The most common coding abuses by a physician practice

I was watching a special on CNBC about healthcare fraud and it reminded me again about the most common coding abuses by physicians and their billing staff. Compliance in coding and documentation are crucial in today's enforcement enviroment. Don't get yourself in trouble by being ignorant or complacent:

Upcoding Billing using a more expensive code that the service or item that was actually provided.

Unbundling Billing separately for services that are properly grouped together in a global code.

Lack of Medical Necessity Billing items or services to patients that they do not need.

Billing for Services Not Rendered Billing something that was not actually provided to the patient.

Billing for Worthless Services Billing for items or services that are of such low quality as to render them virtually worthless.

Duplicate Billing Billing two or more times for the same item or service.

Lack of Documentation The medical record cannot support the claim.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.