A very big issue impacting healthcare institutions is billing errors. This is leading to delays in settlements, and sometimes even delays. This is mainly due to improper billing. Again improper billing can be either due to a mistake or intentional.
Professional help from medical coding companies helps in solving this problem. A medical coding company in India helps in solving the issue of improper billing.
Healthcare institutes in some cases try to manipulate billing by up-coding in order to receive higher reimbursement. However, this issue could happen unintentionally. So, it is essential for the billing companies to verify the bills before declaring the bill as improper.
Improper Payments
These are the payments that do not fulfill the payment criteria. These cannot be directly declared as false billings. There are chances that errors might creep up during the billing process. The bills may contain mistakes because of human errors. In some cases, the institute tries to intentionally project a bigger bill amount. They try to show bills for a service they did not provide.
In maximum cases, the improper bills are due to incomplete information. Sometimes, important patient information or the documents for eligibility determination is missing. Other cases also include cases when the states do not follow the enrollment process properly or do not confirm beneficiary eligibility. These forces delays in settlements and disruptions in revenue flow.
Not all improper payments are fraud, but all fraud attempts are improper payments.
Imposter Billing
This is a bad practice sometimes intentionally done by healthcare institutes. They use this process to gain money. They try to claim reimbursements for services that were not even availed. This leads to a disparity in the revenue flow. Government regulations condemn this practice.
Unintentional mistakes are also categorized as improper billing. Therefore it becomes highly essential to ensure that the bills are error-free. The most common types of imposter/fraud billing are –
Up-coding –
This refers to the situation when the service provider sends a bill to medic care or any insurance company with a bill of higher value. This includes –
- Exaggerating the time for performing a procedure
- Mentioning equipment that was not used
- Misrepresenting staff in the procedure
- Vaguely claiming a service that was not even availed
- Performing services that the patients do not need.
Another case of up-coding also involves exaggerating the diagnostic data of the patient in order to submit large claims.
Unbundling –
This refers to the process of billing when billing for a group procedure. The healthcare institute bills each service individually. The total combined cost of all the separate procedures gives a cost that is more than the bundled cost. This leads to a higher reimbursement, resulting in overpayment.
This process is primarily done by institutes for increasing their income. Mistake of this form is very rare.
Billing for services that were not performed –
It is a violation to bill for services or equipment that were not availed. Penalizing healthcare institutes is possible under the False Claim Act which tries to raise undue bills. There are cases when the bills contain services that were not even performed. In such cases, the bills are completely vague and rectifications are immediately required.
The improper bills require immediate rectification. If proper proof cannot affirm the claim, then legal action may be applicable. Therefore, it becomes essential for healthcare institutions to ensure proper billing to avoid legal issues. In case of any unintentional mistakes, proofs are essential to substantiate the claim.
Completion of claims is possible only on submission of proofs. Rectifying mistakes is possible only if they are occasional. But repetitive mistakes bring the institute on the radar. This makes it difficult for the institute to reclaim lost customer satisfaction.
Further healthcare institutes do not want to lose credibility. Therefore the majority of the institutes want to ensure proper billing. Submission of claims for only the rendered services helps in quicker settlements. This also helps in avoiding all hassles. Along with the help of a proper billing company, healthcare institutes are able to maintain a smooth revenue flow.
Way Ahead
Improper billing creates multiple problems for healthcare institutes. It is essential to make sure that the billing process is error-free. This has a positive impact on customer satisfaction. Ensuring error-free billing helps in maintaining smooth revenue flow. The Accounts book also looks simple with minimum complications.
For this process, the medical coding company in India uses advanced software. This enables them to understand the points where errors occur. Identifying the mistake points, and rectifying them leads to efficient workflow.
Small healthcare institutes can complete the billing process with ease. With the growth of the institute, the billing process gets complicated too. It becomes essential to hire additional staff or outsource the process completely.
