Season 7 - Episode 48 - Monday Auditing, Coding and Compliance Roundtable

The Compliance Guy

Summary

The conversation revolves around the topic of padding medical bills and the importance of clear communication with patients regarding their financial responsibilities. The speakers discuss instances where unnecessary charges are added to the bill, such as billing for lifestyle medicine codes during a visit for a finger fracture or adding charges for services that were not provided. They emphasize the need for providers to stay in their lane and let the billing office handle financial matters. The conversation also touches on the No Surprise Act and the importance of notifying patients about potential changes in billing during procedures. Overall, the speakers stress the importance of running a compliant practice and ensuring patients are not surprised by their financial responsibilities. The conversation covers various topics related to compliance and healthcare, including personal anecdotes, the importance of commenting on proposals, the need for a collective voice in healthcare, the impact of fee schedule reductions, the complexities of telehealth, the role of contracts in telehealth, and the significance of having an effective compliance program. The main takeaways include the importance of staying informed and engaged in healthcare policy, the need for healthcare professionals to advocate for themselves and their patients, the value of having a strong compliance program, and the potential consequences of non-compliance.

Program Takeaways

• Providers should avoid adding unnecessary charges to medical bills, such as billing for services that were not provided or adding charges for unrelated conditions.
• Clear communication with patients regarding their financial responsibilities is crucial to avoid surprises and maintain a good patient-provider relationship.
• Providers should let the billing office handle financial matters and stay focused on providing medical care.
• Understanding and adhering to the rules and regulations set by insurance companies and government programs is essential to avoid compliance issues.
• Providers should have a waiver of liability or an advanced beneficiary notification in place for procedures that may convert from preventive to therapeutic or diagnostic services.
• Running a compliant practice includes educating providers on coding guidelines and ensuring proper documentation to support billed services. Stay informed and engaged in healthcare policy
• Advocate for yourself and your patients
• Have a strong compliance program
• Understand the potential consequences of non-compliance