Evaluating Compliance Strategies Research Paper

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Evaluating Compliance Strategies HCR/220 February 24, 2013 Angela Colbert Evaluating Compliance Strategies This essay will evaluate the medical billing and coding compliance strategies. There are many mistakes that are made during the medical billing and coding process that could possibly be minimized with the proper strategies. In this paper the following questions will be addressed: What is the importance of correctly linking procedures and diagnoses? What are the implications of incorrect medical coding? How are medical coding, physician, and payer fees related to the compliance process? Also covered in this essay is an overview of the compliance process as well as judgments either supporting or criticizing a particular…show more content…
Also incorrect medical coding linkage could lead to incorrect medical diagnoses being put into the patients’ medical record and could potentially cause the patient to be uninsurable should they lose their health insurance coverage and need to find a new insurance company. Some diagnosis could possibly be the reason for a person being denied insurance coverage with some…show more content…
The medical coder will need to make sure that codes are not being unbundled and the global period pertains to surgical procedures. Next the coder would need to compare the providers evaluation and management codes with the national average. When this is done patterns of fraud may be able to be seen. Using modifiers correctly is also a part of the compliance strategy. Modifiers help with duplicate billing and unbundling of codes. The coder must understand professional courtesy and discounts to uninsured or low income patients. Professional courtesy is when the doctor may not charge for services to other doctors or their family. This is not allowed because health insurance deductibles and co-pays must be paid. When giving discounts the system used to determine who gets the discount should be documented in the compliance plan. Finally an office would need to maintain compliant job reference aids and documentation templates. Having a job aid is like having a cheat sheet because it has all the answers you need regarding compliance. Templates help to save time and possibly reduce errors when

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