30 May Medical Billing and Coding Services Protect You from Insurance Company Lawsuits
If you’re a doctor who has decided to outsource their medical insurance billing and coding to a professional management company, it’s important that you and that company have an open communication process. Doing so can save you from numerous, very serious headaches later on.
A responsible and reputable medical billing and coding company will bring errant, incomplete, and questionable billing information and practices to your attention. In doing so, they may save you from insurance company audits and lawsuits.
If your medical billing and coding company sees a problem with charges, such as exorbitant fees, they may need to consult with you on such. This is especially true if your fee structure suddenly rises. As an example, in 2011, Aetna, Inc. sued numerous physicians in New Jersey whose fees became, according to their estimation, excessive.
According to the insurance company, one cardiologist increased his fee from $1,400 for the first hour to $16, 380. If this occurs with your practice, such a situation should involve some sort of discussion for the sake of clarity with your medical claim processing company.
Phantom Bills and Charges
If a doctor submits bills for the same procedure performed on numerous patients over a short amount of time, for medical devices or prescriptions that are excessive, or for services that are unwarranted, your billing and coding company may want to discuss such before they submit these claims to insurance providers. They will do so if they feel that such bills may raise red flags, and they believe they will need clarification in addressing possible questions.
It’s important for healthcare professionals to understand that medical billing and coding companies have a legal responsibility to ensure that medical insurance claims are accurate, properly processed, and in accordance with the law. If they suspect fraud or recognize inconsistencies, they could be partly culpable if they do not report such. Bringing such issues to the forefront prior to submitting medical insurance claims protects you and them.
Does It Look Right To You?
One thing that medical doctors can do is to ask a very simple question concerning their bills- does it look right to you? Would you pay the invoice as submitted? Does it raise questions? If you believe a medical claim needs more explanation, submitting additonal supporting material will help, as will contacting your medical billing and coding company and discussing the situation with them before it becomes an issue. Open communication will go a long way to keeping you and your practice free from insurance company and government audits and lawsuits.
Offering a High Standard of Service
It is important that in choosing a medical billing and coding company that you elect to work with one that has high standards of service. By that we mean that the company is committed to properly processing all of your medical claims in an efficient and thorough manner, and they are also invested in making sure that all rules, regulations, and laws are properly followed.
This type of commitment will help to greatly reduce the likelihood of an insurance company lawsuit. If you would like to discuss how Medical Practice Management Resources, Inc., can help your medical practice be compliant in all aspects of medical insurance billing, please contact us today. We are committed to the highest of standards.