How to avoid medical billing fraud?

Medical billing has become an important need of the healthcare industry. However, some medical care providers try to commit frauds to get maximum advantage by getting payments for the services they have not provided. These frauds are done willfully as even a small change in medical billing and coding gives a profit of millions of dollars to the provider annually. Not only medical care providers, but medical billers also can also commit such frauds by knowingly reporting the wrong codes and procedures that were not performed.

Remember, Honesty and integrity are the key aspects of a successful medical care organization. A good medical billing system is important for stopping such frauds. Medical billers make some changes in medical billing and coding and then make uniform checklists to get paid for such claims. However, checking these checklists can help in spotting such fraud before it even happens.  For doing so, medical billers and coders can work together to strengthen the process and can double-check the claim for future adjustments.

Before getting to know the ways about preventing the medical grounds, it is important to know the  type of fraud that happens in the medical billing process:

• Up coding: It means assigning a diagnosis or a procedure that costs more than the medically necessary procedure.
• Downloading: It provides information to the patient about a lesser diagnosis and sometimes, it also shows a fake patient improvement. However, it can extend the period of hospital stay or time of recovery that is not provided to the patient.
• Billing twice for the same treatment: It happens when the same treatment is billed two times, or more than once, even if the patient does not get the medical treatment. With such fraud, the healthcare provider can bill the same treatment more than once even if the patient does not receive the treatment.
• Unnecessary therapies: It usually happens when treatment or medical services are provided to patients that are not required.

What are the ways to prevent frauds from happening in medical billing?

Having a better knowledge of healthcare laws and regulations: The false claim restricts the practitioners from finally submitting any claim that is overpriced or charged twice for goods and services. This act also identifies the individuals who are involved in such fraud and does not report their knowledge to the government. In this case, the government has the liability to punish such offenders so that they don’t commit such fraud twice.

Doing the right billing: As the insurers and patients both have a huge trust in healthcare providers thus they need to be punished if they submit false claims. To avoid such type of fraud from happening, medical care providers need to follow the right billing practices to avoid inaccurate charges, false claims for undocumented services.

Keeping an updated and proper documentation: Medical care providers need to maintain accurate records to make sure that future medical procedures provide the best patient results. According to the Centers for Medicare and Medicaid Service, if a healthcare provider does not document the provided such treatment that means treatment is not performed. Thus, a healthcare provider must maintain a record of every delivered healthcare service.

Charging high for the same procedures: It is a common mistake in which different amounts are charged for the same procedure based on the medical insurance. In order to avoid post-insurance write-offs on any patient’s accounts, many a time, the medical care provider team often charges a different amount of the same service to different patients. This fraud should be avoided at every doctor’s facility. If any medical team wants to offer a discount to any patient due to any reason like financial help, they can do so by asking a patient to fill a financial hardships form. Please keep in mind that every patient needs to be charged equally the same amount for the same medical services.

Patient co-payments: Many times while providing healthcare services to some poor patients, many healthcare providers want to decrease the amount due to lack of finances on the patient’s part, however, they should not do it. Doing so may violate the insurance contract, instead of that ask the patient to fill a hardship discount form.

The best way to avoid medical billing fraud is to educate doctors and staff about the new rules and regulations, to make sure that they are not unknowingly putting the wrong claims. The medical billing process is a complicated procedure that can be more complicated if the staff is not aware of the new rules and regulations.