Ways to prevent medical billing fraud

Have you ever been a victim of medical billing fraud? Medical billing fraud, especially those related to insurance billing, are much more common in practices than you might think. There are cases of fraud committed as well as those that are committed without even knowing it. In either case, the responsibility for the fraud and its legal consequences lies in practice. How can you prevent this from happening in your practice? Well, here are certain things you can do…

Same Procedure – Same Charge

This is one of the most common mistakes: charging different amounts for the same procedure depending on the insurance allowed. To avoid having to post insurance cancellations to a patient’s account, health centers often charge different patients different amounts for a similar procedure or treatment. Make sure this practice is avoided in your facility. If you wish to offer a patient a discount due to their financial hardship, please have the patient complete a financial hardship form. Remember, all patients must receive the same treatment and be charged the same amount for the same procedure.

Patient Copays

Your heart wants to reduce the amount owed by a patient experiencing financial hardship and you waive patient copays, don’t do it! Your waiver of a patient’s copay amounts to medical billing fraud as it violates your insurance contract. This is also considered an unfair advantage over other practices and an attempt to attract patients to your practice. Have the patient complete the required form to take advantage of a hardship discount.

federal laws

You may not be a lawyer, but it is important to know the laws that apply to your practice and follow them to the letter. For example, under the False Claims Act, it is illegal to submit claims for payment to Medicare or Medicaid that you know, or should know, are false or fraudulent. Any violation of this law could lead to heavy fines, reimbursement of up to three times the amount and also criminal penalties. Another example is the Anti-Bribery Law, according to which financially rewarding another physician for referred patients or receiving gifts or money in exchange for prescribing certain medications is punishable under both civil and criminal statutes. It makes sense to be aware of these and other laws, and to stay away from breaking them.

Accurate medical billing and coding

Entering the wrong code will likely cause your invoice to be rejected. However, depending on the error, it could also be seen as ‘upcoding’ billing for a more expensive procedure or service than the one provided. It may be a genuine mistake, but the onus will ultimately fall on you and you will have to prove that it was a mistake and not an intention. Medical billing fraud. With the implementation of ICD-10, the number of codes has increased, thus creating more chances of such errors. Double check all invoices before you send them and make sure your staff does too.