Tip: Use Compliance Guidance to help with billing and coding
Healthcare Auditing Weekly, August 5, 2008
Use the OIG’s Compliance Program Guidance for Hospitals to ensure your program is following OIG recommendations. The Guidance spells out that providers should take the following steps to ensure their facility complies with billing and coding regulations:
- Ensure accurate and timely documentation of all services prior to billing.
- Emphasize that the hospital should submit claims with appropriate documentation that is available for audit and review. Documentation should identify who provided the service and the time spent performing the service.
- Ensure records and notes used to back up claim submissions are organized and legible so that they can be audited and reviewed.
- Require that the diagnosis and procedures reported on the reimbursement claim are based on medical records and other documentation. The documentation necessary for accurate code assignment should be made available to coding staff.
- Indicate that compensation for billing department coders and billing consultants should not provide any financial incentive to upcode claims.
This tip is adapted from The Compliance Program Effectiveness Handbook. For more information about the book or to order your copy, visit HCMarketplace.
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