Physicians are being heavily penalized for overbilling! Are you at risk?

Physicians are being heavily penalized for overbilling! Are you at risk?

Physicians are being heavily penalized for overbilling! Are you at risk?

Oops another Medicare scandal has rocked the healthcare industry!

Every now and then a Medicare scandal hits the headline and sends the healthcare industry into, a, frenzy. Ranging from carefully orchestrated scams to genuine mistakes and oversights, Medicare inspections and fines have almost become de-rigeur. Recently a Michigan based gynaecologist was in the news for overbilling routine visits.

The executive director of the American Medical Billing Association, Cyndee Weston, expressed concern over the physicians’ billing method. “I can’t see a situation where every visit would be a level 5, especially on an established patient”, she said. Physicians who are the black swans in the lake are more likely to be identified and penalized.

A report by the US department of health and human services found that Level 4 visits have increased by 15% and conversely Level 3 visits decreased by 8 points. This shows that physicians have either been deliberately overbilling or have lost their way amongst the wilderness of pre-designed EHR billing templates.

There have been repeated complaints about EHRs fostering a culture of overbilling. They induce physicians to click and pick from a limited set of codes. Automatic alerts and auto-generation of codes is another reason why overbilling errors are on the rise. Cloning, carrying forward medical data, copy pasting records and relying too heavily on templates are one major reason for overbilling errors.

The Harvard affiliated CIRCO analysed 147 EHR related claims and found that inaccurate medical information topped the list of errors. Documentation errors mean erroneous claims erroneous claims can lead to overbilling errors which means the next time a Medicare audit is around the corner, your practice runs the risk of being penalized.

Medicare Auditor General MacPherson says that about 53% of Medicare payments are being audited.