Medical Billing Case Study

The main contact person that would handle the process and procedures for billing and reimbursement in health care office is the Medical Office Specialist. They would clearly know the rules, regulations and requirements of billing as well as the time frame for submitting health care claims and receiving payments from insurance companies. The Medical Office Specialist has a tremendous responsibility, since they are the liable party for any fraudulent billing. They are typically the first person that can be legally prosecuted for their actions, if fraud is proven. There are joint efforts by several task forces like Health Insurance Portability and Accountability Act (HIPAA) and the Office of Attorney General (OIG), just to name two of them, that
enforce the rules that have been put into place to help prevent and punish fraud offenders. These organizations also oversee health care audits and maintain strict adherence to stated rules and regulations. When it comes to fraudulent billing, there are some of the most common in medical billing: “Submitting claims for services or equipment not provided or necessary
Kickbacks in exchange for referrals or false claims
Up-coding
Ordering unnecessary procedures
Inflated pricing of drugs
Misuse of certificates of medical necessity for DME
Inflating costs for inpatient and outpatient care
Scheduling unnecessary patient visits
Self referrals between physicians
False diagnosis As you can imagine with the amount of money spent on health care, health care or medical billing fraud can take many creative forms” (All-Things-Medical-Billing).
I have known for many years that Medical Billing and Coding can be a frightening field to work. The person handling the task is ultimately responsible, as well as the provider can face legal ramifications. Most definitely a lot of consideration needs to be taken in to count before entering the field of Medical Billing and Coding. The person in this position, must have a strong attention to detail in every facet of their job. Here are some really good tips to adhere to as given by the FBI.gov website for us to follow to avoid going down the wrong road of our career: Never sign blank insurance claim forms.
Never give blanket authorization to a medical provider to bill for services rendered.
Ask your medical providers what they will charge and what you will be expected to pay out-of-pocket.
Carefully review your insurer’s explanation of the benefits statement. Call your insurer and provider if you have
questions.
Do not do business with door-to-door or telephone salespeople who tell you that medical services or equipment are free.
Give your insurance/Medicare identification only to those who have provided you with medical services.
Keep accurate records of all health care appointments.
Know if your physician ordered equipment for you. All very crucial and sagacious rues to follow as a patient, as well as a Medical Office Specialist or any representative that is associated with the daily activities of billing and receiving payments in health care.