Evaluating Compliance Strategies Essay

682 words - 3 pages

Evaluating Compliance Strategies
Patricia Estrada
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 ...view middle of the document...

, Bayes, N., Newby, C., & Seggern, J. ,  2008). There are a number of errors that are related to the billing process, some of the most frequent errors are; billing for uncovered services, billing overlimit services, unbundling, using not modifier when one is required or using an inappropriate modifier, always assigning the same level of E/M service, billing for a consultation instead of office visit, billing invalid/outdated codes, upcoding-using a procedure code that provides a higher reimbursement rate than the correct code or downcoding- using a lower level code, billing without proper signatures on file work (Valerius, J., Bayes, N., Newby, C., & Seggern, J. ,  2008).
Medical coding, physician, and payer fees are all related to the compliance process by ensuring the patient is provided with appropriate care based on details that are provided in their medical records. Making sure of optimal patient care and allowing for excellent patient satisfaction. Ensuring accuracy and compliance in the...

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