Top Five Red Flags with Medical Billing to Watch Out For

Top Five Red Flags with Medical Billing to Watch Out For

Five Medical Billing Red Flags

If you have a medical practice of any sort, you need to be aware of five medical coding and red-flag-hibilling red flags that will catch the attention of payers. Red flags can lead to audits, your having to return payments, and even charges of fraud.

Thus, making sure that you and your staff keeps accurate records, your billing department or company is vigilant, and insurers find that your claims contain accurate information are all very important. Towards this end, proper monitoring of the medical coding and billing process is the responsibility of each healthcare provider.

Individual Charges Rather than Bundling

Insurers and administrators of Medicaid and Medicare are always on the lookout for healthcare providers who, instead of properly bundling services, charge individually for such. When visits, procedures, and treatments are bundled they cost less than those that are charged for individually. If payers, who are constantly checking for this practice, perceive that it is happening fairly regularly, they may start investigating for fraud

Habitual Double Billing

Double billing is also fairly common amongst healthcare providers and is a major concern for insurers. Although double billing may be the result of sloppy recordkeeping, it may also be part of a fraud scheme. If you have been cited for double billing, make sure you address the issue and correct any deficiencies in your process that may be causing it to happen.

Billing for Phantom Services or Supplies

Healthcare providers who bill for services or supplies they have not provided are asking for trouble. Patients will often catch this occurrence and will report it to payers. Also, insurers and government agencies are always looking for doctors, hospitals, and others who offer services and tend to provide a high volume of care or supplies. If bills in terms of the amount of personnel involved and the amount of time in a workday do not make sense, you make be the candidate for an audit or an investigation.

Unnecessary Procedures or Treatments

If your medical practice does high volume billing and shows a pattern of adding on specific procedures and treatments on a regular basis, that practice may be a red flag to insurers. When combined with excessive charges this type of ongoing activity can easily trigger an audit. It can lead to determinations that may involve y ou having to repay insurers and agencies, and it may be perceived as being fraudulent activity.

Excessive Charges

As mentioned above, excessive charges can also catch the attention of insurers. This is especially true when they are connected to a practice that does a lot of procedures or treats a large number of patients over a short amount of time. Overcharging can open a doctor up to audits, investigations, and more. If there’s a clear pattern of activity that stretches over months or years, that can result in your being scrutinized for a prolonged period of time.

Work with Your Billing Department

The best way to avoid medical billing red flags is to work with those who are processing your invoices. There should be open communication between your medical practice and those involved in working directly with payers. If your medical coding and billing professionals have questions or raise concerns, answer their queries as quickly and thoroughly as possible. Correct any problems, work towards eliminating red flags, and make sure that the coding and billing information that comes from your practice is accurate and honest.

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