STATISTICS

Rounding up billing units can be considered fraudulent if it is done deliberately and solely to increase reimbursement. However, Claim Scrubber or Billers can legitimately round up the billing units in certain circumstances. The following are examples of situations where rounding up billing units may be appropriate:

Rounding to the nearest whole number: Rounding up to the nearest whole number is generally considered acceptable, as long as it is done consistently and accurately. For example, if a patient receives 1.6 hours of infusion, rounding up to 2 hours would be acceptable.

Minimum time requirements: Some insurance payers may have minimum time requirements for certain services, such as therapy or infusion. In these cases, rounding up to the minimum time requirement may be necessary in order to bill for the service provided. For example, if a payer requires a minimum of 30 minutes for an infusion session, rounding up to 30 minutes would be appropriate if the actual session time was slightly less.

Payer guidelines: Some insurance payers may have specific guidelines or policies regarding rounding of billing units. In these cases, it is important to be familiar with the payers guidelines in order to ensure compliance with billing regulations.

Dosage requirements: In some cases, the dosage of a medication may need to be rounded up to the nearest available unit, such as when a medication is only available in certain dosages. This should only be done when it is medically necessary and supported by documentation.

Supply limitations: Similarly, if a medical supply or device is only available in certain quantities or sizes, it may be necessary to round up to the nearest available option. However, this should only be done if it is medically necessary and supported by documentation.

Billers and billing companies should always aim to accurately report the quantity of services or items provided, and should not engage in practices that are intended solely to increase reimbursement