• 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 code linkage, 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 process? • 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
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