How To Avoid Fraud In Your Medical Billing

Understand The Law

You must adhere to the law and not submit inferior and overpriced services and goods. The False Claims Act states that if you know that a false claim is being submitted but do not report it, then you are equally guilty of fraud. Your fines can be up to three times the disbursement plus an additional $11,000 for each false claim.

The FCA gives whistleblowers enhanced protection and even offers you part of the money recovered to encourage whistleblowing.

Be Transparent About Conflicts Of Interests

You’ll find that most fraudulent activity usually begins with legal but conflicting interests. You must report these conflicts of interest immediately. The state agencies, the National Institutes of Health and other universities, and the FDA have created rules for you to follow about how to disclose conflicts of interest.

You must consider how accepting gifts from partners from the medical industry will affect your practice. You must disclose gifts to the appropriate authorities or boards to maintain legal compliance. You should seek advice and consider the impact of those relationships when they become public knowledge.

Keep Billing Accurate

Congress mandates severe penalties for false claims because both patients and insurers have great trust in you as a healthcare provider. You’ll find that the government has broad power for investigating and auditing cases of suspected fraud. You must ensure accurate billing practices to prevent inadvertent fraud. Your practice must ensure that there are no claims that have overcharges or claims made for undocumented or undelivered services. Accurate billing practices must be maintained for you to avoid charges of fraud.

Maintain and update documentation

You must maintain accurate records for review to give the best possible treatment. Accurate records assist your case when you must defend against malpractice suits. You must document their treatments and procedures for record purposes.

Stay Away from Unnecessary Referrals

The Anti-kickback statute considers it a crime if you willfully and knowingly offer, pay, solicit, or receive any remuneration, whether indirectly or directly for referrals, of items or services that are reimbursed by any federal healthcare program.

If you receive an office space for below-fair-market-value or cash in exchange for referrals is an example of breaking this law.

Learn About Improper Payments

There is plenty of Medicare Abuse or inappropriate payments that can open you up to criminal and civil lawsuits. You must learn them to avoid being charged by the appropriate agencies.

Here is a list of the different types of improper payments:

Errors are caused by a mistake in your coding

Waste when you do an unnecessary medical procedure

Abuse when you inappropriately bill an example of which is upcoding

Fraud billing for products or services you did not provide

Establish a Compliance Plan

You must create and observe a compliance plan to avoid fraudulent activities. This practice is mandated by the Affordable Care Act to keep your practice Medicaid and Medicare eligible.

A voluntary compliance plan consists of seven parts.

1. Detecting violations and responding to them
2. Oversight for compliance and practice standards
3. Election of a compliance officer
4. Continued training and education
5. Auditing and monitoring while reporting misconduct within 30 days to the appropriate agencies.
6. Clear organizational communication
7. Consistent in implementing disciplinary measures

Seek Guidance from the appropriate Legal Professionals and Government Agencies

The practice of medical billing is very complicated and you can’t expect to know everything. You need to consult with lawyers and government agencies when your knowledge is lacking to avoid penalties. Search for lawyers to help you make sure you’re not breaking the law. Government agencies have resources that can help you with your medical billing and can answer questions about requirements, etc.

Hire a Medical Billing Firm

The practice of medical billing is very complicated and you can’t expect to know everything. You need to consult with lawyers and government agencies when your knowledge is lacking to avoid penalties. Search for lawyers to help you make sure you’re not breaking the law. Government agencies have resources that can help you with your medical billing and can answer questions about requirements, etc.
Hire a Medical Billing Firm
Medical Billing firms have all the knowledge and resources to ensure your medical billing is handled properly. They can keep up with all the new announcements and rules in medical billing and make the appropriate adjustments for your billing. The medical billing firms have years of experience and will know how to comply with your various legal requirements by heart. Hiring a good medical billing firm will take out all the challenges listed above to allow you to focus on your patients.

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In the end, handling your medical billing requires understanding the law, transparency about conflict of interest, accurate billing, maintaining and updating documentation, staying away from unnecessary referrals, learning about improper payments, establishing a compliance plan, and seeking help from legal professionals. There are many steps needed for proper medical billing, but you can skip all of that by hiring a medical billing firm. Medical billing firms have all the knowledge about billing and can ensure your process follows the law. You can leave the billing to a medical billing firm and focus more on your patients.