. You’re excited for this opportunity to expand your skill set, as you have some education, but limited experience in coding and billing. During your training, the manager explains how many visits are nearly identical when it comes to coding. She explained how Medicare reimbursement rates are low, making it difficult for the practice to profit off Medicare patients. Therefore, the physician will often tack on additional codes for a standard encounter. His preference is smoking cessation (99406) or advanced care planning (99497) to “pad” the claim.
Explain how you will proceed, by answering the following:
What is your response to the manager?
Who is at fault here, and why?
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