Preventing upcoding and overbilling in your health care practice

When you own or operate a California health care practice, you may trust others to handle the administrative end of things, including creating and sending invoices to patients. Medical billing and coding are not easy, though, and if your practice references the wrong codes or overbills Medicare for patient visits, you may find yourself facing serious trouble. Often, medical billing errors are the result of an oversight or honest error, rather than intentional malice. Yet, the consequences are often severe regardless.

Per Medical Economics, prevention goes a long way when it comes to stopping upcoding and overbilling in your practice or clinic. What are some of the things your operation should do to help avoid possible allegations of fraud?

Hire a compliance officer to help

Having a second set of eyes review all your documents before they hit the mail may help you catch mistakes before those bills fall into the wrong hands. When hiring a compliance officer, seek out someone who has a background in medical coding as well as fraud prevention.

Implement strict internal procedures

Establish strict internal procedures for reviewing bills before you or your team members send them to Medicare. Compare all such bills against patient medical records to ensure consistency and accuracy before sending them.

Conduct regular trainings

Make sure the people responsible for creating and sending your bills undergo frequent trainings so they stay current on all coding and compliance protocols and regulatory requirements. Requiring your administrative team members to continue their education also gives you an opportunity to drive home your expectations of them in terms of preventing overbilling and upcoding.