Problem
The new coding assistant at the Gordon Medical Group office coded and submitted a claim to Cigna for an initial evaluation and management office visit. However, the patient was established with the practice and was seen only for a follow-up medical check. The employee who submitted the claim is new, but has submitted similar claims on several occasions.
o As the Manager, discuss how you would address this issue. For instance, was it an honest error, additional education or training needed, or an act of fraud and abuse?