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Risks of malpractice and negligence in the medical billing industry


The risk of malpractice and negligence is hurting the medical billing industry. Here’s a brief article talking about various risks involved with these threats to practices, clinics, and coders.

Extreme damages are rare due to medical billing malpractices, frauds, and negligence; however, various risks involved with these threats were surfaced during the pandemic.

Medical billing agencies usually decode healthcare specialists' notations and the insurance agency's necessities. A misstep could mean refusal by the insurance agency to pay for their services. Almost 50% of all Medicare claims contain errors.

Malpractices in medical billing

If a medical professional fails at performing required medical services, performs the wrong treatment or gives the wrong diagnosis, there can be a legal consequence. Most healthcare professionals, clinics, and hospitals require professionals to carry malpractice insurance.

Conversely, medical billers don't deal directly with patient care and aren’t responsible for the actions of medical professionals. This makes them ineligible for medical malpractice claims; however, a mistake by medical billing agency may result in financial loss to the medical practice or a patient. Although these mistakes won't directly affect medical treatment and care to the patient, it was observed in 2019 that more than half of patients owe $1,000 or more to their doctors. Is this due to negligence?

Negligence of the agency

Even though medical billers and coders won’t receive medical malpractice claims, they can face legal actions for negligence for their mistakes. For example, if a medical billing agency's error resulted in major financial loss to a patient or even the practice, they might be sued to reclaim damages. Currently, double billing is major issue faced by this industry—over 411,000 seniors faced double-billing for their Medicare premiums in September 2019.

Most of the time, an error on a claim can be covered by filing a new claim; however, a medical billing services provider might lose their contract and might have to face serious legal actions.

Risk of Privacy Breach

In some events, agencies face legal actions due to negligence with patient privacy. Violation of the Health Insurance Portability and Accountability Act (HIPAA) can be a risk for a medical billing service provider if they reveal private information without a patient's permission.

If a medical biller exposes such information, they can be subject to penalties, even if the reveal happens due to mistakes.

Protection against liability

An independent biller or medical coder can protect themselves with a professional liability policy against claims for damages. Here, policies may differ. If you are a medical billing service provider, you need to discuss your policy with your insurance provider.

You could also acquire a "named perils policy" which gives extra coverage to incidents like privacy breaches. If you are handling medical billing in-house with a medical clinic, hospital, or practice, you can check the policy with your employer to see if it covers you as an employee.

If you are worried about such risks and threats to your practice, you can get in touch with an expert medical billing agency and they will help you assess the situation and determine if you need further assistance.

Author Bio
Harisudan is the CEO & founder of 24/7 Medical Billing Services, a revenue cycle management company that helps practices boost their practice performance & increase their revenue through custom billing solutions. Drop an Email to Hari here to know more.
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