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You are a medical assistant in a small rural physician practice, and you have noticed that...

You are a medical assistant in a small rural physician practice, and you have noticed that the physician you work with has, in your opinion, been marking the electronic superbill incorrectly. For example, the physician has spending 10 minutes with the patient yet marks 99205 new PT Level 5. How would you address this with the physician?

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I will address the physician in a polite and nonconfrontational way. First I will aks him Dr " I am afraid that you may be wrongly entering the patient visits as Level 5". I will also remind him that level 5 is used when there are 3 key components: involved in visit 1, A comprehensive history; 2,  comprehensive examination; and3, Medical decision making of high complexity. .I will ask him whether am I right or wrong ? I will move ahead depends on his/her answer. If he/she accepts the error I will ask him to rectify it and a report will be written on the hospital incident book. If my doubt was wrong I will apologize to the physician politely. If he/she continues with this practice I will inform the concerned authorities and my next line manager.

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