Video Update: How to Avoid the Three Deadly Sins of Compliance in Medical Billing

Kathy McCoy, MBA August 29th, 2011

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The U.S. Office of Inspector General has been keeping very busy fighting fraud and abuse in the health care industry. And they are making great progress. In fact, for every dollar the OIG spends on this effort, $16 is returned to the U.S. treasury. That’s a 16:1 return on investment! Is it any wonder the government is making such an effort to fight fraud and abuse, wherever it occurs?

While much of that fraud is perpetrated by companies that never even see a patient, no one is impervious to a compliance audit. In order to help health care practices avoid a costly and serious compliance infraction, Kareo recently sponsored a short video entitled How to Avoid the Three Deadly Sins of Compliance featuring noted practice management and medical billing consultant Betsy Nicoletti, MS, CPC. The video is just one in a series of complimentary informational webinars and videos sponsored by Kareo. This blog will offer highlights from Betsy’s video. You can view it now by clicking on the image below.

Betsy’s first “deadly sin” is staying out of Medicare’s business. This can indeed be deadly to your bottom line because Medicare is frequently issuing clarifications and updates to its guidelines for claims submissions and what it will or won’t cover. There are other guidelines you need to pay attention to as well. Betsy advises joining Medicare’s contractor listserve and listen to its contractor audio advisories. You can also check out the CMS website for updates or other important information. It is imperative that you stay up-to-date on any news from Medicare.

Betsy’s second deadly sin is encouraging a whistleblower in your practice. No one would do this intentionally, of course. But dismissing any concerns that your staff bring to you is a mistake. How many time have you read about a whistleblower who states, “I tried to tell them, but they didn’t listen.” Take concerns seriously. Also, Betsy advises that you have a compliance plan that includes a code of conduct and privacy statement that stipulates staff members will come to you first if they have any concerns about how claims are handled.

And finally, Betsy’s third deadly sin is failing to compare your coding and billing data to industry norms for your specialty. While this is admittedly a tedious task, it is the only sure way to determine if you are in the ballpark with other like practices. She suggests downloading reports from your medical billing system and finding comparative data to analyze your charges and billing practices. You may find comparative data from commercial vendors or professional medical societies – the latter would be your best resource, if it’s available. Look at such items as the frequency of E&M codes, use of modifiers, and diagnostic test orders or procedure codes. Taking the time to compare before an audit may help you avoid one!

Betsy Nicoletti, M.S., CPC, is the founder of Codapedia.com, a wiki for physician reimbursement. She is a nationally known speaker and consultant, and can be reached at www.mpconsulting.org. You can watch another informational video by Betsy Nicoletti on Better Collections Through Improved Medical Coding now. Or, view her archived webinar on What You Can Do to Prepare for Medicare Payment Reductions.

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