Checkpoint: Medical Records Documentation and Billing
Compliance plans are a process for finding, correcting, and preventing illegal medical office procedures (Valerius, Bayes, Newby, & Seggern, 2008). Therefore; all steps in the medical billing process correctly carried out, would apply as part of a compliance plan. In order to prevent illegal medical office practices, every step should be carried out as it was designed. In collecting accurate demographic and insurance information in step one; you are preventing illegal use of someone’s identification and insurance (Valerius, Bayes, Newby, & Seggern, 2008). In establishing financial responsibility in step two; you are verifying eligibility for coverage of present and future services and procedures (Valerius et al., 2008). In step three; by verifying patient identification and insurance, acquiring signatures for consent to treat, all other administrative and clinical forms (Valerius et al.), as well as, providing the patient with HIPAA regulations and provisions; you are complying with federal, state, and local laws; HIPAA requirements, and preventing fraud or abuse (Valerius et al.). In step four; checking out the patient, along with applying and entering proper codes (Valerius et al., 2008); you are complying with federal regulations for coding and billing. In step five; the process of reviewing coding compliance (Valerius et al., 2008), you are, again, satisfying official requirements. When checking billing compliance in step six; you are assuring the proper charges have been billed and correcting any errors (Valerius et al., 2008). This reduces the risk of liability to the practice for improper billing or fraud, thereby maintaining a proper compliance plan within the practice (Valerius et al., 2008). For step seven, preparing and transmitting claims properly and in a timely manner (Valerius et al., 2008); you are, as an employee of the practice, helping the practice to comply with billing...
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