Problem
I. What are the reasons that health care providers contract with third-party billing companies to submit their claims for reimbursement from payors such as Medicare?
II. The compliance concerns of the billing companies are intertwined with those of its provider-clients. Those clients can create problems that lead to legal liability for the billing companies. How can the companies reconcile this potential conflict between them and their clients?
III. List five benefits that billing companies receive from operating a good compliance program. (Just listing is fine).
IV. The policies and procedures in a mandatory compliance program should address those areas of company operations that are most vulnerable to misconduct leading to fraud and abuse. These are the company's "risk areas." There are over 20 of them. Identify five and explain them.