The content contained within this toolkit includes defining the various code sets used in provider practice; a summary of applicable coding guidelines; the impact of EHR documentation templates on coding compliance; introduction to typical coding workflows; best practices for coding audits; coder training; and more.

2024年8月30日 · A risk-based approach to coding and billing compliance assists the Institution to identify the areas of highest risk for non-compliance and to prioritize mitigation strategies to reduce

2023年5月1日 · Coding compliance policy and procedure – All health information management, coding, compliance, and billing departments should have written policies and procedures that designate who will assign the medical coding. Policies should also describe who will append modifiers, when necessary, and what the process will be to carry these actions out.

2023年11月1日 · A billing and coding compliance policy ensures accurate billing, coding, and documentation practices to prevent errors, fraud, and abuse. An anti-fraud and abuse compliance policy focuses on preventing and detecting fraudulent activities within the organization, including education on reporting suspected cases.

Coding compliance is inherently linked to a number of the preceding compliance risk areas including proper documentation, accurate billing, medical records creation and retention, referral guidelines, and teaching physician rules.

2018年1月31日 · The implementation of a comprehensive compliance plan with coding policies will provide consistency, accuracy and reliability of all your practice coding and billing, assure sound and ethical coding practices, and provide back up if your practice is questioned by insurance companies or Medicare.

Establishes a company-wide standardized coding compliance monitoring process to reduce variances in coding practices and ensure compliance with Official Coding Guidelines.

What a Compliance Program should do . . . • Provide oversight to Detect, Prevent and Correct “Fraud, Waste and Abuse”. • Define expectations • Create and foster a culture of compliance – Do the right thing • Encourage reporting – Open lines of communication • Monitoring and Auditing • …

The primary objective of a coding compliance plan is to establish a systematic approach to coding that aligns with industry standards, reduces the risk of coding-related legal and financial penalties, and safeguards the integrity of healthcare revenue cycle management (RCM) processes.

When we know the risk areas and/or potential risks, we can start with the seven key compliance elements [3] and see if they are in place before diving into the coding compliance program/plan: These elements should be a foundational guide for any and every healthcare organization, company/system, practice, hospital, clinic, etc.