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Evaluating Compliance Strategies In Medical Billing And Coding

927 words - 4 pages

In the medical billing and coding process there are several steps. In the medical billing process physicians prepare and sign documentation of the patients visit. The next step is to post the medical codes and transactions of the patients visit in the practice management program and to prepare claims. The process used to generate claims must comply with the rules imposed by federal and state laws as well as with payer requirements. Claims that are correct help to reduce the chance of an investigation of the practice for fraud and also the risk of liability if an investigation does occur (Valerius, Bayes, Newby & Seggern, 2008). Most physicians depend on their personnel to process their ...view middle of the document...

Despite all of the errors that can occur during the medical coding and billing process there are a few strategies that could help avoid these problems. These strategies include; avoiding unbundling (billers and coders must be clear on what individual procedures are contained in bundled codes), be clear on professional courtesy and discounts to uninsured or low-income patients (professional courtesy occurs when a physician chooses to ignore the charges for service to other physicians and their families), benchmarks the practices E/M codes with national averages, use modifiers appropriately (CPT modifiers can eliminate any impression of duplicated billing or unbundling), and maintaining complaint job reference aids and documentation templates. These simple steps can help avoid billing and coding errors.
Linking procedures in the correct way and diagnoses avoids denial of payments and avoids the possible consequences that can occur due to billing incorrectly. The consequences that could possibly occur because of billing incorrectly are things such as; delays in processing claims and receiving payments, denied claims, reduced payments, fines and other sanctions, loss of hospital privileges, exclusion from payers’ programs, prison sentence, and loss of the physicians license to practice medicine.
Medical coding, physician, and payer fees are all related to the billing and coding compliance. Physician fees consist of the usual services and procedures that they usually perform. These usual fees are determined by the services they charge to most of their patients. Payers must also establish the rate they pay their providers. There are two main methods; charged based and resource based. Charged based are fees that providers of similar training and experience have charged for similar services. Resource based fees are built by...

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