Does the Billing Company Have a Compliance Plan?
One of the most important components of doing your due diligence in hiring a billing company is to ensure that they have an active compliance plan. In fact, having a compliance plan should be a hiring requirement. Having a compliance plan is imperative and, at the least, shows the billing company’s commitment to follow all federal and state rules. The Office of Inspector General (OIG) has reiterated that physicians remain responsible to the Medicare program for bills sent in the physician’s name or containing the physician’s signature, even if the physician had no actual knowledge of any billing impropriety. In addition, OIG has a long-standing concern that arrangements between a billing company and providers based on a percentage of collections may increase the risk of intentional upcoding and similar abuse of practices. Although, these agreements are not outlawed, OIG is keeping a watchful eye on any irregular billing patterns. In the meantime, the OIG stated that, to the extent a billing company contracts on a percentage basis, the billing service must not receive Medicare payments on behalf of the physician into a bank account that it solely controls. A billing agent cannot bill claims under its own name or tax identification number, nor could a billing service have the Medicare payments sent directly into a bank account over which the billing service maintains sole control. Rather, the billing company must bill claims under the physician’s name and tax identification number, and the payments should instead be deposited into a bank account over which the physician has control. In order to ensure compliance with the law, the Centers for Medicare and Medicaid Services (CMS) has instructed carriers to obtain documentation concerning the billing arrangement where there is evidence that the rules are not being followed. OIG recommends that billing companies have a fraud and abuse compliance plan in place. On November 30, 1998, OIG released its guidelines to help third-party medical billing companies detect and fight Medicare and Medicaid fraud and abuse. In the OIG’s guide, it recommends a bilateral reporting system. Thus, if a billing company discovers credible evidence of misconduct of its client’s activities, the OIG recommends the billing company report such conduct immediately to the appropriate government authorities. In such cases, the billing company should refrain from submission of questionable claims and notify the provider in writing within thirty (30) days of such determination. Where the misconduct is continued or fraudulent, the billing company is advised to:
The OIG does not believe that misconduct includes “inadvertent errors or mistakes.” “Continued misconduct” includes “patterns of misconduct, particularly with respect to conduct that previously had been identified by the billing company or carrier as suspect.” The OIG guidance directs billing companies to focus on the following seventeen (17) risk areas, both in their own and their clients’ operations:
The Compliance Program Guidance for Third-Party Medical Billing Companies is posted on the OIG’s website. (Access at https://oig.hhs.gov/fraud/docs/complianceguidance/thirdparty.pdf) Overall, you should select a billing company that complements your needs and matches your practice culture. In addition, you should see significant savings in money and time. Furthermore, you should have enough assurance that you are dealing with an ethical and reliable company. A good match will ensure your business success, however, a bad choice will have a drastic negative outcome.