Medical Billing and Coding- Duplicate Billing Is a Red Flag

Medical Billing and Coding- Duplicate Billing Is a Red Flag

If your medical practice is involved in duplicate billing, for whatever reason, it’s important to understand that you’re sending a red flag to insurers, as well as to regulators and investigators. Often duplicate billing is the result of some sort of malfunction within your medical billing and coding process. Thus, if you are habitually double billing insurers, it’s important that you assess your process in order to find and correct any problems.

Reasons for Duplicate Billing

Duplicate billing can occur for various reasons. The problem may be associated with the manner in which a healthcare practice is keeping, organizing, and communicating information related to the medical services it’s providing. The other problem may be connected to the billing and coding process itself. Finally, there could be a situation where your billing department or the company handling that process is miscommunicating the information to the insurers.

Many times it starts at the source- when a patient is being seen. Often duplicate billing occurs when a doctor and a nurse both record the same treatment, service, or procedure for a patient. This can result in a double bill.

Also, double billing often happens when numerous healthcare providers are seeing a patient at once, such as when they go to the emergency room, are admitted to the hospital, or undergo a procedure that may involve various physicians. In addition, a busy physician who is hard-pressed to keep track of services may inadvertently double bill a patient, forgetting they have already processed the patient’s form and sent it along the billing chain.

Possible Ramifications

In essence if you are duplicate billing for services, treatments, medications, visits, or supplies, medical billing and coding companiesyour medical practice will suffer in various ways. One major result is a loss of trust by insurers as well as patients. The red flags that are generated by duplicate billing can call into question your integrity and raise suspicions.

This can result in patient animosity and complaints. They may formerly complain to the insurance company or regulators, raising concerns and engendering closer scrutiny of your practice and billing procedures. Healthcare providers may even lose patients due to such billing errors.

Investigations, audits, and rejected claims can put a lot of strain on a medical practice. Those pressures include slow cash flow, loss of revenue, and mental anguish. Plus, medical billing and coding workers, nurses, and other staff members will find their time occupied as they become involved in rectifying specific invoices and remedying the overall medical coding and billing problems.

medical billing serviceAddressing the Situation

The best way to take care of a duplicate billing situation is to address it before it ever happens. Thus, setting up a system of checks and balances when it comes to coding and billing is essential. Is there one person or a group that is responsible for carefully monitoring electronic billing information before it is processed? How solid is the communication link between those who render services and those who submit invoices to insurers and payers?

If you do have a problem with duplicate billing, then have a professional audit done as soon as possible. Once the audit is finished and problems have been identified, address them quickly and directly. Doing so may involve upgrading your medical coding and billing process, outsourcing those services, and updating billing software and other tools.

Duplicate billing can harm your medical practice in many ways. If you have a problem with double billing take care of it as soon as possible to ensure that your practice can function properly and remain productive and fiscally healthy.

MPMR offers top medical billing and coding experts who work nationwide with all types of specialties and ambulatory facilities. Services routinely increase revenue substantially and include operations management as well!

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