medical billing solutions

Avoid Healthcare Fraud By Improving The Medical Billing Solutions Process

Recently, Apollo Healthcare has published its findings regarding how physicians are dealing with the unique challenges that come with this COVID-19-related pandemic. The report also pointed out staffing shortages as the primary problem in managing practices. Medical billing is a process that involves sharing patient information and other medical data that is confidential Most providers aren’t sure about sharing their information with billing firms. Medcare Medical Billing Services (MSO) is a top HIPAA compliance business. 

Medical Billing Solutions

Medical Billing Solutions
Avoid Healthcare Fraud By Improving The Medical Billing Solutions Process

Make sure you have a strong conformity

Establishing solid healthcare billing solutions is essential in preventing healthcare fraud and abuse therefore compliance programs can be useful to detect and stop healthcare fraud.

The compliance program includes:

Training and education for the employees. A defined process for receiving the reports and complaints about healthcare fraud and the creation of procedures to guard the confidentiality of whistleblowers and protect them from retaliation. For instance, understanding the different medical terms as well as the cost associated with it. 

However, there is another factor that involves improvement in the providers’ health billing, coding, and billing methods. Apart from above mentioned other mistakes include, the note is not signed; the billing provider’s and service provider’s names don’t match; the note doesn’t support the CPT codes reported for it; CPT codes are inconsistent with the place of service; the patient has reached the benefit maximum for the time period; claims are duplicated; procedure/modification combinations are incompatible; referral(s) are not listed on the claim. As a business owner, you’re not able to find the time to perfect the management of your revenue cycle.

Reduce the risk of healthcare fraud by increasing the efficiency of the medical billing process

Intentional fraud could cause civil lawsuits and criminal charges. Practices should verify eligibility and benefits each time a patient visits. Verifying eligibility and benefits helps in determining the coverage of insurance for the procedure you are planning to perform.

Insufficient coordination of patient benefits COB, also known as coordination of benefits, is the procedure of determining a health insurer’s eligibility as main or second payer in order to offer medical claim benefits to patients with several health insurance plans. The majority of practices do not request additional insurance details. 

The majority of medical frauds can be classified into these types:

  • Billing that is excessive
  • Physician groups are aware of the amount of time needed to determine and treat patients suffering from specific ailments, therefore they are able to spot overcharges.
  • This allows doctors to pinpoint a practice that could treat a potential number of patients during the course of a single day.

Improper Medical Documentation

The reason to avoid Improper Medical Records is that various types of claims can be filed without medical documentation, which allows healthcare providers to boost their reimbursement by manipulating claims and not trigger an audit. But altering medical records in order to increase profits and not including vital information in claims to cover mistakes that occur during a patient’s treatment are both illegal and therefore doctors must beware of both.

Provide a wide range of services to patients

  • The most frequent type of medical fraud involves charging the insurer for services that are more than the patient requires.
  • It’s often difficult to spot the deliberate billing of excessive services because of inadequate billing procedures.
  • To stop this type of fraudulent practice, hospitals need to have procedures in place to effectively record the cost of each procedure, though it’s not always the case.

To know more about our Medcare MSO billing services, contact us at +1 800-640-6409.

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