providers

Many holistic and non-physician providers don’t understand their risk of billing fraud. To learn more, read these case studies related to practices that suffered due to inaccurate coding, business relationships, billing errors, and misunderstanding the regulations governing insurance claims.

A cash practice is not a defense against fraud because you can’t prevent your patients from filing a claim with their insurer for your services. Once the insurance company enters your bill into their system, it becomes a claim and is subject to the False Claims Act rules. In 2020, the False Claims Act minimum penalty fine was $11,000 per claim. To learn more about how this law is enforced and potential consequences of violation, read this information published by the federal government.

Most providers associate HIPAA with patient privacy and data security, but they don’t understand that HIPAA also covers Fraud and Abuse/False Claims. You could be subject to violation of HIPAA Title II by submitting a claim with incorrect coding. We are experts in training medical billers to code correctly to reflect your entire scope of practice. Our services help you establish internal controls to avoid violation of Fraud and Abuse under HIPAA.

Most providers don’t understand that insurers can be fined for paying for an illegal service. We set up your integrative practice correctly to assure payers that your practice is in compliance with federal and state regulations - before you file insurance claims. Then, we facilitate communications with the insurance companies so that they are paying for your full scope of practice and training. We do this by making sure your credentialing information is available and current within a system that is used by over 90% of the insurance industry to verify provider credentials. We also ensure that your credentials are reflected in your NPI. By making your training visible to insurers, we can then hold them responsible to follow the provider non-discrimination clause of the Affordable Care Act. We demonstrate the steps your practice has taken to reduce risks. This attention to detail reduces the insurer’s liability as well as yours.

We’ve created a webinar that details our process and what you can expect when you engage with our services:

Many providers are not aware that they limit their billing capabilities by not using the right codes to describe their training. They also rely on inaccurate codes to describe the services they are billing, further limiting their chances for reimbursement.