Medical billing is its own specialized profession. Some people go into billing because they started working in reception and could train on the job. Other people might actually take professional education courses to learn the skills involved in medical billing.
Especially if you haven’t had formal training, some of the ways that you try to bill for medical services might put you at risk of criminal charges. When does someone’s billing work put them at risk of health care fraud allegations?
When they charge separately for combined services.
Insurance companies negotiate specific reimbursement rates to keep costs predictable. For example, it is common to include anesthesia and incision care in the bundle of expenses for surgery. If there is a bundled service rate and a medical practice bills for each service separately, this behavior could constitute fraud.
When you upgrade from one procedure to another
You may have worked at the office for long enough to realize that these supplies used her two procedures are identical but the costs are quite different. It might seem like a harmless change to bill for a more expensive procedure to make the practice more money. However, changing the procedure performed is fraud and could result in criminal charges.
When you charge for services the company did not provide
Billing for an appointment that didn’t occur may seem like a minor issue. Yes, your company gets paid more than it should, but it may seem like a victimless crime. In reality, billing for services not rendered pushes up the overall cost of insurance and puts strain on the financial systems that support American health care.
Realizing what billing practices might constitute health care fraud could help you avoid making a big billing mistake.