Medical Billing Techniques That Will Get Your Practice Audited

Millions of dollars each year are lost through outright fraudulent medical billing claims. Unscrupulous individuals deliberately file some of these medical billing claims, others are the result of an inexperienced coder in an office just getting it wrong. Either way, it can cost your practice big time in the form of time spent gathering information to answer an audit and in the form of some very stiff fines if there are improprieties found in your medical billing practices.

The most common fraudulent medical billing practice is when services that were never rendered to a patient are billed. Since all charges are listed on an explanation of benefits form that is provided by the insurance company, most people should catch this, however – studies show most individuals do not look at their EOB’s beyond a glance.

Another form of fraudulent medical billing method is the misrepresentation of a diagnosis and/or the service or services that were provided or the time and date a particular service was provided. For example: If an insurance company does not pay for a routine procedure or preventative procedure but it will reimburse the practice for a diagnostic procedure on a patient, a fraudulent medical practice could take full advantage of this situation. Along with misrepresentation of services is the situation where unnecessary services are rendered to a patient under the pretense of diagnosing or treating a problem.

Many medical billing practices labeled fraudulent are innocent mistakes by people doing coding who honestly don’t know any better or are attempting to make a claim “fit”. To ensure there are no mistakes in your medical billing or coding, consider outsourcing your medical billing to a third party partner that will keep your claims above reproach and ensure you get the highest and quickest reimbursement on all your medical billing claims.

View all Articles by: Melissa Clark, CCS-P