The federal government loses 30 cents for every dollar earned from Medicaid and Medicare due to medical billing error and fraudulent practices, but some experts attribute a portion of this loss to confusion, according to Business 2 Community.
Here are the five most common types of billing mistakes made my healthcare providers.
1. Upcoding. Upcoding could be as simple as submitting a claim for a broken ankle when a patient received treatment for a sprained or less severely injured ankle. Large insurance companies frequently do not catch the improper terminology or code.
2. Phantom billing. Healthcare companies commit phantom billing fraud when submitting claims for services not actually performed.
3. Inflated hospital bills. Inflated bills occur when patients are billed more than a procedure should have cost, for extra equipment not actually used or for the same cost twice.
4. Service unbundling. This occurs when procedures were intended to be submitted as one package but instead are each billed separately, creating a higher invoice amount.
5. Self-referrals. Self-referrals occur when a physician orders a test or surgery to be completed by him or a fellow faculty member from whom he receives financial compensation.
More Articles on Coding, Billing and Collections:
5 Observations on Handling Out-of-Network Reimbursement From Surgery Center Leaders
7 Statistics on Outpatient Surgery Medicare Margins
Hospital System Owner HCA Used Aggressive Billing Tactics to Financially Thrive
Here are the five most common types of billing mistakes made my healthcare providers.
1. Upcoding. Upcoding could be as simple as submitting a claim for a broken ankle when a patient received treatment for a sprained or less severely injured ankle. Large insurance companies frequently do not catch the improper terminology or code.
2. Phantom billing. Healthcare companies commit phantom billing fraud when submitting claims for services not actually performed.
3. Inflated hospital bills. Inflated bills occur when patients are billed more than a procedure should have cost, for extra equipment not actually used or for the same cost twice.
4. Service unbundling. This occurs when procedures were intended to be submitted as one package but instead are each billed separately, creating a higher invoice amount.
5. Self-referrals. Self-referrals occur when a physician orders a test or surgery to be completed by him or a fellow faculty member from whom he receives financial compensation.
More Articles on Coding, Billing and Collections:
5 Observations on Handling Out-of-Network Reimbursement From Surgery Center Leaders
7 Statistics on Outpatient Surgery Medicare Margins
Hospital System Owner HCA Used Aggressive Billing Tactics to Financially Thrive