Providing excellent patient care while running a successful company is a delicate balancing act for healthcare practitioners. Unintentional fraud is a major danger that may catch even the most careful suppliers off guard. Even if you swear, “I’d never commit fraud,” the truth is that most fraud cases are accidental. It might happen as a result of basic human error, inadequate paperwork, or a failure to fully grasp intricate healthcare legislation. Here are nine tried-and-true methods for safeguarding your practice from accidental fraud, allowing you to devote your full attention to your patients.
Keep Yourself Informed About Regulations
What was acceptable compliance a year ago may not be today due to the ever-changing nature of healthcare laws. A person cannot use ignorance as an excuse for deception. According to Nicholson & Eastin LLC, a group of healthcare fraud lawyers, “Always be up-to-date on all the latest coding changes, Medicare and Medicaid billing regulations, and more. Regularly examine any relevant changes.” Setting up frequent training sessions to ensure that everyone knows their part in avoiding fraud is just as vital as keeping your employees informed.
Put Money Into Training for Compliance
Your workers greatly influence compliance with your practice. Employees’ lack of knowledge about what constitutes incorrect billing or coding is a common cause of accidental fraud. Invest in continuous compliance training to protect your practice. This should cover everything from proper patient data management and record-keeping to correct medical coding and billing methods. The training you receive should be customized to meet the unique requirements of your practice and should include a thorough review of all applicable legislation. An effective team is the first barrier to preventing fraud that may result from unintentional errors.
Talk to an Attorney About Healthcare Fraud
Intentional or not, there are situations when you should seek the advice of an attorney to safeguard your practice against fraud. An attorney specializing in healthcare fraud can help you understand the risks facing your business and the measures you must take to remain in compliance.
Recruit an Expert in Medical Billing
Coding and medical billing are intricate processes with little space for mistakes. False claims may arise from even the smallest of errors. Hiring a qualified medical billing expert or contracting with a dependable third party to handle your bills is a great approach to safeguard your practice. Codes, modifiers, and claim filing are all areas in which these experts excel. More than that, they learn to recognize warning signs that might indicate fraud is taking place. You may ensure compliance and lessen the likelihood of unintended mistakes by outsourcing your billing to experts.
Establish Strict Internal Audit Procedures
It is still possible for errors to occur, even with a highly trained staff. By conducting internal audits regularly, mistakes may be caught before they escalate. Audits are a great way to check whether everything is in order with patient records, billing, and coding. Use an outside expert or third party to conduct the audit if you want an impartial opinion. To address problems proactively, it is recommended that comprehensive audits be conducted regularly, such as quarterly or biannually.
Thoroughly Record Everything
Having thorough documentation is crucial in the healthcare industry. Improper billing resulting from inaccurate or incomplete patient data can inadvertently trigger a fraud alert for your clinic. Be careful to meticulously record all services rendered, including appointment dates, timings, and specifics of any procedures or consultations. Legal ramifications can exist if the paperwork doesn’t back up the services claimed. If your practice is inspected, too much documentation is preferable to insufficient since it provides a safety net.
Foster an Open Environment
The possibility of accidental fraud decreases when your practice is open and honest. A culture of seriousness about fraud prevention may be established when team members are encouraged to freely report errors, ask for explanations, and debate billing issues. In addition to ensuring your employees are aware of the consequences of accidental fraud and the significance of accuracy, you should encourage an atmosphere where employees feel safe disclosing mistakes before they escalate. To promote, a whistleblower policy may be set up to provide employees with a safe channel to disclose issues.
Use Up-to-Date Software
Inaccuracies that set off fraud investigations might occur when billing and record-keeping software is old. You can keep up with the ever-changing requirements using the built-in compliance capabilities of modern healthcare software. Common code ideas, automated billing systems, and error alerting may all help to avoid accidental fraud. You must regularly update your practice management software and include compliance checks to detect inconsistencies before submitting claims.
Keep an Eye on Things
No one on your staff should have unrestricted access to any parts of your patient or billing records. The greater the number of people accessing your data, the greater the potential for human error and, by extension, fraud. Limit access to critical information to authorized individuals only by establishing role-based access controls. Because of this, the possibility of accidental fraud due to staff members making modifications without authorization or filing false claims is reduced. Keeping tabs on who has access also simplifies finding and fixing problems.
