Medical Billing : The Pros And Cons Of Medical Billing

Double billing is when a patient is billed for the same service more than once. Double billing can occur when there is a product name change and also if there is an error involving the product's software. There are different reasons why a medical claim could be denied. Here are some of the reasons why:

Offices should have a well written payment/collection policy because you want to make sure that the patients know what is expected of them. Collecting and taking payments from patients can already be a challenge. So when a patient is aware of the written payment/collection policy, they are less likely to have problems with person taking the payments.

Debt collections in the Medical field affects millions of people from all life styles, it’s a big problem that I don’t see an end to. There are situations that we can control regarding our own health state but there are unforeseen circumstances, which lead to having medical debt. There are laws that protect a consumer but not everyone is aware of the kind of protection. We need to all educate ourselves on medical debt collections and the process.

Accelerating cash collections at the point of service has never been more critical than it is today. Sophisticated accounting tools that enable providers to analyze patient utilization and outcomes help practice managers monitor payer performance and evaluate external contracts effectively. Growing financial pressure to strive toward more efficient claims flow through the revenue cycle means every provider must search for innovative tools to overcome the challenges.

One of the drawbacks of a uniform fee for medical services in the United States is that medical providers cannot agree on a set price because of price-fixing. In regards to competition, they are having difficulty of maintaining the prices at a certain level by agreement. The reason why it’s at a fixed-pricing is because it puts the price at the level where they can control the supply and demand. In other words, the uniform fee reduces competition between providers as everyone received the same rather than someone trying to do it for less and received more of the market.

Internal and outside auditors have a heavy role and responsibility in performing audits, preventing major accounting errors, and following (GAAP) guidelines. Several duties comprise the role of internal and outside auditor to follow specific protocol and ensure ethical standards are priority. The National Health Care Billing Audit Guidelines are relevant to address as well as why audit failures happen. Finally, how internal vary from external audit and why audits are overall important to health care organizations. It’s vital for health care organizations to maintain all necessary standards to conduct proper audits and uphold ethical standards for the financial health of the organization.

When it comes to the “incident of billing,” the Commission decided to consider that services rendered by clinicians who are not physicians but billed as “incident to” must be paid 100% of the physician fee schedule. The Commission stated that the incident care fee is predicated upon the care or service provided by the team, with the non-physician giving the direct patient care services and the physician taking responsibility to the overall welfare of the patient. They concluded that the team approach

Souza, M. & McCarty, B. (2007). From bottom to top: How one provider retooled its collections [electronic version]. Healthcare Financial Management, 61(9), 67-73.

It is easy to see how fraudulent medical billing is having a major impact on the Unites States and the citizens of this country who rely on it on a daily basis. We often hear through the various new sources in this country, on the internet or out of the mouths of politicians and experts in the healthcare field about the failing healthcare system in this country. We often hear many different opinions on what needs to be done to fix our healthcare problem within this country and fix what looks to be a very broken system at this point. No matter what the solution to our poor healthcare system is one thing that is very clear is that healthcare fraud and abuse is playing a major role in the depletion of money in this country and the rise in healthcare costs for the citizens of this country.

When I was younger I wanted to be a nurse, as I grew up my career choices changed based on different situations. I was a nursing major my first years of college. After witnessing different situations in life and job shadowing a nurse, I decided I wanted to be the person the patient talked to and confided in. I change my major to psychology in hopes of becoming a counselor. I received my bachelors in psychology then realized that it was not possible to become a counselor without a master's degree. So now I am in the process of finding another career that I would love. Medical billing and coding allows me to stay within the health field and gives me experience in a medical setting. Medical billing and coding is a well-paying entry level job.

The billing for services not rendered for are often done as a way of billing Medicare for things or services, that basically never occurred. This can involve forging the signature of those enrolled in Medicare or Medicaid, and the use of bribes or as Healthcare calls it, kickbacks to corrupt healthcare professionals. Upcoding of services is the act of billing Medicare programs for services that are more costly than the actual procedure that was done. Upcoding of items is also very similar to upcoding of services, but it involves the use of medical equipment. For example, billing Medicare for a highly sophisticated and expensive wheelchair, while only giving the patient a manual wheelchair is upcoding of items. Duplicating claims occur when a provider does not submit exactly the same bill, but alters small things such as the date in order to charge Medicare twice for the same service rendered. Therefore rather than a single claim being filed twice, the same service is billed two times in an attempt to receive payments from the government twice. Unbundling involves bills for particular services are submitted as fragmentary, which appear to be staggered out over time. Although, these services would normally cost less when bundled together, but by manipulating the claim, a higher charge is billed to Medicare resulting in a higher pay out to the party committing the healthcare fraud. Excessive services occur when Medicare is billed for something greater than what the level of

Debt Management Center (DMC) was created to assess veterans’ accumulated debt when using the VA services. This program’s purpose when assessing the veterans’ debt is to create a plan that remains professional, financially responsible, compassionate, and reasonable to help the veteran pay their debts. This program is directed towards veterans who have accumulated debt using the services provided by the VA (U.S. Department of Veterans Affairs,

Failure to develop methods to identify patients before they are billed to Medicare has increased strain not he billing process such as:

Anthony, I do think this court case represent the “aggressively” proactive preservation and accuracy that those in oversight of Medicare billing and schedule fees have take towards even slightly unacceptable billing practices. These investigative techniques and strong enforcement clarify that those who providers who participate in Medicare are solely responsible for making sure their billing practices are verified and accurate in accordance with Medicare participation standards. It is clear that there are people within the system that try to take advantage of Medicare’s payment guarantee such as this case I found regarding a fraud bust in resulting in 46 doctors and nurses arrested, and overall 243 people were arrested in 17 cities that accounted for $712 million in Medicare fraud. Here is how they implemented some of their fraudulent billing to Medicare by “Sometimes fraudsters, known to the Feds as ‘patient recruiters,’ will go to places like homeless shelters and soup kitchens and offer money to those who would share their Medicare patient numbers, a Department of Justice spokesman said” ((Lobosco, 2015).

There was a time not so long ago when a doctor would make house calls and had a modest private practice. People did not have to worry about calculating the medical costs as the doctor would only charge what he knew someone could afford and would allow payment arrangements to be made. With this type of service, the doctor was more concerned with the quality of care provided as opposed to just getting the patients in and out.