Words to the Wise – And How to Use Them

It is far too easy to be accidentally tripped up by a careless word choice. As anyone who has ever annoyed a friend or partner knows, poor wording can come back to bite you. And that is certainly true in the world of compliance. Here are some words that are commonplace, but shouldn’t be. 

First, “fraud.” And not just because of the alliteration. Avoiding fraud is such a priority that the word is often on the tip of many a provider’s tongue. But labeling an action as “fraud” greatly limits your defenses. I never want to characterize my client’s conduct as fraud. If I use the word at all, it is typically expressing concern about how someone ELSE might use it. “Someone might try to label this as fraud.” But even that phrasing isn’t ideal.

Similarly, “overpayment” is worth banishing from your vocabulary. Once money is referred to as an overpayment, you are effectively admitting you billed improperly. I’ll talk about making a refund, but try to avoid saying I’m returning an overpayment.

“Required” is another word that seems pretty innocuous, but is potentially loaded. A legal requirement is very different from a corporate expectation. My law firm has a “requirement” that we return calls within a day. But that’s not a legal requirement. I try to limit my use of the word “requirement,” or, if I’m using it, specify exactly who is imposing the obligation. A statement that, as a matter of policy, the company requires “X” is very different than a more generic statement that “X is required.”

This might be a good time to also mention that the passive voice has a tendency to create trouble. Rather than stating “documentation is required,” which is passive, explain that the organization requires that you have documentation. The active voice makes it clear that it’s a corporate policy, not a legal obligation. There are times when documentation is an explicit legal requirement. In most states, Medicaid requires documentation. But for most Medicare services, documentation isn’t required. I strongly believe that organizations should expect complete documentation even when it is not a condition of payment. But broad use of “requirement” often leads to people to believe you have broken a law, which can result in unnecessary government investigations.  Explicitly stating that documentation is required, even when it is not a condition of payment, sets proper expectations while also allowing you to avoid baseless legal claims. 

The word “overcoding” has similar drawbacks to “fraud.” It limits the ability to defend what was done. In many cases, a situation referred to as “overcoding” is really just the absence of documentation. Instead of referring to something as “overcoded” or “undercoded,” I prefer to say that the “documentation supports” or the “documentation does not support” a service.

I even try to avoid the word “audit.” The term is often used for a casual examination of facts. I prefer using the word “review.” It’s a small thing, but it gives you a bit more flexibility.

Choosing your words wisely is one of the most efficient risk management practices out there. It can help you avoid having to pay a lawyer to defend a baseless case.