Compliance plans correlate to different medical records documentation standards by prevent fraud and abuse through a process in which it identifies, investigates, and prevents violations relating to the reimbursement for healthcare services (Valerius, Bayes, Newby, and Seggern). Compliance plans are a major important part of the medical billing process. Compliance plans are involved within every step of the medical billing process. The administration staff has to follow the guidelines with compliance plans to prevent fraud and ensure that everything is entered correctly with the billing procedures. There are paper medical records and electronic medical records. When a patient is registered in the system all demographic and insurance information have to be completely accurate or mistakes will be made when filling claims. Documentation standards establish standards of performance for all employees to conduct business with honesty and integrity.
In or text book it states that the medical billing process includes duties such as verifying patient insurance information and eligibility before medical services are provided, collecting payments that are due, such as copayments, at the time of service, maintaining up-to-date information about health plans’ billing guidelines and following federal, state, and local regulations on maintaining the confidentiality of patient information (Valerius, Bayes, Newby, and Seggern). Individuals are responsible in making sure that they follow compliance rules and guidelines so that all procedures are easily completed without mistakes.
Valerius, J., Bayes, N., Newby, C., & Seggern, J. (2008). Medical insurance: An integrated claims process approach (3rd ed.). Boston, MA: McGraw-Hill.
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