Billing Practices That Can Be Costly Part II

In part II of this article we will further discuss costly medical billing practices. In some cases, these have led to the loss of medical licenses for false reports include billing unnecessary services, double billing, upcoding or altering CPT codes, unbundling and false diagnoses. 

Unbundling is when you charge separately for a visit or a procedure that is normally part of another procedure or visit.  Double billing is when you bill for the same procedure multiple times on different dates. 

Upcoding refers to using a higher procedural code than what was performed.This includes billing for services that the patient did not receive or using codes that are at a higher level of what really took place during the visit or procedure.  Some examples of that are where a practice submitted bills for office visits for established patients on days where the office was closed, where the physician was not in the office or on vacation and on holidays and weekends when the office is closed. 

Another example is when a physician billed for office visits for parents and siblings when one child was brought into the office for a visit.  The parent had never been seen before but the physician used all the information provided for the insurance where the parent was the subscriber of the health plan, so it was easy to gain access to bill under the parent as well as the child.

Some health care providers advertise “free” services.  When the patient arrives it appears to be a “free” service but ends up being charged for the office visit and other procedural codes.

Other costly practices include failure to produce or complete medical records, which are required to back up billing codes, delegating treatment to individuals that are not qualified or it is not in their scope of practice, and performing procedures and tests that are not with valid consent from the patient.

Billing fraud leads to higher premium assessments by the insurance companies.  HIPAA prohibits billing for medical services “that a person knows or should know are not medically necessary.”  Also violating HIPAA laws and guidelines can result in monetary penalties up to $10,000 and an additional cost of 3 times the dollar amount for each claim.  These crimes are also punishable by up to 10 years in prison or even life in prison if a patient dies as a result of fraudulent activity.

Billing fraud is costly for all those involved, the practice, the doctor and their license and more importantly the patient.  Fortunately, most health care providers are honest and dedicated to helping and providing the best care for their patients and only want what’s best for them and their medical practice.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

Click here to read testimonies regarding MariAnn Medical Billing Service

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Medical Practice Management Tips Part II

In part one of this article we discussed ways to avoid gaps in the schedule due to no shows, offering patients more services and creating a niche to get new patients.  We’ll now be discussing two more areas that will help to increase revenue and lower costs. 

 1. Multiple physician practices where some are pulling their weight and others are not and how to deal with those who aren’t

 Many offices have more than one physician on staff, usually there is a senior physician who runs the practice or has been there the longest.  In order for the practice to run smoothly all partners should have a part in working towards the common good of the practice.  The senior doctor shouldn’t carry more weight than the other partners.  When a physician is underperforming, a discussion should happen to determine what they need to improve on and this should not be a singled out plan but should be done as a united group.

 Their should be a spokesperson to address these issues with the other physicians backing up the claims as a whole.  This will come across better to the physician and he or she will not feel like it is one person’s opinion.  Stress to the physician that it’s only in their best interest as well as the practice that these issues be addressed.

 2.  If a patient’s check bounces, how to still receive payment

 The physicians practice should not only have a financial policy already implemented but it should also include in that policy on bounced checks and what the steps the office will take to receive that payment.  Most banks charge for a returned check, this fee should be charged to the patient.  Some states allow you to charge a processing fee above the bank charges, these both should be stipulated in the financial policy that the patients signs.  The “National Check Fraud Center” lists the bad-check laws for each state.  This also should be in the financial policy which explains and proves that you are legally allowed to collect these fees. 

In order for physicians to have an increased flow of revenue they should make available every method possible for payment such as cash, checks, credit cards, debit cards or ability to pay their bill online with a service such as PayPal.  When accepting checks, there is technology such as a check scanning system from a company that can guarantee that a patient’s check will clear.  The money is directly deposited into the practice’s bank account and there is no need to make a trip to the bank to make the deposit.  Most of these services do have some fees involved but if you consider the time and effort to collect the money otherwise is well worth it.

Marina Hall is a Certified Medical Reimbursement Specialist (CMRS) and founder of MariAnn Medical Billing Service. To read a full “Interview with Marina Hall” visit her website at

Click here to read testimonies regarding MariAnn Medical Billing Service

“Like” us on Facebook at