Essay Evaluating Compliance Strategies

1123 Words Nov 12th, 2010 5 Pages
Evaluating Compliance Strategies

HCR/220
November 7, 2010

Evaluating Compliance Strategies This assignment will concentrate on medical billing, and compliance strategies, and the evaluation of these strategies. Many mistakes are made during the billing process, and some of the mistakes that are made could be caused by the strategies, and the processes themselves. In this essay I will offer a quick overview of the strategies, and an evaluation of these strategies. I will also offer my suggestions on how to fix the problems that were found in the evaluation. In this essay I will also attempt to answer these questions: What is the importance of correctly linking procedures and diagnoses? What are the implications of incorrect
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Many times, patients and payers are subjected to incorrect billing because the codes used are not the correct ones. If the codes are incorrect, it would most likely result in incorrect billing to either the insurance company, or the patient. This usually results in the patient owing large amounts of money on medical bills, but could also result in not getting billed for procedures that were actually performed on the patient. Therefore, implementing one specific set of rules and codes that all health care providers and insurance providers must abide by would perhaps eliminate the majority of discrepancies in most medical billing. The next step in the strategies for compliance is comparing the practices E/M codes with national averages. This is a great way to keep up with up coding. Not keeping up with the previously mentioned up coding could cause discrepancies in the billing. Valerius, Bayes, Newby, Seggern (2008) states that “…reporting only the top two of a five-level E/M code range for new or established patient office visits would not fit a normal pattern and might appear fraudulent” (pg.212,para.2). This step could also benefit from a single list of codes and rules, but a step should be implemented that requires all billing offices to acquire certain software that will automatically update the codes, and also send alerts to every medical billing office that possesses such software. Step

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