hcr220wk7assignEvaluating Complianc

hcr220wk7assignEvaluating Complianc - Running head:...

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Running head: EVALUATING COMPLIANCE STRATEGIES 1 Evaluating Compliance Strategies HCR/220 June 12, 2011
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EVALUATING COMPLIANCE STRATEGIES 2 Evaluating Compliance Strategies Billing and coding compliance strategies are physician’s protection against revenue loss and any kind of financial risk. The strategies for compliance are: Carefully defining bundled codes and know the global periods Benchmark the practice’s E/M codes with the national average Use modifiers appropriately Be clear on professional courtesy and discounts to uninsured/low income patients Maintain compliant job reference aids and documentation templates Carefully defining what procedures are within a bundled code is important so they do not have to be unbundled. The most used bundling set of rules is the Medicare’s CCI list of codes. Some payers have their own set of codes that are unique. If there is a different set of codes used than the payer must make them available for the medical biller. Many sets of codes are used it all depends on the payer. A problem that can rise from using different sets of codes is linking the right diagnoses with the right procedure. Linking diagnoses and procedures is important for the payers to determine if the appropriate charges have been billed and if they are necessary. “Remember: the ICD-9 code must support the medical necessity for performance of the
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This note was uploaded on 07/14/2011 for the course HCR 220 taught by Professor Brinson during the Spring '11 term at University of Phoenix.

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hcr220wk7assignEvaluating Complianc - Running head:...

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