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20 March
2018
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Untrained Billers Can Raise Risk of Fraud

Healthcare practices that submit incorrect or inaccurate claims may face allegations of fraud. This can result in penalty and loss of reputation. Fraud may not always be intentional. Incorrect billing by untrained and inexperienced billing staff runs the risk of fraud. To ensure your practice files correct claims, here is what you can do.

Accurate Coding

Codes and coding combinations are in thousands. They can be for a visit, diagnosis, a procedure or a combination of procedures and much more.

A common example of incorrect submission is ‘upcoding’ or incorrect codes that indicate a more complex procedure was performed. Another example is ‘unbundling’ which refers to using different codes for various steps in a medical procedure even though there is a single code to cover all the procedural steps.

This can be prevented with accurate coding by trained and experienced coders. When you hire a medical billing company for your practice, they have large teams of trained coders who are experts in coding and billing accurately.

Billing Under your NPI

In some cases, you may get more money from Medicare for billing under the physician provider number. To stay away from fraud, if you are conducting specialty billing under the physician’s NPI number, ensure that the encounter meets incident to criteria.

To learn more or to take advantage of internal medicine billing service offered by the leading medical billing company in Massachusetts, call Emerald Health LLC at 855-650-9906 Today. Emerald’s Electronic Medical Records (EMR) Software was designed with a very powerful and simplistic user interface allowing users to quickly find and enter patient data. Ease of use and a minimal learning curve ensures you and your staff can start using the software almost immediately.

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