Medical coding is an everchanging landscape. New technologies emerge and new ways to classify different procedures and categories of illness are common. As such, year-to-year, professional medical coders and billers should always be on the lookout for changes in the terminology and technical codes, as repeatedly inputting the wrong codes or billing errors can and will lead to rejected claims, lost money, and lost work efficiency as well.

False Coding vs Billing Fraud

An important thing to remember is that it is expected, as per the law, that people make mistakes. Making billing or coding errors may cost you in fines, but they do not constitute fraud…unless they keep happening. A Medical billing fraud charge can be levied on a business should they continually make the same improper coding errors. That is to say, even if fraud was not willfully committed, after a certain point, continual errors may warrant a payout for fraud damages. The intent is irrelevant when it costs the system millions of dollars per year if businesses are not stringent about their billing/coding standards.

A Cautionary Tale About Improper Medical Billing

Just last month in September, a doctor and physician practice in PA were fined $178,000 due to false coding claims. That kind of fine could sink a business with less than favorable margins, in other words, it’s nothing to shake your head at!

Richard P. Frey and the Physicians Alliance (PAL) were fined to resolve liabilities regarding the False Claims Act which was invoked due to the improper billing of what are called “P-Stim” devices. These devices are an electronic acupuncture device that is placed behind the patient’s ear and attached using a simple adhesive. As the name suggests, it provides intermittent electronic stimulation through electronic pulses.

As you might imagine, Medicare does not cover this procedure.

The problem? Frey and PAL either themselves or authorized their medical billing team to bill the procedure as the implanting of neurostimulator electrodes, which is a costly surgery that requires a person to go under the knife—so to speak.

Interestingly enough, the improper billing occurred in 2013-2014, respectively. Consider that 5 years later, they are now paying the price for those mistakes. Suffice it to say, this is an egregious example of false medical billing as well as an example of how detrimental to your practice it can be. This should encourage any practice or office to outsource their medical billing/coding needs to professional medical billers and coders. What may seem like an investment to you now will reap dividends down the line when the lack of errors and rejected claims ends up saving you money and time!

 Professional Remote Medical Biller

When Maureen R. Dixon, of the U.S. Department of Health and Human Services, Office of the Inspector General, was asked about the situation. She replied, “Accurately billing for services provided to Medicare beneficiaries is required of all health care providers.”

We at The Psych Biller couldn’t agree more, it’s our business to make sure your medical business runs smoothly. Contact us here today to be on your way to less rejected claims, better profits, and more free time to spend tending to your business rather than paperwork!