Compliance risk areas for physician medical practices

The following are identified compliance risk areas for physicians:

- Unbundling;

- soliciting, offering, or receiving a kickback, bribe or rebate;

- routine waiver of copays and deductibles, regardless of need;

- billing for services not rendered;

- upcoding;

- double billing;

- billing for physician services rendered by non physicians/teaching physician requirements;

- medical necessity;

- misrepresenting diagnosis to justify services;

- completing certificates of medical necessity for patients not personally and professionally known by the physician;

- billing Medicare/Medicaid for investigation research, medications, and procedures without proper authorization; and

- billing for a non covered service as if covered.

Rarely do I find "intentional" compliance errors; most "unintentional" errors are the result of carelessness, a lack of monitoring, a lack of checks and balances, a lack of education, poor billing staff, etc. etc. get the point. Just make sure this isn't happening within your physician medical practice.

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