Banner Health Compliance Training

Prohibited Billing Practices Falsifying Documentation

Billing for items or services based on falsified documentation is a prohibited billing practice. Falsified documentation includes notes of visits or procedures that were not actually performed, documentation that intentionally misconstrues or exaggerates a patient’s diagnosis to obtain more coverage, forged signatures, and false documentation of a physician’s presence during a procedure. Using Incorrect Provider Numbers Billing for services using a provider number not assigned to the providing clinician is a prohibited billing practice. Unless allowed by a specific rule, regulation, or contract provision, bills may not be submitted using the provider number of a clinician who was not the actual provider of the services. Using Incorrect Charge Codes Billing for items or services using incorrect charge code information is a prohibited billing practice. Charge codes, modifiers, and other billing information must accurately reflect the items or services actually provided.