Healthcare Insurance Compliance
One of the most difficult aspects of providing healthcare to those that need it most is that they often have government health insurance. This insurance (Medicaid) carries its own set of rules and regulations that must be abided by and also has its own punishment procedures for fraud and other practices of abuse. What this means is that a simple mistake could cost the provider who is billing Medicaid a lot more than it would with other, private, insurance companies.
Thankfully, there are many different companies out there that run businesses that are designed to help alleviate the fears of providers and assist them in being sure that they are in compliance with the regulations. Because of the ever evolving nature of healthcare, it is important that each provider know what are considered to be acceptable treatments for their patients before pursuing any treatment plan that they intend to bill Medicaid.
Once the treatment is completed (or at least ongoing), it is then up to the medical billers to properly complete the documentation that they send to Medicaid in order to receive payment. Taking extra care to be sure that what they are entering is acceptable according to Medicaid is important as is being sure that they aren’t double billing or unintentionally wasting the funds of Medicaid as that could carry serious penalties for waste and abuse of the system. Additionally, it’s important to remember that errors will happen and that the best solution is to remedy the situation as soon as they are noticed and not wait for contact from a Medicaid Integrity Contractor.