Billing Practices That Can Be Costly – Part I

Obviously, to receive proper reimbursement it is very important to have accurate coding practices for all health care practitioners however; here are several reasons.  A group that is often involved in the billing process is nurse practitioners. Generally they are billing for their own services or they may be using a billing form (superbill) provided by their employer by marking procedural codes and diagnostic codes in order to bill for their services.  The responsibility for the accuracy of the coding and billing, as well as for maintaining medical records that support the diagnosis code and procedural code that is being used to bill for specific services, is the professional provider or the nurse practitioner. 

Keeping up to date with accurate coding procedures is very important when billing to receive maximum reimbursement.  However, due to new codes being added, modified or deleted, this may cause an impact on reimbursement.  Sometimes the definition of a code may not be so clear.  That’s why it is vital to utilize sources that are available to the medical community.  Such as workshops, online information and online telephone consultation services for health care providers to get better clarification on a code before billing.

It’s also important to remember that even if billing by the physician or nurse practitioner is outsourced to an outside billing service or a trained billing clerk that is onsite, it is the person on whose professional licensure the care and billing are based is the person that is responsible for accurate billing.  A nurse practitioner or a physician still has to learn something about reimbursement and coding.

Any health care professional who knowingly cheats on coding to enhance their reimbursement, can be guilty of both civil wrongs which is considered a “breach” of the insurance contract, and it’s considered a crime, which can lead to costly legal fees.  Billing fraud can also result in having to return part or all of the wrongly paid money, fines, loss of their professional license and possibly serving time in prison.

How do fraudulent claims get noticed?  There are several ways.  Some insurance carriers have fraud detection software which they use to analyze data.  When unusual billing patterns are discovered, they initiate an investigation.  Sometimes it is the patient that is complaining about the amount of the bill or services that were billed.  Employees have revealed on their good conscience of fraudulent practices and don’t want to be part of the scheme or it violates their own ethics.  Bottom line is physicians or other health care providers who engage in this type of behavior have been costly and have led to them no longer being able to practice in the medical field.

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 



Electronic Medical Records Part I

Electronic medical records are currently the new trend that most physicians are heading towards.  This practice has been a way for physicians to improve the care of patients, reducing costs and to avoid medical mistakes.  On the other hand this new technology may come with some legal risks. 

There are many benefits to using a system of electronic medical records which include being able to read the record without having to worry about sloppy handwriting, immediate access to the records, built-in safety features and also it would reduce the risk of a physician prescribing a medication that the patient is allergic to.

However EMR’s may create some problems.  Some physicians could be sloppy typists and the fact that some physicians will most likely take home the laptop and that poses a problem with the patients confidentiality which could result in a HIPAA violation.  So with this in mind it’s good that physicians or any other healthcare worker that has access to patient records pay attention to the risks that are important to consider.

Here of 5 of the 10 ways to reduce legal risks.

1.  Implement personal and practice policies regarding electronic order entry

Be careful when reading messages from the system.  If there is a multitude of emails being sent often, unsubscribe these unnecessary emails.

2.  Develop a system and policies of what to do when an order occurs when the physician is not at his or her workstation or if the system is temporarily down

There must be in place a system of how to handle this situation if it happens.  For a period of time, physicians may have to go back to pen and paper to record important information for the patients record and later enter that information into the electronic medical record.

3.  Print out progress notes from time to time and evaluate the accuracy of the record

These records should then be evaluated to see if they are easy to follow and read.  They should also be evaluated to see if the record accurately show what the physician did for the patient.

4.  Back-up the records.  Make sure to check the back-up method frequently. 

It’s important to make sure the files are backed up everyday.  If a physician fails to do this, they could possibly lose patient records and have no other way of showing what the physician has done for the patient and also no documentation in the event the physician is sued.

5.  Install virus protection software on server and workstation computers

This is extremely important to install on the computers that are being used for electronic medical record technology in order to avoid a virus infiltrating your system which could be very damaging.

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

Things To Consider When Using An Outside Billing Service

It’s very common for physicians that have a small private practice to a mid-sized group of physicians to feel overwhelmed by paperwork in order to process their billing.  Many physicians now are considering using an outside billing service to handle all of their claims.  It’s good to make sure the person or company you decide to hire has a back-up system and can also handle your billing in a timely manner. 

Important Requirements

Bill only for services rendered

Claims should be correctly coded for services performed

All bills should be submitted in a timely fashion

EOB’s should be read and checked for proper payment

Late payments from patient’s should be follow up on and monitored frequently

Patient’s should be made aware of charges that may not be covered

Charges that were not covered or co-payments should be collected from the patient’s

Provide monthly reports on the status of claims submitted for payment

Before an account is turned over for collections, it should be discussed with the physician first

Complying with HIPAA


A written agreement and contract should be signed and clearly identified within the agreement before signing. Just because the physician decides to use an outside billing service does not relieve them of the responsibility of complying with HIPAA.

Selecting a reputable outside billing service

When selecting an outside billing service it is good to do your homework.  One way is to ask your colleagues for recommendations.  Ask for their references and talk with them.  Below are a some key questions to ask potential outside billing services.

Do you have a written compliance plan?

What billing system do they use?

Can the software they use be networked with the office so that the physician can view billing and collection data?

What are the security and access features to assure HIPAA confidentiality compliance?

Does the system being used have a back-up system that can retrieve information if the computer fails?

Does the billing service educate the physician about accurate coding to get maximum reimbursement for services rendered?

Finalizing the contract agreement

Once you have made your decision on the billing service you intend to use, make sure there is a written contract.  The contract should detail exactly what services you are to receive for the fees agreed upon and also list what services are available for additional fees.

The contract should also include renewal, dispute resolution, and cancellation terms.  If you feel uneasy at first, set a short-term agreement so that will give you time to find out whether you feel comfortable with the billing service and you can test out their service without being held up into a long term contract.