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Federal Agencies Change Rules for Handling Medicare Claims

April 02, 2012 | Comments: 0 | Views: 149

Media reports recently focused on an announcement from the office of Inspector General that clarifies some of the rules around Medicare billing. For billing in Medicare situations, a provider receives a specific provider ID number or NPI. Federal officials are reminding doctors that they need to know who is using this number to bill the government for Medicare, and doctors who are not taking this warning seriously can become embroiled in situations that can leave them with undeserved black marks on their reputations.

The recent notice comes after more than a few providers have been charged with Medicare fraud after ceding control of their NPI number to a fraudulent third party. When physicians and medical office administrators release this information to third party firms that provide billing services, the results can be profoundly negative if the third party business is not operating with integrity and billing the government accurately for Medicare claims. Fraudulent third party use of Medicare billing information is part of a larger issue in all 50 U.S. states where dishonest providers also may bill Medicare in fraudulent way. As the federal government allocates money and resources to punishing fraudulent Medicare billers, honest physicians and offices need to be vigilant about who uses their NPI and how they provide documentation for accurate Medicare billing. Doctors need to understand that they may be judged by Medicare and other outside auditors according to the "letter of the law," and that when it comes to the services that are billed to these government programs, each one had better be fully documented with reasonable ICD coding and a clear support of medical necessity, along with other compliance protocols that will assure auditors that the services were, in fact, performed as described.

Medicare's site contains a Provider Enrollment, Chain and Ownership System or PECOS, which may help to alleviate some of the confusion among physicians by creating a record of who has authority to use their NPI number. This process also provides more monitoring of Medicare billing that may clear up some issues with a third party abusing a provider's NPI. Still, the bottom line is that as a physician, you don't want somebody billing on your behalf without a thorough understanding of whether that party handles claims with accuracy and integrity. Check with your third party billing system to be sure that these services are correctly carrying out your intents and purposes with regard to government programs like Medicare.

Source: EzineArticles
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Third Party Billing


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