Medical Fraud: A Big Dollar Concern

With reports about identity fraud making waves throughout the news media, it’s especially important for those looking at the American health care industry to consider a specific kind of identity fraud that can be especially expensive for victims. Medical fraud is commonly defined as any kind of identity theft that facilitates the use of insurance or medical information which allows for an unauthorized individual to get access to medical insurance, medical care or other services, or that in some cases, allows for false billing or funneling money directly from the victim to the fraud perpetrator. Learning more about it can help you avoid medical bankruptcies or other problems.

The Numbers on Medical Fraud

Although it may be more obscure than other types of fraud, for instance, credit card fraud, some reports estimate that medical identity theft affects almost two million people in America each year, with an overall monetary impact of over $40 billion. Experts also estimate the costs of medical fraud per victim at over $20,000. That means that this kind of fraud can destroy the budgets of many American consumers or families who become victims of this type of identity theft.

Common Scenarios

Experts suggest that some identity thieves pursue medical fraud in order to get insurance coverage through illegitimate means, while others may be looking to get their hands on prescription drugs that they will sell on the black market. But although these kinds of situations can hit consumers or families out of nowhere, other reports suggest that in many cases of medical fraud, there’s a gray area: the victims of these kinds of fraud may have let their family members misuse their medical information or otherwise been complicit in fraudulent claims or other types of identity theft.

Medical fraud is just one way that the average American family can find itself bogged down in medical debt or otherwise trapped in eternal debt cycles. In order to prevent these kinds of nightmare scenarios, it’s important to safeguard identity information and do regular credit checks and basic financial monitoring. You can also get help from third party medical advocates that understand the health care system and how to fight various kinds of financial challenges to make sure that you and your loved ones are not taken advantage of by a system that often generates extremely high costs. Talking to these types of agencies and organizations can help you gain a better idea of how to prevent medical fraud, unfair denials or bills, or any other financial struggle that could have been avoided through good documentation and vigilance. Get the facts and protect yourself against medical fraud and unfair medical debt for a better financial future.

How to Become a Medical Billing Advocate

If you would enjoy a medical billing career but wish to work more on the side of the patients and insurance companies getting billed for medical care, a medical billing advocate position may be ideal for you. Becoming a medical billing advocate is not very difficult and can contain the same education you would receive for a medical billing career within a medical facility. The major difference in your duties is that you won’t be billing patients and filing insurance claims, but acting as a billing consultant that looks over medical bills to ensure there aren’t any unnecessary or mistaken charges or upcoding present. Upcoding is an act that has been found to be fraudulent and consists of patients being billed for a higher level service than was actually received. This is illegal and as a medical billing advocate, you would be pointing out these errors.

Getting a Higher Education

Just like you would attend a medical coding program or related program in order to enter the medical billing specialist position, you would do the same to become a medical billing advocate. You will be responsible for learning appropriate medical terminology and appropriate codes for billing procedures. You will also be trained on the appropriate procedures for pinpointing billing errors and addressing them properly. It is a federal law that all errors must be reported by the physician to the federal regulating agencies, and you will act as the consultant that checks for these errors.

Entering Into the Position

There are many medical coding consulting agencies that offer the position to those that wish to investigate medical bills and billing procedures. Your main role will be inspection of patient bills and decoding to identify any improper charges or upcoding that have occurred. Once the issue is found, the patient as well as the physician is notified and given appropriate details for making the appropriate reporting measures to the correct agency.

Why Become a Medical Coding Advocate

In a world where health care costs are always on the rise, it is important that there are medical coding advocates to ensure that patients are only billed for the services and resources they receive and no more. You will serve as the voice for the patients, and the insurance for the insurance companies that the payments due are necessary and should have been charged. In the event that you are able to identify any type of fraud, you will be able to ensure that the issue is resolved and the patient only charged what should have been from services.

A medical billing advocate holds a key role in the health care industry with a strong influence over the future of this industry. There are organizations that go further to ensure that policies are enacted to provide security to patients from medical billing fraud. Patients may not be able to decipher medical code, so it is up to you to ensure that there haven’t been any mischarged items on a patient’s bill or insurance claim.

What Can a Medical Billing Advocate Do For You?

Terminology and complexity are the rules of today’s healthcare system. Most consumers are not even aware that there may be hidden problems with their bills. When you are busy or not feeling well, you often don’t have the time to do the necessary work to get corrections made. You might not even realize that you are being overcharged!  

All kinds of errors are found on medical bills. We see examples of billing more than once for the same service, billing for services or supplies you didn’t receive, using the wrong diagnosis and procedure codes, unwarranted denials by the insurance company, and plain old human error. All of these causes can add up to you, the patient, paying more than you should be for your health care services.  

Medical billing advocates help individuals review medical bills for errors. We make sure that what you are being asked to pay is something that you actually owe, that you are not being over-billed, and that your insurance company (if you have one) is paying the amount it is obligated to pay.   You can think of us as medical bill analysts too. We analyze your bills and your coverage and make sure you get the benefits you are paying for.  

National reports show that 90% of medical bills have errors, and they are not to your favor! Most people do not ask for and do not receive an itemized statement showing what they are being charged for. If you went to the grocery store and they handed you a receipt that said, “produce $40, meat $100, and canned goods $50, total $190” you probably wouldn’t accept it. Why do we accept these types of bills from medical providers?  

If you are interested in hiring a medical billing advocate, where do you find one? As with most professional services, the best way is through word of mouth. You can also check out billadvocates.com, the website for the Medical Billing Advocates of America. This site offers a feature that allows you to search for an advocate. Since most of what medical billing advocates do is done by telephone and email, it isn’t necessary to hire someone who lives near you. It’s best to hire someone who has a background in health care, insurance, or related fields.  

Many  medical bill consultants conduct an initial NO-COST telephone review to help you determine if hiring a medical billing advocate makes sense for you.  In general, if your advocate doesn’t find savings, you only pay the costs associated with obtaining copies of your medical records. 

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