Remain Compliant with Assistance from Former FBI and OIG Agents
Billing Audit Team Lead – Timothy E. Allen | Former Special Agent (U.S. Secret Service & DOJ-OIG)
Unfortunately, there are several ways that your practice could get into trouble with federal regulations. Incorrect coding and billing are at the top of the list. Your facility’s inadequate billing and coding practices could put you at risk for federal audits, criminal investigations, fines, and other penalties.
While some facilities may think their medical coding and billing procedures comply with all laws and regulations, there is a chance that rules have changed, leaving your facility with non-compliant protocols. Remaining compliant is an ever-evolving process. You must ensure all laws and regulations are followed.
What separates successful healthcare facilities and practices from unsuccessful ones is how they stay organized. Thriving organizations understand that processes and protocols must promote accountability. All staff members play a role in helping your facility remain compliant with billing and coding procedures.
Whether you want to establish a new program or implement a few changes, trust the team at Corporate Investigation Consulting to help with these tasks.
Put our highly experienced team on your side
Roger Bach
Former Special Agent (OIG)
Timothy E. Allen
Former Senior Special Agent U.S. Secret Service
Chris J. Quick
Former Special Agent (FBI & IRS-CI)
Maura Kelley
Former Special Agent (FBI)
Ray Yuen
Former Supervisory Special Agent (FBI)
Michael S. Koslow
Former Supervisory Special Agent (DOD-OIG)
Marquis D. Pickett
Special Agent U.S. Secret Service (ret.)
We Can Improve Your Compliance and Boost Revenue
Without a compliant billing and coding program, your facility could face significant problems, such as:
Lack of Organization
With so many rules, regulations, and laws, it is vital to remain organized. Some of the most prosperous practices have streamlined the internal process to ensure all aspects of the facility are organized and compliant. Staying organized can be easier said than done. You need a trusted team to help your facility find the ideal solution to keep it organized.
At Corporate Investigation Consulting, we will help you find the best practices to implement in your facilities. With that, you will not have to worry about opening your facility up to potential liabilities or losing revenue because of inefficient organization.
Additionally, we focus on other aspects of your practice. Our team will enhance the patient experience for everyone. With accurate billings, streamlined medical care, and proper codings, we can help your practice deliver a first-class experience to your patients. If you are ready to find a better way to organize your practice and deliver those exceptional results to clients, contact our Corporate Investigation Consulting team.
Accusations of Fraudulent Claims
Any fraudulent claims will have a negative impact on your practice or facility. When you work with an experienced team to assist with medical billing and coding, you will not have to worry about these fraudulent claims. With our medical coding auditing services, we can detect any fraudulent activities before they can become a problem for you. In most cases, you can resolve the issue before attracting the attention of federal auditors or investigators. Some of the most common fraudulent claims include:
Billing for Non-Covered Services
Not all services are covered by an insurance company. In those instances, the patient may be ineligible for the service. If the facility bills for the treatment, it could be deemed a non-covered service, leading to an accusation of fraudulent billing.
Billing for Unnecessary Services
When team members sign off on the billings, they ensure the services are medically necessary, accurate, and complete. While the requirement will vary depending on the insurer, you must ensure that your billing protocols adhere to ethical billing practices established under state and federal regulations.
Billing for Services Not Provided
While this issue is uncommon, it is the basis for a claim of billing or insurance fraud. Unfortunately, some practices and practitioners could bill for services not provided to the patient. When that happens, it can lead to serious legal liabilities. By establishing a strict and efficient accounting system, you can document which services were provided to the patient to ensure proper billing.
Unbundling
Some providers and facilities may want to bill in a way that allows them to recover more money from an insurance company. Unbundling is one type of practice. With that, the services are billed individually to receive more from the insurance company. When the services are bundled, it will reduce the amount of reimbursement to the provider or facility.
Upcoding
When a facility or provider bills for more services than provided, that is known as upcoding. Once again, these practices can lead to an investigation of insurance fraud. Upcoding can include billing for brand-name medication when a generic was used or rounding up the provider’s time to half-hour increments.
