Proper Charting And Documentation Analysis

Proper charting and documentation play a big role in improving the practice to maintain everything being accurate. It is known that a procedure was no documented that it did not occur. Also, you will be liable for the patient's record if you do make a mistake, this puts the patient's life at risk. The patient's record is like a book. documentation is important because it aids in exchanging information within those in the practice. It helps in arranging a treatment for the person being treated for the medical problem. Making a file will assist you patient with their health in the future if anything occurrences happen. Documentation also assists in the progress of analysis. In order for your statements to become supported it needs documentation …show more content…
A crucial part that plays in this is making appointments for patients. A greater number of practices use an operating system to make it easier for the staff to compose the appointments accurately. While carrying out this task it helps the day continue in a steady manner. Those that do schedule these appointments will be able to make multiple appoint without the appointment colliding with each other. People have events that can occur unexpectedly, with a software it makes it easy and reliable for the person who had set up the appointment to cancel. Some operating systems are color coded as well with the help of aiding the staff …show more content…
Showing integrity means a lot because you want your patients to come back and especially since it relates to their health you want them to trust you. Correct coding also ensures that the patient will be safe especially with reliable documentation to back them up. With accurate documentation, the patient will get efficient and the best care. Proper and precise documentation will keep the practice ensured that there won't be any legal actions regarding fraud and abuse. These issues can arise from upcoming. Making sure that there is documentation for everything that is performed. If it is not documented it didn't happen. Be sure that what is on the paper is accurate and proper. Don't code the code that's more expensive unless that is the actual code for the procedure. When it regards to being accurate always ask questions. Always protect yourself from getting into trouble. Preventing duplication saves a lot of time, making sure that your documents are in order are correct help contribute to this. When records are documented incorrectly excessive medical procedures are taken that are not needed, if the records are documented correctly you can actually treat the patient for what they are needed to be treated for. This saves time. EHR's should be accurate, easy to read and