Understand that there's a difference between performing an unnecessary study and billing for one. If your billing department doesn't submit a claim for any service it's not fraudulent per se. If you submit a claim for a bilateral venous study because somebody has knee pain on one side after a fall then the argument could be made that you ran up the bill deliberately and filed a false claim.
So you can protect the institution by doing whatever they ask for in the ED as long as you don't try to get paid for it. Handing out free health care is problematic as well but that's another whole discussion. You need to get the bean counters to sit down with the head of the ER, a lawyer and your head of billing if you want to make sure everybody is on the correct side.

Personally, I think this kind of attitude (the one held by the ER doc's) is what has driven the health care system over the brink of affordability. Why not just put everybody into an MRI while they're in the waiting room? It would save a lot of time.

Good luck with all that.

On Thu, May 27, 2010 at 4:25 PM, Phil White <[log in to unmask]> wrote:
Dear FLO-

Can anyone help me with specific rules regarding the responsibility of a
vascular technologist to make sure inappropriate exams are not billed to
Medicare or other insurers?

Specifically, the ED department has stated and that they will order a Venous
study on everyone who comes to the ED with a leg or toe complaint, so they
do not miss a DVT.  This has been in effect for quite some time and the
increase in venous studies have doubled.  We have all experienced how
frustrating it is to be called in for silly stuff but now it kick up to a
new level.

I feel this is entering into the bizarre world and there is no end to it
except to explain to them this is fraudulent.


Phil White BS RVT

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Steve Knight BSc RVT RDCS
Specialists In Ultrasound, Inc.

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