• What is the importance of correctly linking procedures and diagnoses?
Correct claims report the connection between a billed service and a diagnosis.
The diagnosis must support the billed service as necessary to treat or
investigate the patient’s condition. Payers analyze this connection, called
to decide if the charges are for medically necessary services
What are the implications of incorrect medical coding? Implications of incorrect
medical coding can lead to denied claims, a delay in claims, wrong amounts being
paid, provider being investigated for billing fraud. Incorrect medical coding can also
effect the patient due to service that would have been covered, and not billed
correctly, could become the patients responsibility.
How are medical coding, physician, and payer fees related to the compliance
In every geographic area, there is a normal range of fees for commonly performed
procedures. Different practices set their fees at some point along this