Medical billing outsource - povider responsibility

Hiring Someone to Prepare Claims - Tips from Medicare

Some physicians and suppliers find it helpful to obtain the assistance of a billing service or consult- ant to submit their Medicare claims. While such entities can provide valuable services, physicians/suppliers must clearly understand that delegating this process does not relieve them from responsibility for overpayments received due to claims filed on their behalf. Therefore, physicians/suppliers should get involved and oversee their billing service or staff. Additionally, before hiring a service or consultant, physicians/suppliers should carefully check references and ensure that the service or consultant:

* Provides periodic reports of claims billed on the physician ’ s behalf and, if the billing service receives the Medicare payments, it should be able to provide data regarding how much Medicare paid

* Protects the physician ’ s PIN and any other information used to act on the physician ’ s behalf 

* Does not change procedure codes, diagnosis codes, or other information furnished by the physician without the physician ’ s knowledge and consent 

* Keeps the physician informed of all correspondence received from Medicare 

Physicians should review information submitted by a billing service or consultant regularly to ensure consistency with their records. They should also keep complete administrative records for the claims a billing service files on the their behalf.

Hiring Employees

The physician is responsible for the actions of his or her billing staff. Therefore, physicians should perform background checks before hiring new employees and conduct periodic quality checks of sensitive processes, such as the posting of account receivables.

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