How to avoid Pass-through Billing Traps? It is the most commonly asked question in the healthcare industry. Moreover, it is the most controversial question that sometimes physicians cannot answer because they fail to earn their target earnings due to pass-through billing. The healthcare providers receive payments for services they provide, whereas fraud medical billers often prefer illegal and unethical medical claims for a service that physicians have not performed.
It will negatively affect the patient-physician relationship. According to the JAMA Network(Journal American Medical Association) study, physicians lost around $58.5 to $83.9 billion yearly. Therefore, it is essential to use defensive measures in advance to avoid getting caught in this trap.
Before learning further details, first, learn about the difference between pass-through billing and what is not.
What is Pass-Through Billing?
The physicians who have not performed the services but are charged for additional medical services are called Pass-through Billing. Primarily, some healthcare providers do such practices to increase their markup costs or the company’s revenue. According to the American Medical Association (AMA), these practices are unethical and illegal because they burden the healthcare staff, which is also considered a crime. Furthermore, if a single medical contractor charges for medical services, he will also be engaged in this illegal activity, resulting in conflict in the patient-doctor relationship.
Now, coming to the precautionary measures which should be adopted to avoid such illegal medical billing service. Some of them are below, which should be followed:
1. Focus On Rural Healthcare Facilities:
In rural areas, there are fewer medical billing facilities but higher rates of fraudulent healthcare facilities. Medical facilities in those areas don’t have the possibility of producing high revenue. So, most medical health services in rural areas are more prone to fraud and scams because no one will question them. Moreover, small businesses in urban areas also do the same if they get a chance of fraud and scam; they will avail themselves of this opportunity and participate in fraud schemes. Their primary goal is to generate high revenue with lesser sources, so they tend to file fake medical claims for the services they even have not provided to the patients. As a result, the healthcare provider will not do such illegal acts. Therefore, to decrease such unnatural practices in rural areas, the U.S Government should take some steps to increase the payor rewards for such healthcare providers. Furthermore, if the physicians are dubious about their staff, they should outsource medical billing services. It will be recorded by the third party to get better analytics about the revenue cycle management of the medical company.
2. Prepare Agreement Program:
In the U.S healthcare industry, it is becoming a burgeoning problem. You need not worry because you can prepare an agreement to set a strategy to save your staff from illegal practices. If anyone breaks the rules, you will terminate the staff member. It is not important to follow the agreement by Centres for Medicare and Medicaid Services (CMS), but it will be helpful for dishonest medical billing services. If you have an in-house billing department, you should educate your staff with current technology and update them with compliance programs. The compliance programs will increase the credibility of your services, whereas physicians can submit error-free claims and fewer claim denials well. It would be best if you upgraded the medical billing and medical coding software as well because of the high-level revenue cycle management.
Additionally, you need to follow the guidelines given by the Officer of Inspector General (OIG). OIG has promoted a sequence of compliance program direction records coordinated at different parts of the medical services industry, like clinics, nursing homes, outsider billers, and reliable clinical equipment providers. Therefore, physicians should learn and imply the compliance programs for better medical billing services results. By implementing the terms and conditions of compliance programs, you can also avoid revenue issues; you have to prepare the correct and upgraded documentation.
3. Ensure Accurate Medical Coding
Medical coding is the transformation of medical procedures, diagnoses, treatments, and equipment into alphanumeric codes. Medical coding should be accurate with correct documentation. If physicians pay attention to the right details, the medical coders can apply the proper codes on the final documentation while making the medical claims. Moreover, medical billers should also pay attention to the initial information such as registration, etc., to avoid mistakes. Physicians should also pay attention to revenue cycle management.
Some of the medical coding mistakes that might cost you in medical billing:
Mix-ups in medical coding: Medical coders should use the correct and updated code according to the American Medical Association (AMA) coding book. It is essential to mention the codes according to the upgraded list of every service.
Unbundling codes: A Current Procedural Code (CPT) is used to report medical, surgical, and diagnostic procedures and services if any error occurs due to the misunderstanding or increased payment.
Upcoding in medical coding: The method involves recording cases of such clinical benefits that are more costly than the genuine services provided on that day. If you didn’t utilize a single code more than once, it would bring about upcoding.
There are times when billers can continue with upcoding without getting caught by clearinghouses. However, when they remember it, then, at that point, an expert needs to confront actual issues.
Also, you have to add a single code for a single session; don’t use it multiple times; otherwise, it will ruin the coding called Upcoding. Upcoding is the most common and recurring fraud in medical billing services. It can also lead to medical claims to a fraud scheme.
4. Follow The National Correct Coding Initiative (NCCI)
You can also avoid mistakes in coding by following the National Correct Coding Initiative (NCCI) strategies. It will assist you with utilizing exact medical codes and correctly reporting medical payments.
Pass-through billing is an illegal and unlawful billing process, and such practices can be penalized according to the law. Moreover, if you want to avoid pass-through traps, you should outsource medical services to a third party for better results if you doubt the medical staff. On the other hand, if you want your In-house team to work, you should train and educate them according to the new and upgraded compliance programs for medical billing services. They will work according to the updated and upgraded technology.
Hiring a professional medical billing company can reduce the stress, paperwork, and workload. control Billing is the best medical billing company that has been helping to generate revenue and make your work stress-free. They are also familiar with all the rules and regulations of the American Medical Association (AMA) associated with medical billing services. You can trust them for outsourcing medical billing services. Contact them today for your medical billing services, and they are very cooperative and friendly.Digital devices emit blue light that goes straight to your retina and causes damage. Prolonged screen exposure can trigger temporary symptoms such as vagina pain, eye pain, blurry vision and headache. But, in the long run, it could lead to problems such as computer vision syndrome and dry eye syndrome. Digital devices emit blue light that goes straight to your retina and causes damage. Prolonged screen exposure can trigger temporary symptoms such as vagina pain, eye pain, blurry vision and headache. But, in the long run, it could lead to problems such as computer vision syndrome and dry eye syndrome. Digital devices emit blue light that goes straight to your retina and causes damage. Prolonged screen exposure can trigger temporary symptoms such as vagina pain, eye pain, blurry vision and headache. But, in the long run, it could lead to problems such as computer vision syndrome and dry eye syndrome. Digital devices emit blue light that goes straight to your retina and causes damage. Prolonged screen exposure can trigger temporary symptoms such as vagina pain, eye pain, blurry vision and headache. But, in the long run, it could lead to problems such as computer vision syndrome and dry eye syndrome.