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| Evaluating Compliance Strategies| [Type the document subtitle]| | This is about the evaluating compliance strategies on billing and coding and how if following the guidelines of the insurance companies. Also that the payer will paid the bill if it is correct. | | By: Bonnie S. Jarosiewicz| 1/15/2012| | It is a very long process for billing to prepare the bill that is required to submit for payment. There also have been a lot of mistakes when billing because some did not know the guidelines of medical coding when sending the bill to the insurance company.
This assignment will show how to making medical billing and compliance strategies so mistakes will not be made. Even through that not any means is any one perfect and mistakes will be made. All medical practice relies on the medical claims to be correctly coded and billed. If it is not done right there could some delay in payment, and the medical practice revenue could be a loss, fraud investigation, financial sanction, disciplinary action, and exclusion from any government programs.
They are not only using the correct codes, known as CPT or Current Procedural Terminology and explain the procedures were done and why they were done. There are times that the claims are not complete and are return to the medical office for further information. Because a lot of claims have been sent back to the medical office they have to come back with a decision that is evaluating compliance strategies in medical coding to keep the billing consisting and efficient.
There are so many methods of evaluation compliance strategies in medical coding then meeting with the doctor and billing staff to make sure the necessary handbooks are understand and how to use the coding systems. The insurance companies sends out there rules and guidelines to make sure the billing staff has a better understanding in billing codes and form completion procedures. One of the biggest complaints that the insurance companies have is that the doctor reports are incomplete. This is very hard on the insurance companies to give the properly bill for what the patient was diagnosis with.
When starting out doctor has to see the patient and then signs documentation of the visit. In the document it will explain what the doctor has done with the patient. For example if the doctor has order labs then it will be in the document. When sending the claim to the insurance company all document needs to be fill out correctly and they do there own investigation to make sure every thing is correct if there is something wrong with the diagnosis or in the report the insurance company will send it back and payment could be a delay or even worse.
By make sure the information is correct the billing department in the medical office needs to make sure it is legal to read and that the codes are correct. The Medicare and Medicaid have there on guidelines so the billing department needs to read all rules that Medicare and Medicaid have. If the billing department has any question they can call the Medicare and Medicaid office or look up on the website to see how to code the diagnosis right.
If Medicare Integrity program was cited as example of guidelines used by regulators to identify coding errors during audit and deny the payment to the provider when improper billing occur. For each denied claim payment owned to the medical practice are also denied. One way to make sure that the code is correct is to go by the rules of all insurance companies. That is to make sure that all information is correct and that the diagnosis are correct in the report that it is send to the insurance companies.
If to fail to this you can have consequences of hilling incorrectly that is denied claims, delay in processing claims and receiving payments, fines and other sanctions, loss of hospital privileges, exclusion from payers’ programs, prison sentences and result of loss of the physician’s license to practice medicine. To make sure that this does not happen you should practice timely, accurate and complete documentation, appropriate diagnosis codes fro examination and personal history, link appropriate diagnosis with appropriate procedure code, modifiers appropriately and identify other insurance coverage when billing Medicare or Medicaid.
Have a class with the staff member if they still don’t understand all guidelines are rules. Show how the documentation is filled out correctly and how that some information is not there. This will take time but in the end it will help our medical billing staff member, also tell them to make sure they look at the updates because something’s do change and some can be drop from the insurance company and they will denied the claim. Reference: http://www. ehow. com/way_5519814_evaluating-compliance-strategies-medical –coding. html