Medical Practice Management, Uncategorized
Jun 08

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. etc………you get the point. Just make sure this isn't happening within your physician medical practice.

About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →