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Deceptive Medical Billing Practices and Your BI Investigation

Deceptive medical billing practices are always a challenge, but nowhere is this more evident than in third party bodily injury demands.

By Christopher Tidball | Updated on June 05, 2014

Deceptive medical billing practices are a challenge irrespective of the complexity of claims being presented.  From upcoding and unbundling to modifier abuse and improper global surgical edits, figuring out what is REALLY owed can be one of the greatest challenges for adjusters.  Perhaps nowhere is this more evident than when it comes to third party bodily injury (BI) demands.

When a demand for an injury is received, there will be consideration for both special damages, providing compensation for economic loss, as well as general damages to compensate for pain and suffering. While both areas can be challenging, it is special damages that warrant particular scrutiny. Specials are often used as a foundation upon which large demands for generals can be made.  Because of the opportunistic nature that personal injury claims can pose, it has become more important than ever to conduct a thorough medical bill review.

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