Evaluating Compliance Strategies

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Submitted By pestrada63
Words 682
Pages 3
Evaluating Compliance Strategies
Patricia Estrada
HCR/220
November 2012
Deborah Ryan

Medical billing and compliance strategies are used to bill for medical procedures and treatments. The compliance strategies are in place to prevent incorrect billing, but mistakes are still made. Answers to the importance of correctly linking procedures and diagnoses, the implications of incorrect medical coding, and how medical coding, physicians and payer fees are related to the compliance process will be discussed. It is very important that procedures and diagnosis are correctly linked together. There are certain steps to follow that help to correctly link the procedure to the diagnoses. By following the correct procedures to apply the correct codes that link procedure with diagnosis, insurance companies can be correctly billed for reimbursements. Correctly connected claims can be analyzed and to make sure charges are for medically necessary services provided to the patient. Correct claims help reduce the chance of an investigation of the practice of fraud and the risk of liability in an investigation does occur. (Valerius, J., Bayes, N., Newby, C., & Seggern, J. , 2008). If the procedures are not linked correctly to the diagnoses, then they will not be covered by the insurance company and therefor will not be paid. The major implication of incorrect medical coding would be fraud. Even though incorrect work may simply be an error, it may also represent a deliberate attempt to obtain fraudulent payment. Some compliance errors can be a result of incorrect code selections or billing practices, while other errors are related to medical necessity. Errors also result in non-payment of services performed on patient. Some errors in the coding process would be; truncated coding- using diagnosis cods are not as specific as possible, mismatching between gender or age of…...

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