Residency Education, Billing Practices, and Compliance Issues

To the Editor .— Two articles in the October 2001 issue of Pediatrics have raised some important concerns regarding resident education today. Ng and Lawless1 provide statistics that coincide with my anecdotal experience with both pediatric and otolaryngology residents from 2 major university medical centers. That is, these young physicians receive little or no instruction in billing and compliance issues. In his commentary, Young2 correctly points out that there is more at stake than simply lost revenue when evaluation and management (E/M) coding does not correspond with a physician’s documentation in the patient’s medical record. Under the current federal law, a physician is fully responsible for each bill submitted to any payor—be it an insurance company or a state or federal agency. Under the False Claims Act, any discrepancies, upcoding, or undercoding are subject to monetary penalties that could total >$10 000 per incident. Unfortunately, lack of knowledge of proper coding is not considered an adequate defense by the federal government. Young further states that …