Billing systems

Please read and review the text Chapter#6 “Billing Systems”, Appendix-C Glossary of Reimbursement Terminology and the attached supplemental article from the AARC on RC-related billing Codes. An investigation by the Center for Public Integrity has found that physicians and other medical professionals have steadily billed higher rates for treating elderly patients on Medicare over the last decade- adding an estimated $11 billion to their fees and signaling a possible rise in medical billing abuse. Medical groups argue that the fee hikes are justified because treating seniors has grown more complex and time-consuming, both due to new technology and declining health status. The rise in fees may also be a reaction to years of “under-charging”, and reflect more accurate billing. The fees are currently based on a system of billing codes that is structured to make higher payments for treatments that take more time and effort (more acutely ill/complex patients). However, the Centers analysis of Medicare claims from 2001-2010 revealed that over time, thousands of providers turned to more expensive Medicare billing codes, while spurning use of cheaper ones. They did so despite little evidence that Medicare patients as a whole are older or sicker than in past years, or that the amount of time doctors spent treating them on average was rising.

Based on the information contained in the text, please discuss several of the more common billing errors noted in audits. How can RC managers help to reduce billing errors and unintended fraudulent billing practices? 

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