The recent case of a southern California internist becoming a victim of identity theft and billing fraud shook the medical fraternity. The physician’s credentialing numbers, such as her National Provider Identifier (NPI), were used to commit the fraud. The thieves used her identity to falsely bill Medicare for procedures she did not perform. The result: the Centers for Medicare & Medicaid Services (CMS) prosecuted her for the theft of thousands of dollars, equivalent to what Medicare had paid out in claims made in her name by the criminals.

Many physicians have reported becoming victims of such fraudulent billing practices. It is crucial that they to go all out to safeguard their personal and professional information, which is on publicly displayed in the National Provider Identifier (NPI) registry. It’s important to have measures in place for detecting Medicare fraud such as

  • checking a Medicare beneficiary’s ability to pay before waiving copays and deductibles
  • checking rates charged to Medicare patients
  • checking for missing documentation such as physician or nurses notes

The issues that physicians face become even more complex as the nature and challenges faced by medical practices rise. Physicians have to deal with increased regulations and administrative burdens, often meaning less time for patients. Carrying out medical billing practices in-house needs greater focus on revenue and people management.

Most of these issues can be dealt with by medical billing outsourcing to an established service provider. A competent medical billing company would provide a full suite of services that cover the checking of patient information, patient scheduling, patient enrollment (demographics and charges), insurance enrollment, verification and authorizations, coding and audits, billing and reconciling of accounts, EOB Analysis, AR Management and financial management reporting. Many physicians are realizing outsourcing these tasks is the only way to maintain a viable practice and also prevent various kinds of medical fraud.