Corporate Compliance

Ensure coders submit compliant claims

Strategies for Health Care Compliance, November 1, 2008

Physician documentation plays a big part of the billing process in medical facilities. But no matter how clear and concise the documentation, a payer could still deny a claim due to mistakes made by coders and data entry staff members. Don’t rely solely on an interview or a reference check to prove that a coder performs high-quality work or that he or she knows how to code for a particular specialty. “Without any monitors over the quality of the work, you really don’t know,” says Joe Rivet, CPC, CCS-P, CICA, a regulatory specialist at HCPro, Inc., in Marblehead, MA. Although human error remains inevitable, auditors and compliance officers should employ the following practices to decrease mistakes as much as possible.

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