Earning your medical degree included many facets of practicing medicine effectively and ethically. However, you probably did not take many business courses in med school. Nevertheless, you are running your practice as smoothly as possible. Perhaps you have a skilled staff who helps with the business and compliance end of things, or maybe you do it all yourself.
Either way, one of the details that requires your careful attention is billing. Billing your patients is essential to paying your bills and keeping your practice running. However, mistakes during the billing process, particularly when it comes to coding services, can create a mountain of trouble that can place your business and your license at risk.
Common coding violations
Few coding errors pass as innocent mistakes in the eyes of the federal government. In fact, if your practice is under investigation for coding errors, authorities may assume either fraud or abuse as the reasons for the mistakes. Codes for medical services are complex, and some of the following are common mix-ups that occur during the billing procedure:
- Unbundling: Instead of billing combined services at a reduced rate, your office bills each service separately, which results in a larger payment to you.
- Upcoding: This serious violation involves billing for a more expensive service, such as a full examination when the patient came to your office only for a brief medication check.
- Documentation: If you bill more for a procedure because it was unusually complicated but fail to provide documentation to show why you used a modifier for increased services, you may face accusations of fraud.
- Unlisted codes: Any time proper billing requires you to use an unlisted code, you must include the correct documentation for the service.
- Hydration codes: A common coding error involves the intravenous hydration or infusion that includes stopping and starting time but which the staff codes as one continuous infusion.
- Injections: The bill for a patient who receives multiple injections in one visit should not include separate codes for each injection.
These are only a few of the potential errors a medical office may make when coding bills for medical services. An audit or complaint may bring investigators to your practice, and you may find yourself facing accusations of fraudulent or abusive medical billing. To protect your practice and your future, you would be wise to seek the counsel of a skilled Minnesota attorney who has experience assisting medical professionals facing similar allegations.