The complexities of medical billing

If you are involved in a medical practice, you probably know billing can be a pain. There are a lot of rules and regulations to follow, and proper oversight is critical.

Even so, mistakes still happen. You could even be under investigation for billing fraud and not know it. To that end, here are some tips to help prevent overbilling and misbilling:

First things first

Before listing the tips, it is important to point out that if you uncover overbilling or have reason to believe fraud might be occurring, get in touch with an attorney before attempting to handle the issue on your own. Trying to manage the situation alone could land you in hot water even though your intentions are noble.

Choose software wisely

The right types of software can automate many billing processes and significantly lower the risk of manual mistakes and overbilling. It is a win-win, as your office becomes more efficient and compliant. Look for software that updates as laws and regulations change.

Conduct regular audits

Aim to have at least one yearly audit in which you put current billing workflow practices under the microscope. Whether the auditor is internal or external, he or she should look for patterns in claim denials and ways to fix these.

Have a zero-tolerance policy

Unlike misbilling, there is little flexibility with overbilling. In fact, it can be difficult to argue that overbilling is anything but intentional. So, if anyone in your office is overbilling, it could be fraud. Treat explanations with caution. Actions such as up-coding and overcharging could put your entire office in jeopardy, and you may want to implement a culture of zero tolerance from the beginning. That is, hire and train new billing personnel thoroughly so they have little wiggle room for claiming ignorance or undertraining, and make it clear that even one instance of overbilling could get someone fired. After all, the alternative is constantly monitoring that person, which can be a huge drain on resources.

As always, remember that overbilling can get a medical office in tremendous legal trouble. It is best to consult a lawyer first before trying to do anything about suspected overbilling in your office.