What billing methods put your practice at risk?

What billing methods put your practice at risk?

There are several illegal medical billing practices that could get you charged for fraud or abuse. Millions and sometimes even billions of dollars each year is lost to fraudulent medical claims. Every one of us pays for it in some way or another. This article is meant to alert you of fraudulent medical billing practices so you can prevent them from happening in your practice.

One common fraudulent medical billing practice is when services and procedures are billed for but were never provided. You may think, “How can a practice get away with this? Wouldn’t the patient know?”

Since absolutely everything a practice charges is written on an explanation of benefits sent from their insurance company, of course they SHOULD know. The sad part is that most people don’t even glance at these explanation of benefits statements before they hit the garbage can. This means, doctors and hospitals could be billing for services not rendered and the patients may not know.

Another fraudulent medical billing method is the misrepresentation of a diagnosis, a service provided, or when a service was provided. For example: If an insurance company does not pay for a routine colonoscopy, but does pay for a diagnostic colonoscopy, a fraudulent medical practice could take advantage of this. They may use medical billing to their advantage and untruthfully state a colonoscopy was done for diarrhea when really it was done for routine care. They get paid by abusing the system.

Providing unnecessary services is another way doctors and hospitals can be fraudulent. This is when a doctor orders a test to be done that isn’t necessary to diagnose or treat a problem. Later, the doctor bills for this with a medical billing company and probably uses a false diagnosis to substantiate it.

These medical billing practices put your practice at risk of fraud. When companies are fraudulent, everyone pays. Creating and maintaining honest medical billing methods allows everyone to benefit.

View all Articles by: Melissa Clark, CCS-P