You want to optimize your revenue cycles and generally balance the tasks of patient care and day-to-day administration so you may reach out to a third party service to effectively outsource some of the work. This can be an effective way to plan for the future or expand a busy practice, but there are also some risks to this kind of process, if you don't practice thorough due diligence.
While legitimate third party services can help streamline billing cycles, educate patients and provide other key parts of making your healthcare practice run smoothly, not all third party medical billing and administration offices are equal, and some can actually have a very negative effect on your patients. With some of the rules in place in today’s healthcare market, the burden is on you to carefully research who you are hiring.
HHS Guidelines on Vendors
Recent notices from the Department of Health and Human Services Office of the Inspector General show that the OIG maintains an “excluded entities” list. This list includes firms that have practiced Medicare or Medicaid fraud in the past. The problem is that not all of these offices are readily identifiable and some of them may be handling new business for many doctor’s offices around the country. In most cases, the provider may be ignorant of any past wrongdoing, but the HHS is warning that this may not make the practice immune from significant fees and penalties. And, the government agency states it will not honor claims generated by these blacklisted parties.
The new reports from HHS are largely aimed at ambulatory surgery centers or ASCs, otherwise known as outpatient centers, where patients can get minor surgery and leave the premises the same day. But many of these kinds of guidelines can also affect individual family practices and specialists, as well as parts of larger health networks. The federal government is making strides to crack down universally on fraudulent billing as Medicare and Medicaid fraud remain significant concerns.
OIG resources
The good news is that the Office of the Inspector General does maintain a searchable list of excluded parties online. A quick search can make a big difference in whether your chosen third party service will provide you with a stable patient financial strategy or drag you down into legal liability. Don’t neglect the research that’s required to choose the best firms that have a clear track record with government agencies.