Avoid Medicare Investigations On Medical Billing

Avoid Medicare Investigations Over Your Medical Billing

Sending in medical billing claims to any government organization can be nerve racking, especially when submitting to Medicare. Medicare will do an audit on your claims if you show suspicious charges or activity that does not match your FACP. There is one main thing you can do to prevent this medical billing audit: provide adequate records.

The Centers for Medicare & Medicaid Services is very hesitant to pay more administrative costs then you claim on your FACP. This is one organization in which you will probably not make any profit. It is important that your FACP report closely matches the Medicare charges you submit. If this does not occur, Medicare will more then likely perform an audit on your services.

Terminating your Medicare participation will not protect you from these audits. For example: Blue Cross & Blue Shield of Rhode Island recently terminated their Medicare participation, however, for the years 2000 and 2004, their FACP did not match their medical billing charges to Medicare. Unfortunately, even though their agreement is terminated, they are getting audited.

To avoid this medical billing hassle, it is important to keep extensive financial records. You should keep all activity reports and accounting records. That way, if your Medicare expenses do exceed your FACP, you have the documentation and records to back up your claim. Unfortunately Blue Cross & Blue Shield of Rhode Island did not keep these records.

Since medical billing is so sensitive, you should only designate this responsibility to individuals and organizations you can trust. Accurate medical billing can improve a practice, but poor medical billing can run a practice into the ground. To avoid auditing and investigation by the Centers for Medicare & Medicaid Services it is important to keep detailed financial records and activity reports.

View all Articles by: Melissa Clark, CCS-P