All medical procedures or services, regardless of medical insurance, will be billed. To keep a record of all medical services rendered, a medical provider must save all the bills related to the patient’s services. In the areas of Medicare and Medicaid, there is a set procedure in place that all medical providers must follow. This means here is no exception to the rule.   

Generally, a medical provider sees a patient and provides a bill. The bill is then sent to Medicare for payment. In the age of sophisticated technology, medical providers use an electronic form which has medical procedure codes, which are generally known as HCPCS or CPT codes.  

The HCPCS or CPT codes provide Medicare with the medical services that were provided by the medical professional. The medical provider will certify that the information is true and correct. Medicare will, in turn, reimburse the medical providers based on this claim.  The problem is there are thousands of claims that Medicare must reimburse.  

The reality is that Medicare does not have the manpower or resources to scrutinize every claim.  For years, medical providers have been getting rich off of the government by billing for services that were never rendered. In essence, there has been no check and balance system for bills submitted to Medicare.  

Medical care providers have an obligation to provide correct and accurate information to the government. In submitting a claim to the federal government, the medical provider is attesting to the fact that the bill is correct for the actual services provided and that they are in compliance with the government requirements for the billing.  

Providers need to know some examples of improper claims which consist of: