One way to help keep your practice operations squeaky clean and in compliance with fraud and abuse laws is to develop an internal set of warning indicators.
These might include:
- Significant changes in the number and/or types of claim rejections and/or reductions,
- Correspondence from carriers and insurers challenging the medical necessity or validity of claims, Illogical patterns or unusual changes in coding patterns or usage, and
- High volumes of unusual charge or payment adjustment transactions.