Primary Error Outcome

The claim is usually denied if the claim does not show medical necessity or if the diagnosis does not correlate to the procedure.

Paid Wrong Providor

If the physician billing number is wrong, the wrong provider can be paid and reported incorrectly to IRS.

Paid Incorrectly

If too many or too few units, days of services or number of products are billed, the payment will be underpaid or overpaid.

Abuse

Billing abuse occurs when the same type of error is made continuously and the provider does nothing to correct the error, even when the provider knows he should educate the biller to bill correctly.

Fraud

Billing fraud occurs when a provider has knowingly billed incorrectly from the beginning and does not care that it is wrong. Common billing fraud is billing for services never rendered, the number of units billed being inflated in number or stealing patients' insurance identification numbers.