Question

A solo-practice provider has been practicing in a specific area for 19 years. At 20 years, the staff, several of whom have been with the doctor since the start, can collect retirement through a contracted vendor. However, due to a diminishing of insurance reimbursement, the doctor cannot keep the doors open any longer. The provider realizes that both her and her employees are unlikely to find employment that will provide for any means of financial security in their aging years. Attempts at marketing and attracting additional clients have been unsuccessful as a result of managed care contracts and preferred provider arrangements that have gone to hospital-based physicians. There are no other options, save one. The provider knows that if she upcodes the visits and charges more, she can keep her doors open and retire in a short 12 months.

In your main discussion post, discuss the current dilemma from the perspective of the provider and from the perspective of the staff. Are there any gray areas to this dilemma? If so, can you understand why a provider would be tempted to upcode? in 150 word include reference in APA form

Answer 1

The dilemma of the provider here is how to manage the financial loss, how can the staffs be benefited who are employed for many years. The difficulty and the legal consequences of upcoming. Cancelation of license when found fir the fraudulent act.This can affect the patient's financial status as well and raise legal complaints when they understand they are upcoded for a service.

From the perspective of staff they feel the most financial insecurity after the loss of a job's benefits. This can impact the emotions of the provider as well as the staffs.

The grey areas to the dilemma is the long term staffs who has to be benefited cannot be left hopeless by the provider when other possibilities is not there.

A provider would be tempted to up code

• If needed money in excess out of greed or due to circumstances
• Due to wrong coding
• Due to double coding
• When there is few codes to code the different services
• In case of any novice stffs or provider
• Who have inadequate knowledge