Even though working
from the comfort of home as a medical billing professional may seem like the
near-perfect career, offering benefits and advantages that within a doctor’s
office or healthcare center are unavailable, the ramifications of possible
mistakes can be very costly.
An example of how things can go wrong can be shown by MSO Washington, Inc. MSO
is a medical practice management and billing service company that had to agree
a settlement against claims of healthcare fraud, to the value of $565,000. The
Dept. of Justice alleges that the company made claims to Medicare and Medicaid
for settlement which failed to include the proper records and claims for
procedures that were deemed medically unnecessary. The Department found that in
some cases the procedures claimed for were never completed, or they were
executed but charged for at rates above the industry standard.
It seems as though the healthcare providers were allegedly not aware of the
questionable billing practices, and consequently, they were not a part of the
investigation. The system that was under investigation was a home visitation
program, in which doctors and medical professionals visited homes to inspect
the residence itself.
As a professional and highly-trained medical professional, one would be able to
detect anomalies and point out possible fraudulent activities. There is great
value placed on such individuals, and as a result, insurance companies and
government-based agencies will depend heavily on that person’s skills and
training, as well as their moral character. After all, one would have medical
documentation of many patients at hand.
Throughout the education and billing services classes, one is expected to learn
every part of the coding systems that are used and relate to procedures,
medical products and the services that their respective companies provide.
Important aspects that medical offices and hospitals seek out when looking for
specialists include a concern and prioritization of getting their job done;
correctly and efficiently.
Where claims are concerned, most companies/offices will seek out a fair
reimbursement for their services. Companies can lose vast sums of money through
malpractice, accidental or intentional.
The owner of MSO Washington Inc. did not admit liability, so it can be deemed
that the fraud was accidental and not intentional. This only highlights the
importance of personnel who can account for their work and ensure that there
are no errors. High-quality personnel are able to seek out the correct
compensation while preserving a fraud-free status.
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