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Preventing upcoding and overbilling in your medical practice

As someone who owns or operates a health care business, you may know all too well that medical billing and coding can prove time-consuming and complex. You can land in serious trouble, however, if Medicare, Medicaid or an insurance company alleges that you were fraudulently overcharging in a practice commonly called "upcoding."

In some cases, unethical owners of medical practices may intentionally overcharge in an effort to extract as much money from insurers as they can. In other situations, however, medical or administrative professionals may do so because of a lack of knowledge on billing practices, or because they make unintended clerical errors. The penalties associated with upcoding are the same for both types of offenders, however, so learning how to prevent upcoding issues should be among your top priorities as an owner.

So, what can you do to reduce your chance of someone accusing your medical practice of fraudulent billing practices?

Establish internal procedures

Make it a point to implement set standards when it comes to reviewing bills before your practice submits them to insurers. Review bills thoroughly and compare them against medical records to catch any errors before they hit the mail.

Hire a compliance professional

It may, too, benefit you to hire someone who has a background in coding and fraud prevention to take on the task of reviewing bills before sending them. That way, this person is more likely to spot potential red flags that insurers may notice upon receipt of the bills.

Make smart hiring decisions and train extensively

Because there is so much on the line when it comes to billing and coding errors, it is important that you take the time to hire trustworthy, detail-oriented professionals to fill administrative positions. Furthermore, make training them a priority and focus some of that training on the problems that can arise should they make billing mistakes. Your health care business is your lifeblood, and taking these preventative measures can help you avoid losing it on account of upcoding or related billing issues.

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