Improperly Trained Staff
Unfortunately, your protocols and practices are only as good as your staff training. You can send them to seminars, classes, and training sessions, but it is all for nothing if they need help understanding how to implement the best billing practices. Today’s regulations and rules are constantly evolving, and your team needs to understand these changes to risk the chances of being non-compliant.
When you work with us, we will help you understand the business aspect of billing and coding. Once you know the importance of these practices, you can efficiently train your staff on these measures. Our skilled medical coding audit team has experience with preventing medical fraud. With our assistance, we will help you find and implement the best practices in your billing and coding department to avoid any legal liabilities.
Lost Opportunities To Increase Revenue
All practices and providers want to boost their revenue. In many cases, the answer is in plain sight. Often, practices may forget to resubmit denied claims, underbill for services and supplies, or miscode claims. All those issues can lead to lost revenue for your practice. With a medical billing audit, our team will help to uncover those discrepancies, which can lead to adding a boost to your bottom line.
Billing Policies Do Not Align With Current Regulations and Laws
Insurance companies and government programs regularly change their regulations and laws. Also, billing codes can face frequent changes. If you want to remain compliant with these regulations, you must have the right billing policies to follow these changes. When you work with us, we will provide you with a professional medical billing audit that can determine where you need to focus your efforts. We understand that full compliance can lead to higher revenue for your facility or practice.
Many practices continue to use outdated protocols and processes that can lead to legal liabilities. You never want to continue with “business as usual” and wait for a federal audit. Taking a proactive approach can pinpoint any weak points in your compliance programs. With that, you will be able to address those issues before they become a problem for your practice. We can conduct an audit at any level, helping you manage your organization’s specific needs.
Choose Corporate Investigation Consulting for Your Audits
Whether you have a small practice or a large facility, we will provide you with high-quality medical coding and billing audits for your healthcare organization. We do not offer a “one-size-fits-all” approach. Instead, we will focus on giving you a custom-tailored solution that will address any concerns and needs in your practice. Some areas where we can help include:
- Auditing Medicare patient charts
- Discovering reasons for billing denials
- Finding weak billing practices
- Locating missed charges
- Determining any areas of potential liabilities
If you are currently facing a federal audit or want to avoid one, Corporate Investigation Consulting is ready to help. We will provide you with the most efficient and comprehensive medical coding and billing audits in the industry. There is no second guessing with our services. We will pinpoint any problem area and find solutions to resolve them.
Our team wants you to understand every aspect of the practice, including those vital business procedures. Billing and coding in the healthcare industry are very complex. Without the proper understanding, your practice could be non-compliant with federal regulations.
At Corporate Investigation Consulting, we will provide you with the highest level of service. We were founded by a federal attorney who has extensive experience in the medical billing compliance field. Additionally, our team is composed of former federal investigators, skilled lawyers, and experienced billing auditors who understand the intricacies of healthcare compliance. With that, our team will ensure that your practice or facility remains compliant as you gain a competitive edge over other practices in your area.
We Are Passionate, Dedicated, and Committed To Our Clients
With our services, we want our clients to avoid any issues with federal regulations and audits. However, problems can arise, requiring you to seek out the assistance of a professional team. When you need to respond to government audits or charges, we will defend you every step of the way.
We distinguish ourselves in numerous ways. We want your practice to succeed. Whether you need to fight federal accusations or wish to have a thorough audit, the team at Corporate Investigation Consulting is ready to provide our assistance to you.
Minimize Your Potential Liabilities With Our Medical Billing and Coding Audits
If you want a comprehensive audit conducted on your medical practice, there is only one company to contact: Corporate Investigation Consulting. We will ensure all your needs are met with our thorough billing and coding audits. We can help you understand the business side of your practice.
Determining your weakness and straightening your practice can lead to more revenue for your facility or practice. If you want to take your medical practice to the next level of success, reach out to Corporate Investigation Consulting. You can contact us online or call us at (866) 808-4160.