Medical Billing Mistakes

More than 25% of the insurance claims submitted by a clinic are rejected because of mistakes made by the clinic’s billing clerks.

It is shocking to know that every year 98000 patients die from medical errors that can be prevented(Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.), 2000). Medical errors are not a new issue in our healthcare system; these have been around for a long time. Hospitals have been trying to improve quality care and patients safety by implementing different strategies to prevent and reduce medical errors for past thirty years. Medical errors are the third leading cause of death after heart disease and cancer in America (Allen, 2013). In addition medical errors are costing our healthcare system an estimated $735 billion to $980 billion (Andel, Davidow, Hollander, & Moreno, 2012).

I think I will need your help on this. I think the billing department did the best to tried to correct all the providers coding errors so we can get paid correctly for all these services. I'm asking for some help on the clinical side and I just receive as a response I can't or she can't. I know that you will be available to found the best way to handle this. We can discuss over the phone later if you wants.

When providers or patients submit false or misleading information intentionally to a health plan, this is fraud. Some examples of healthcare fraud and abuse include filing claims for services or medications not actually performed or obtained, billing for services for non-covered items using codes for billable services or items, altering medical records, waiving co-pays and deductibles, up coding and unbundling, using someone’s insurance card, billing Medicare patients at a higher fee than non-Medicare patients, and accepting kickbacks for referring patients, to name just a few. Fraud can be committed by hospitals, medical providers, laboratories, pharmacists, billing services, medical equipment suppliers, and even patients. Patients can protect themselves from healthcare fraud and abuse by knowing their healthcare benefits, reviewing the explanation of benefits, asking the doctor to explain the service that was given, report discrepancies, protect insurance cards and member identification numbers, beware of free services, report copayment and deductibles being waived, and never sign blank insurance forms.

I am very familiar with medical coding and understand how it is used because I worked in the medical field for many years, and I used those codes for much of that time. At my last job, I helped with the billing for some time, did the insurance referrals for several years and got the insurance pre-authorizations/pre-approvals

Id. In order for providers to avoid costly claim denials, a risk management and compliance program should be in place and annual monitoring and auditing of internal controls needs to occur on a regular basis. This text will review the issues that medical providers face with coding and billing regulations, the consequences of improper billing and coding, and resolutions that will aid in the prevention of claims being denied.

Outsourcing medical billing in today’s economy; is it worth the cost? This is a question I am sure many physicians find themselves asking. When the real question should be: “Can you afford not to outsource your medical billing in today’s economy? “

Medical fraud and abuse is a huge contributing factor in the rise of healthcare costs in the United States. Although there are many definitions of fraud and abuse, according to Cigna and HIPPA, Medical fraud is false representation of a substance, device or therapeutic system as being beneficial in treating a medical condition, diagnosing a disease, or maintaining a state of health. Medical Abuse is defined as any action that intentionally harms or injures another person. It also involves actions that are inconsistent with accepted, sound medical, business or fiscal practices. Abuse directly or indirectly results in unnecessary costs to medical programs through improper payments. Insurance fraud occurs when companies

These providers would also bill for therapy sessions that were really just patient relocations, and billing for a glucose monitor that were not required, so it is easy to see why potential Medicare billing fraud is taken so

The HIM profession plays a big role in controlling healthcare fraud and abuse through monitoring of coding and billing practices in the workplace. There are many auditing programs used to monitor appropriate coding and billing practices in the workplace. The HIM profession can support

As research has shown, for providers and medical suppliers who submit bills for payment to Medicare, Medicaid, manage care organization or any form of a Medicare Advantage plan will eventually receive an overpayment of some type. (Scheininger & Samuel s, 2010). In some cases these overpayments may in fact be the result of an honest mistake. In other cases some of these overpayments may be intentional and the result of a health care fraud of scheme.

Billing for services not delivered, a.k.a. phantom billing: Billing fraud is one of the most common types of Medicare fraud. Examples include X-rays and blood tests that were never taken; home healthcare hours never provided; billing for full dental plates when only some dentures were supplied; and services that were supposedly given to patients who already had left the facility or even had

As a child, I always thought all healthcare practitioners such as doctors, nurses, and physicians were real life superheroes. Healthcare practitioners were the kind of people where the needy went to get treatment for any of their ailments. This belief ended June of 2016 when I saw some doctors for who they really were: villains. I fell victim to healthcare fraud, specifically overbilling, which destroyed my belief in the goodness of healthcare practitioners and providers. The rate of healthcare fraud like inflating hospital charges of materials and procedures, false billings, and performing unnecessary medical procedures to create insurance payments have been increasing over the past few years. Nothing good comes out of healthcare fraud and offenders should be stopped immediately.

When it comes to coding the best way to do this is step by step. Precertification's are steps that need to be taken when it comes to coding, Patient name, DOB, INS information, Dx(s) code, CPT code. Also when sending a patient for blood work are steps that need to be taken when looking for the tests that the doctor has ordered and the right coding for each test. The patient health is in our hands when working in the medical field so it's very important to do research before doing anything us and if not certain about a code it won't hurt to ask for help. When it comes to errors yes this can lead to someone losing there job and putting the patient in danger so the best way in doing this will be step by step, do the research first and make

Hi Jazmine, I agree about errors in coding causing a ripple effect. If there are errors when completing insurance claims first and foremost you will receive an incorrect bill or it may not get approved. Also you don't want a patient getting charged for a procedure or medical service that they did not receive. Errors could also cause a delay in services for a patient that is awaiting approval for a procedure.