Medical billing is directly linked to insurance claims and reimbursement. The process of medical billing solely focuses upon billing and charging patients for the medical care services a patient may have received. This means the billing sheet can be easily manipulated to cause medical billing and collection fraud to enhance the revenue cycle illegally. Therefore, it is advisable for patients to keep a track of all the procedures they are receiving as part of medical care. If possible try to enquire about charges for all the medical procedures beforehand. However, despite all the precautions one may still face medical billing fraud. So, what is medical billing fraud and how to report it?
Forms of medical billing fraud
Up-coding: Coding refers to the process of assigning medical codes to the procedures received by the patient. However, sometimes patients are billed for irrelevant procedures by assigning codes outside the data provided by the medical coder and physician.
Unbundling: In medical care, some services are billed together. However, sometimes these services are split up or unbundled to charges individually. Individual billing is likely to raise the charges thus, boosting the profits.
Unnecessary Medical Care Services: This refers to the services that the physician may offer to the patient for no reason. For example, the physician may ask you to undergo an X-ray even though you probably don’t need that.
Billing for Insurance Covered Service: A few medical procedures are included under health care insurance. Despite this, patients may be charged for these services.
Steps to take to prevent/rectify the fraud
Contact Insurance Company: Your insurance payer is obliged to pay a promised amount for your medical care. Therefore, make sure that you update your insurance payer about the fraud and follow-up until the issue is resolved.
Medicare: You may file a report with Medicare to prevent billing scams. Visit https://www.medicare.gov/forms-help-resources/help-fight-medicare-fraud to fill out the form.
State Medical Board: Your state’s medical board is responsible to keep a track and prevent illegal activities, if any. You may file a report with the medical board of your state.
Contact State Insurance Fraud Bureau: As the name suggests, the insurance fraud bureau works to prevent insurance fraud.
As mentioned the above tips, you can prevent medical billing fraud and save yourself from making unnecessary payments.
