Mid Ohio Medical Processing

A toxic workplace will drain you!

Recognize the signs, if you share the rules with reason, and their response is silence, it is out of fear, or they just don't have a moral compass. Move on, there are plenty of offices who pride themselves in following the rules and guidelines and choose to update their guidelines with all their known contracts, often at every quarter. Honesty is the Best Policy!

"When people with integrity cross an invisible line."
It amazes me that even when many practice owners, who claim they do Not agree with their administrator, yet they still allow the administrator to perform inappropriate ongoing billing with their encounters and statements to all their patients who have Standard Medicare or Medicare Replacement plans even when the CMS guidelines and rules are given to the administrator and even after the rules are given to the providers they quietly still believe their administrator has done nothing wrong, and some will say, "they have billed and coded the visits the same way for many years" and in their minds they believe it to be true because nothing has ever happened to their practice.
"Workplace scapegoating rarely begins with poor performance. More often, it starts when someone unknowingly crosses an unspoken boundary a line that was never communicated but is quietly enforced.
People who value integrity usually assume those qualities will be appreciated. Being principled, conscientious, and committed to good work should make a workplace stronger. Most professionals walk into organizations believing effort, accountability, and honesty will improve the system around them and in healthy environments, that assumption is largely true.
But in some workplaces, those same qualities become uncomfortable for the system. When you ask questions others avoid, bring care into processes that run on autopilot, or notice patterns that were meant to stay hidden, something subtle begins to shift.
Often you’re not trying to challenge anyone directly. Sometimes it’s as simple as asking a clarifying question, documenting a concern, or maintaining a professional standard that others quietly stopped following long ago. Yet the moment you disrupt that fragile balance, the environment can change. You may find yourself excluded from conversations, subtly undermined, or labelled as “difficult.” Not because you caused conflict, but because you unsettled an arrangement that depended on silence.
Many workplace systems maintain stability through informal rules. People learn what not to question. Behaviour that isn’t quite right is quietly tolerated. Everyone adjusts just enough to keep things running smoothly. When someone breaks that pattern, the fastest way to restore equilibrium is to redefine that person as the problem.
Scapegoating becomes the system’s defence mechanism. It protects the status quo by redirecting attention away from the real issue. That’s how integrity gets mistaken for disruption. Passion becomes labelled as instability. And a strong moral compass suddenly makes someone hard to manage. If this experience feels familiar, you’re not imagining it. You simply crossed a line that no one told you existed and the system responded by quietly enforcing it.

Most practices just add 12 diagnoses and never link each reason to each service billed on same day, the visit by entering past problem in 1st position will deny for lack of medical necessity when there is a relevant diagnoses and the Primary reason for the visit, but if you do not link icd. 10 codes to correct service , it would be the wrong order that caused your denial for lack of medical necessity when there, it could be tge biller or coder .

Clean claims should be every office’s priority!

https://www.justice.gov/opa/pr/aetna-agrees-pay-1177-million-resolve-false-claims-act-allegations

Aetna Agrees to Pay $117.7 Million to Resolve False Claims Act Allegations Aetna Inc., a national insurer incorporated under the laws of Pennsylvania, has agreed to pay $117,700,000 to resolve allegations that it violated the False Claims Act by submitting or failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees in order to...

It is surprising after the big changes AMA mandated with clear detaled guidelines that began on October, 2021, we as coders still see how Physicians are choosing time for their E/M choices, this is causing upcoding and downcoding which is not accurate and causing problems for those who are following the rules. Try to forward these tips to help improve our communities to improve healthcare !

Administrators/ managers sometimes make the mistake having two coders work at the same time, if their software isn’t a multi user system, you will find out how many more errors not just the forced speed will cause many useless errors, but the dual errrors of both coders will cause omitting items or mixing items on your claims! Sometimes it takes time to reason with them, but once they see no claims are going into hold buckets, they may listen! Never give up! You will win in the end! Always do what is right, many coders will try to sway without realizing the coding rules or description for a common CPT code had changed but one must follow rules and guidelines. It may be tough because just asking a question may be thought to be insubordination and you probably should look for another coding position, but know you’re heart will tell you that you are going to find a better fit, and never let anyone force you to sway from following guidelines , remember your word is your bond! Ethics, morality, integrity, credibility, honesty and adherence to the requisites of your profession should always remain paramount!

I recommend both to ensure surgery will be covered for medical necessity prior to surgery date!

My chuckle of the day! 😎