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HCR 220 Week 7 assignment

HCR 220 Week 7 assignment - Evaluating Compliance...

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Evaluating Compliance Strategies Jontovia Watson HCR 220 Fonzette Mixon There are several steps in the medical billing and coding process. In the medical billing process, after the patient’s encounters, 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
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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. Correct claims help reduce the chance of an investigation of the practice for fraud and the risk of liability if an investigation does occur (Valerius, Bayes, Newby & Seggern, 2008). Physicians depend on their personnel to process their medical bills without looking at the bills before they are submitted for payment. Some physicians who do not review the medical billing procedures There are several errors that can occur in the billing and coding process. When there is a problem in the coding process it can cause rejected claims. Some of these problems consist of truncated coding (using diagnosis code that are not as specific as possible), 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 produced by unlicensed or unqualified clinical
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