Evaluating Compliance Strategies in Medical Billing and Coding

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 medical bills without looking at the bills before they’re submitted for payment. Some physicians who don’t review the medical billing procedures may not receive the payment they deserve (Adams, Norman, & Burroughs, 2002).

There are several errors that can occur in the billing and the coding process. When there’s a problem in the coding process it can cause rejected claims. Some of these problems consist of truncated coding, mismatch between the gender or age of the patient and the selected code when the code involves selection for either criterion, assumption coding (reporting items or services that were not documented, but that the coder assumes were performed), altering documentation after services are reported, coding without proper documentation, reporting services that are produces produced by unlicensed and or unqualified clinical personnel, coding a unilateral service twice instead of choosing the bilateral code, and not satisfying the conditions of coverage for a particular service. These errors can result in denials or payments being delay...

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...d practice standards, conduct training and education, and respond appropriately to correct errors. Even though there are numerous problems in the coding and billing process, if the appropriate steps are followed and carefully reviewed then most of the coding and billing errors can be avoided (Valerius, Bayes, Newby, & Seggern, 2008).

Works Cited

Adams, D., Norman, H., & Burroughs, V. (2002) Journal of the National Medical Association.

Addressing Medical Coding and Billing Part II: a strategy for achieving compliance. A risk

management approach for reducing coding and billing errors. Retrieved July 14, 2009, from

http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=2594405&pageindex=11#page

Valerius, J., Bayes, N., Newby, C., & Seggern, J. (2008). Medical insurance: An integrated

claims process approach (3rd ed.). Boston: McGraw-Hill.