Evaluating Compliance Strategies

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Over the years, physicians have learned that coding and billing are inextricably entwined processes. Coding provides the common language through which the physician can bill their services to third-party payers, including managed care organizations, Medicare programs, and Medicaid programs.

Getting paid appropriately for services the family physician provides involves more than just coding the service and billing the third-party payer. There are aspects of reimbursement management that occur before the coding is even done and aspects long after the claim has been submitted. Coding appropriately is essential regardless of practice setting size.

Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Some steps to achieve accurate and appropriate medical record documentation are: •Practice timely, accurate, and complete documentation

Use appropriate diagnosis codes for examination and personal history •Link appropriate diagnosis codes with appropriate procedure codes •Use modifiers appropriately
Identify other insurance coverage when billing Medicare
I believe the documentation of each patient encounter should include the reason for the encounter with any relevant history, physician examination findings, prior diagnostic test results, assessments, clinical impressions, diagnoses, plan of care, date of service, and legible identity of...
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