Medical Billing Services: Medical Billing Mistakes and Fraud Is Costly

While working from home as a medical billing services professional may sound enticing and offer benefits that you cannot find within a physician office or hospital, the mistakes that can be made are costly.

For instance, MSO Washington, Inc., a medical practice management and billing service company, has agreed to settle allegations of health care fraud and pay the United States $565,000. According to the Department of Justice, the company allegedly submitted claims to Medicare and Medicaid for reimbursement that lacked proper documentation and was not medically necessary. In some instances, the Department of Justice found that procedures were never actually rendered or were billed at rates higher than they should have been.

The contracted healthcare providers were allegedly unaware of the inappropriate billing practices and so were not included in the investigation. The program that came under investigation with a home visit program where doctors and medical professionals visited group homes to see the residence.

As a well-trained and educated medical services specialists, you will be able to recognize the signs of billing fraud. The insurance companies and governmental agencies will rely heavily on the skills and training, as well as moral character, of individuals who have the medical records documentation of individuals at their fingertips.

During your education and billing services classes, you should learn every part of the coding system that is related to procedures, services and medical products for the companies in which you work. Physician offices and hospitals are interested in finding specialists who are concerned with getting their job right.

Most physician offices and hospitals want fair reimbursement for services rendered and a well-trained medical billing services specialists will be highly sought after for this reason. A reputable company can lose millions of dollars because of billing errors, whether done by accident or on purpose.

As the new healthcare bill comes into effect through 2014, the field of medical billing and coding has continued to grow and advance. With new medications, procedures and now a new coding system, the medical billing services specialists must know their business but also be able to maintain continuing education credits to keep up with the fast pace of changes that occur.

The owner of MSO Washington Inc. has not admitted liability in the settlement agreement and so it may be possible that the suit was found upon billing errors rather than intentional fraud. This only points to the necessities of hiring and keeping on staff well qualified medical billing services specialists who can help the practice to avoid the potential of being found fraudulent. Quality personnel are also able to improve reimbursement while maintaining legitimate medical billing services coding to insurance companies.

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