Medical Billing in Eliminating Frauds from Today’s Healthcare

Commercialization of Medical services occurred long back for a host of reasons. These included the failure of the government to support and fund excellent medical services, inefficient management, or lack of interlinked infrastructures. With the commercialization of hospitals came many benefits like the availability of top-notch services, the latest technologies, and skilled or experienced physicians. But healthcare also became more costly. Since the establishment of commercial medical services, it has been noted that they have multiple loopholes in their system. And these loopholes are the same areas where frauds take place. The system fails to notice these errors and hence fraudsters can easily take advantage of them. So much revenue is lost due to the mishandling of these loopholes. And the solution to all these problems is to do medical billing the correct way.

Since the pandemic hit the world, everything has changed, the healthcare sector becomes the only industry that is most demanded and risky. All the hospitals and healthcare sectors have been flooded with the patients and a large dataset has been generated from them. These huge datasets on the one hand will help the future medical industry to cope up with the virus in the post-pandemic era, but on another hand will help the fraudsters to play their game! Hence the question arrives, how the people will be safe from these fraudsters? And hence, we need to know what are some of the common medical frauds and how medical billing can eliminate them from today’s healthcare.

Types of Medical Frauds and How to Mitigate Them 

Just like history is important to our civilizations to avoid future havoc, similarly knowing the frauds are essential to be safe from them. Below are some stripped-down instances where frauds happen generally. 

Frauds Relating to Non-Covered Services 

This is the most common medical fraud that can be seen in the healthcare sector. Most patients give details of the insurance companies and receive services for which they are not medically insured. For example, if a person is only insured for vital organs and he ends up taking the complete treatment for other ailments like malaria which is not covered by the insurance, this leads to substantial fraud. The hospital receives only denials from the insurance companies and it continues. But if you hire the right medical billing service providers then the service providers will go through all the treatment and services the patient took from the healthcare center by covering all the information and history of that patient.

Upcoding Medical Fraud

These medical frauds are the ones which code the medical records in such a way that it is provided by the health professionals. They let the insurance companies pay more due to smart coding. These frauds are easy to miss while verification and require a constant dedicated staff to notice. Using the right medical coding service providers you can save your organization from getting in the hands of these frauds.

Medical Frauds Related to Unbundled Services

Unbundled Services are the services that are meant to be paid as a whole but the billing is done separately to receive extra cash. These services may come in the form of higher taxes or higher single treatment costs, and affect directly the insurance providers draining excess payments. Hiring the right medical billing service providers will help the organization to get rid of these services and the medical frauds related to them.

Double Billing Medical Frauds

As the name suggests double billing is one of the medical frauds where the same bill is made twice. These frauds are generally executed by simply changing either the dates on the bill or the patient’s name itself. It is also one of the popular unethical practices still being practiced to drain the insurance sum from the companies which are not acceptable. To get rid of this double-billing medical fraud, the doctors should use the right medical outsourcing team to hire for the medical billing service, they will do all the work at their responsibility and let the doctors freely treat the patients.

Medical Frauds Related to Non-Serviced Bills

Sometimes bills which are not even relevant end up in the offices of the insurance provider. This may be an error of the demographic data entry or during charge capture which leads to denials. But noticeable times it has been done purposely to drain more cash from the providers. This is concerning as it may be sometimes overlooked and approved, and only the right medical billers team can help you to be safe from these frauds.

This is not very easy to determine who is at fault first. So we divide the categories into two parts. The patients and the healthcare business. The patient or their guardian has to be careful while signing for any services. They need to very precisely read the insurance policy first and then the services which will be taken by them. They should also make sure that the hospitals are not charging anything extra to the insurance company. On the other hand, healthcare businesses can avoid frauds caused to them by simply hiring expert professionals for medical billing and other services like Audits, maintenance of records, and denial management. Finally, it should also be taken care that all the data are correct and completely matches with the patient’s data before filing for reimbursement.

Last but not the latest, the main thing we need to keep in our mind that, if the fraudsters are smartly doing their work, we need to elevate our medical billing techniques to a higher level than them. Only then the elimination of these frauds are possible, even the government of all states disregard any insurance fraud. Also most times, the hospitals are stuck in the loop of denial follow-ups due to the mishandling of information. As discussed it will always be best to let the right professionals handle the work so that you can actively focus on the better treatment of your patients.

Thank you for reading the article. I hope this article answered all of your questions related to medical frauds and the importance of medical billing in it. It will be our immense pleasure if you give your valuable feedback in the comment section. Please share this article with your loved ones and professional circle if you like it. In case you want any information regarding healthcare services, kindly contact us. Team Syanthy Healthcare Services will be happy to help you at a very competitive rate percentage. Thank you again!