E/M Coding Alert - 2011 Issue 32
Compliance: Could Your Billing Service Be Putting You at A Compliance Risk?
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Article Overview
This article examines compliance concerns that can arise when a billing service manages claims for physician practices and other providers. It discusses a reported federal settlement involving alleged false claims, broader oversight issues for medical practices, and the importance of monitoring billing activity, documentation patterns, and contractual protections. The piece is relevant to physicians, practice managers, billing professionals, and compliance staff who oversee outsourced revenue-cycle functions.
Why This Topic Matters
Outsourced billing can create significant compliance exposure if claims are not monitored closely. The article highlights why practices should understand their responsibility for submitted claims and why regular oversight of billing reports and vendor accountability matters.
Article Sections
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Settlement and Allegations Involving a Billing Company
Summarizes the reported federal settlement and the general nature of the allegations involving claims submitted on behalf of healthcare providers.
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Oversight and Monitoring of Billing Services
Discusses why physician practices should review billing activity and request regular summary reports from outside billing vendors.
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Practice Responsibility and Contract Protections
Addresses the general responsibility of physicians for claims submitted on their behalf and the importance of contractual safeguards when using a billing service.
What You Will Learn
- How outsourced billing relationships can create compliance exposure
- Why physician practices should monitor billing patterns and reports
- What general accountability considerations arise when a billing service submits claims on a practice’s behalf
- Why contract terms and vendor protections are important in billing relationships
Who Should Read This
- Physicians
- Medical practice managers
- Billing service staff
- Healthcare compliance professionals
- Revenue cycle administrators
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