Discussion Topic: Billing Audit Scenario
You are a lead certified billing specialist working for a large successful internal medicine practice. The practice is comprised of 10 physicians, three (3) nurse practitioners (NP), five (5) medical assistants and four (4) billing and coding specialists (including you). Your office manager has asked you to assist her with the recent Medicare RAC audit that is being conducted on 75 random charts.
During your review of the documentation and claims that were submitted, you discover that two (2) of your veteran physicians and one (1) nurse practitioner have been billing for services that were not rendered and or upcoding visits totaling approximately $250,000.
What will you do upon discovering this?