Enhance Compliance With Physician & Physician Group Billing Audits From Former FBI/OIG Agents
Poor billing policies hurt individual and group physician practices beyond creating financial losses. Such policies also put them at risk of extensive government audits. Failing to comply with the latest regulations, improper coding, and other mistakes can turn into disastrous problems for any size of practice. The most successful individual and group physician practices have clear processes that enhance accountability and organization. Many practices that have discovered the importance of an efficient system have trusted us to help them implement it with our physicians billing audit services.
Put our highly experienced team on your side
Dr. Stephen Taylor
Former Special Agent (OIG)
Former Special Agent
(FBI & IRS-CI)
Former Assistant Regional Inspector General
Former Supervisory Special Agent (DOD-OIG)
Director of Coding
Former Assistant Special Agent-in-Charge (HHS-OIG)
Former Special Agent-in-Charge (DEA)
Former Special Agent (FBI)
Common Compliance and Revenue Problems Our Auditors Solve
We analyze multiple aspects of your business to look for improvement areas. These are some common issues we find among individual and group physician practices and how we remedy them.
Physician practices can face legal repercussions when there are fraudulent billing claims. With our professional individual practice and physician group billing audit services, we help practices implement solutions that detect fraudulent claims before they can cause damage. These are some of the common types of fraudulent claims.
Billing for Services Not Provided
In some cases, there may be discrepancies between the services provided and those on the bill. When a service that is billed for is not provided, it is a serious form of fraud. With the proper accountability solutions in place, the risk of billing for services not provided is minimized.
Billing for Unnecessary Services
State plans determine the services physicians can bill for, meaning ethical billing practices are essential. Requirements can vary based on providers. All services that are billed for should be complete, accurate, and medically necessary. Having solutions in place to ensure provided services are necessary can minimize risks.
Billing for Uncovered Services
Some insurance companies refuse to cover certain services. This may happen even when patients are eligible for those services. Billing for services not covered by a patient’s plan can be considered fraudulent.
This type of fraud may occur when a physician’s practice bills for more than what was provided. For example, if a specialist bills by the hour, rounding up the time spent instead of charging exactly for it could be considered upcoding. Also, providing a generic treatment and billing for a more expensive brand-name medication is a form of upcoding. Although this type of fraud can be complex, it is becoming more common today.
Bundling services reduces reimbursement amounts. However, unbundling services to increase reimbursement is a type of fraud. While some physician practices do this in an attempt to boost revenue, there are better ways to grow revenue without breaking laws. Our solutions are designed to maximize efficiency in multiple ways to boost revenue legally for individual and group physician practices.
Lack of Organization
Disorganization puts physicians and their practices at risk. However, that lack of organization is not just limited to medical billing. It often includes disorganization in patient treatment protocols as well. All the most successful practices in the country are streamlined and have well-organized processes that dictate daily operations for patient care, billing, and more. With a more organized system, efficiency improves. That opens the way for revenue growth, better communication, improved patient satisfaction, and more.
Inadequate Staff Training
Some physician practices hire office workers who have limited experience or training. While sending new staff to seminars or training classes may help, that may not be enough. Today, new regulations are continually emerging. Those changes can complicate issues and create problems even for trained staff. Professional audit services make it easier to ensure compliance with new or changing regulations. Also, our company ensures that workers are trained to prevent fraud and detect fraud attempts before they become serious problems.
Lack of Alignment With Laws and Regulations
Insurance companies often change their billing policies, and the government is notorious for changing regulations. Also, billing codes may be changed frequently. It is crucial for individual and group physician practices to adapt to these changes as they happen, which requires a well-planned strategy. Our audit services help practitioners pinpoint deficiencies and develop solutions to correct them.
Missing Revenue Growth Opportunities
In many cases, physician practices miss opportunities to drive revenue. While dealing with the busy challenges of daily operations, they may not even see some of those opportunities. Improper billing for services or supplies, resubmitting previously denied claims, and improper coding are just a few examples of those missed revenue opportunities. With a full physician practice billing audit, it is easier to identify sources of lost revenue. We also help our clients find ways to minimize losses in the future.
Using Outdated Processes
Outdated processes can leave physician practices vulnerable to regulatory backlash. Although we can help practices deal with government audits, our approach is to prevent them in the first place with sound policies and solutions. When we conduct physicians billing audits, we often discover outdated or inefficient processes and replace them with better solutions that solve weaknesses in compliance programs. We can perform audits at financial or clinical levels and complete audits based on specific policies.
Services We Provide
Whether you are facing a government audit or want to take a proactive approach to prevent one, we offer the services to accomplish your goals. Although these are some of the key areas we cover in our physicians billing audits, there are others:
- Auditing Medicare patient charts
- Pinpointing missed charges
- Analyzing core reasons for denials
- Discovering possible liability risks
- Uncovering weak or inadequate billing practices
Our individual practice and physician group billing audit services are available for all sizes of medical practices. Whether your practice is just starting out or has years of experience, we are here to help. Finding the correct entity to assist in billing audits and solutions can be the difference between your practice growing or facing problems. Whenever we work with an individual or a group physician practice, we create a customized strategy that addresses your unique needs. Through our experience of helping many other medical practices and facilities of all sizes, we can identify a wide range of issues that many other entities overlook.
Why Choose Fortis?
Our company is located in Dallas, Texas. While many companies outsource their work to other entities, we take pride in being a job provider in our community. Also, we put a high priority on good communication. One of the common complaints physician practices and groups have is poor communication with a billing audit provider. Another common problem practices experience with auditors is a poor understanding of their staff. We establish clear lines of communication and provide in-depth auditing services to learn the needs of your practice and your staff thoroughly. Also, we are available throughout the process to answer questions and address your concerns.
Our team also has a comprehensive range of experience in several related fields, and our combined experience spans multiple federal agencies. When you want to avoid problems with government agencies, it helps to have former federal agents who know the applicable laws and policies on your side. These are some reasons physician practices choose us:
- Access to former CMS auditors and certified coders
- Experience with hundreds of billing fraud prosecutions and billing audits
- Access to compliance, billing, coding, collection, and other services
- Dedicated support from former OIG and FBI agents
With a strategy specific to your practice’s needs, you are in a better position to increase revenue, improve compliance and strengthen your reputation. You can rest assured that your practice is in good hands with our services. We know how complex the healthcare industry is and how challenging it can be for physician practices to keep up with an ever-changing environment. Our team matches services to different complexity levels to provide a degree of customer care that competitors cannot. With experienced billing auditors, federal investigators, and legal professionals on your side, your practice is leveraged for success. Let our capable team discuss your needs with you. Contact us for a free consultation for an individual physician practice billing audit or physicians group billing audit.