Hcr220 Week 7: Evaluating Compliance Strategies

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Evaluating Compliance Strategies; Week 7 The process of compliance in the medical field is set up by an established set of guidelines produced by HIPAA. These guidelines are put into effect in order to protect all employees, physicians, patients, and other professionals in the health care industry. Having a process for compliance assists in making sure as few errors as possible occur during the process of billing. Personally, I see these compliance codes as an excellent method of performing accurate work. In many physicians’ offices now days, it is common to find compliance codes on the physical form that is filled out by the physician. This process only helps to make sure that as few mistakes as possible are made in the coding and billing process. One of the most important factors in the coding process is accurately matching diagnoses and procedures, in order to avoid any possibilities of a claim being rejected. This is also important in the assurance of reimbursement to a medical professional for correct procedures. If an incorrect procedure is sent for billing, the result could be a physician being delayed a payment, or, missing out on payment altogether. If a claim does happen to be rejected, it must be sent back to where it originated for readjustment, and resubmission to the insurance provider. The end results in these situations could affect the accounts receivable portion on the physicians end, and money owed by a patient may end up in collections. One of the biggest downfalls to situations regarding improper and/or incorrect coding is the loss of revenue. The end result for any one mistake could cost into the thousands of dollars. In order to avoid such mistakes, keeping an office staff that is well trained and up to date on their knowledge of coding is vital. Keeping the latest coding procedures on hand at all times will ensure as few

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