Healthcare Billing Compliance: Avoiding Fraud & Ensuring Accuracy

Durable medical equipment companies sometimes bill for deceased patients. Home health agencies may upcode a patient's service records falsely. These are reasons for the continued need of health care billing compliance.

Features

• The Office of the Inspector General (OIG) released specific guidelines for health care billing compliance. Some of the guidelines include appointing a compliance officer and written policies that clearly define internal checks and balances for health care billing departments.

Warning

• Health care billing violations are often divided into two categories. Fraud is a billing violation done with full knowledge of the violation. Abuse is a violation that occurs as the result of a mistake or accident. Fraud violations often carry a higher fine.

Responsibility

• Health care billing compliance guidelines are directed to specific personnel. Health care entity boards, billing managers, CEOs and coding personnel are all in a position to prevent fraud or abuse, or encourage sound health care billing compliance.

Benefits

• The benefits of a proactive health care billing compliance program include credibility as a trusted health care entity with a proven track record of doing the right thing. It also makes medical record documentation more comprehensive and more likely to receive a positive audit review.