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Essay / Evaluating Compliance Strategies in Medical Billing and...
The medical billing and coding process involves several steps. In the medical billing process, doctors prepare and sign patient visit documents. The next step is to record medical codes and patient visit transactions in the practice management program and prepare claims. The process used to generate claims must comply with the rules imposed by federal and state laws as well as the payer's requirements. Correct claims help reduce the chances of the practice being investigated for fraud as well as the risk of liability if an investigation takes place (Valerius, Bayes, Newby & Seggern, 2008). Most doctors rely on their staff to process their medical bills without reviewing them before submitting them for payment. Some physicians who do not review medical billing procedures may not receive the payment they deserve (Adams, Norman, & Burroughs, 2002). Several errors can occur in the billing and coding process. When there is a problem in the coding process, requests may be rejected. Some of these problems consist of truncated coding, a mismatch between the sex or age of the patient and the code selected when the code implies selection for one or other of the criteria, hypothesis coding (reporting items or services that have not been documented, but which the coder assumes have been performed). ), modifying documentation after reporting services, coding without appropriate documentation, reporting services produced by unlicensed and/or unqualified clinical personnel, coding a one-sided service twice instead of choosing the two-sided code, and failing to meet the coverage conditions for a particular service. service. These errors can result in denials or delays in payment... middle of paper ...... enforce standards, provide training and education, and respond appropriately to correct errors. Although there are many problems in the coding and billing process, if the proper steps are followed and carefully reviewed, most coding and billing errors can be avoided (Valerius, Bayes, Newby, & Seggern, 2008) . Works Cited Adams, D., Norman, H. and Burroughs, V. (2002) Journal of the National Medical Association. Addressing Medical Coding and Billing Part II: A Strategy for Ensuring Compliance. A risk management approach to reduce coding and billing errors. Retrieved July 14, 2009 from http://www.pubmedcentral.nih.gov/pagerender.fcgi?artid=2594405&pageindex=11#pageValerius, J., Bayes, N., Newby, C. and Seggern, J. (2008) . ). Medical Insurance: An Integrated Approach to the Claims Process (3rd ed.). Boston: McGraw-Hill.