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Evaluation Compliance Strategies

Evaluation Compliance Strategies - Evaluation Compliance...

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Evaluation Compliance Strategies HCR/220 Courtney Taylor July 1, 2011
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Courtney Taylor 2 The medical practice today relies on medical claims to be correctly coded and billed. Improper medical claims filed result in loss of revenue to a medical facility, fraud investigations, financial sanction, disciplinary action, and exclusion from participation in government programs (Adams, Norman, & Burroughs, 2002). The encounter with a patient involves a series of actions. First the physician sees the patient and then signs documentation of the visit. Codes are assigned based on the documentation provided by the physician. The encounter is then billed from the codes assigned according to the documentation. The procedures performed must be linked directly to the services that are being billed. Medical record documentation is evidence of coding and justification for billing. Failure of the physician to appropriately document the medical records could result in improper coding and erroneous billing. If the procedure and diagnosis are not supported from the documentation then there is a risk of the claim being denied which could result in delays in receiving payments, reduced payments, fines, and ultimately the loss of the physicians license to practice medicine (Adams et al.,
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