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“and see that there is no deception there. There is compassion and a stubborn de- sire to fight cancer.” He said Dr. Jabboury never altered any patient medical records nor with- held any records when the insurers re- quested them. “Dr. Jabboury … is a man totally fo- cused and preoccupied with curing can- cer. He is not a man preoccupied with cash,” Mr. Androphy said during the trial. Trial testimony revealed that Aetna’s Medical Policy and Operations senior medical director originally determined Herceptin should be billed as a single- dose vial, which ultimately turned out to be incorrect.


Lt. Don McWhorter, an investigator in TDI’s Fraud Unit, testified that he reviewed 17 of Dr. Jabboury’s patient records during the inquiry into his bill- ing of Herceptin but never examined the physician’s prompt pay complaints against Aetna. Prosecutor Martina Longoria painted


Dr. Jabboury as “money-hungry” and motivated to defraud the health insur- ance system. “For us to say that doctors are above the law, that because of his position in society, his status in society, we’re not going to convict him of this offense would send the wrong message. It’s shameful, it’s unfortunate, but the per- son who brought us here today is Dr. Jabboury’s conscious decisions …. You have afforded him the presumption of innocence, but now you know different,” Ms. Longoria said in her closing state- ment to the jury. It took the jury less than one hour to


return a not guilty verdict. Dr. Jabboury says he hopes his story will inspire Texas physicians to work to change the systems of investigation and prosecution for the benefit of physicians and patients. “To me, it’s very clear that the system is not adequate or fair. TDI ignored my complaint and took the other side. Physi- cians and patient access to care are vul- nerable under the current system. My hope is that the system can be reformed,” he said.


In July, TMA officials met with Cpt. Jeff Kirk, chief investigator for TDI’s


September 2012 TEXAS MEDICINE 55


TMA ADVANTAGE TMA’s coding resources


TMA Practice Consulting offers evaluation and management (E&M) coding and documentation help that includes a review of claims, coding, and medical record documentation to deter- mine whether the practice is following the coding guidelines for appropriate billing. An abbreviated checkup and a full review are available. TMA Practice Consulting reviews a practice’s documentation


for:


• Accurate CPT coding, appropriate application of CPT cod- ing guidelines, E&M coding guidelines, and the correct use of modifiers;


• Accurate ICD-9 coding, appropriate application of ICD-9 coding guidelines, and documentation of medical necessity; and


• Encounter forms, claims, and corresponding explanations of benefits to ensure accurate billing and reimbursement levels.


TMA also offers an E&M coding and documentation training


program for practices that need help understanding documen- tation guidelines or identifying inappropriate or inaccurate coding and weaknesses in medical record documentation. The two-hour session covers a review of 1995 and 1997 E&M docu- mentation guidelines, time-based coding, modifiers, audit trig- gers, prolonged services, preventive medicine, and E&M utiliza- tion patterns, among other topics. Services are available for a fee based on a practice’s needs. For more information, call TMA Practice Consulting at (800)


523-8776, email practice.consulting@texmed.org, or log on to www.texmed.org/PracticeHelp to access all of TMA’s billing and coding resources, plus other tools to make your practice run more smoothly.


TMA also published TMA Practice E-Tips Greatest Hits, Vol. 3:


Coding. Available for free online at www.texmed.org/template .aspx?id=1492, the publication has helpful information and resources.


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