Billing coding and compliance strategies take some learning and some practice but they can be done easily with the correct knowledge. Billing compliance has some billing rules to know and it also has many steps involved to get the billing and coding cycles done. The connections between claims, files and diagnoses will be discussed in this essay. The importance of correctly linking procedures and diagnoses and implications of incorrect medical coding will also be discussed. It is also important for me to include how the billing, coding payments and physicians all link together in the compliance process.
It is extremely important to connect the procedures and diagnoses correctly when billing and coding for medical procedures and visits. The procedures each have their own code and it must be linked correctly in order for the claim to be paid by the payees correctly. A correct claim will report the connection between a billed service and a diagnosis and the diagnosis has to support the billed service so that the service can be completed for the patient or for the patient’s condition to be investigated. There is a process called code linkage which is where the payers analyze this connection and they then decide if the charges are for medically necessary services for the patient. If procedures and diagnoses are not linked correctly then they will not be covered by the insurance company and paid for. There are contracts and rules that have to be followed to prepare claims correctly because contracts change and rules are updated regularly. The medical insurance specialists also rely on the payer bulletins, regular communication with the payer representatives and websites to keep them up to date on what is going on. The updates that are posted help the insurance specialists keep up with what is changing with the rules and the contracts and if it were not for the updates then they may code things wrong and pay for the services that were billed to them. It could be really...
References: Sage, M. J. (2004). Strategies for coding, billing and getting paid appropriately. Retrieved from http://www.familydocs.org/assets/Practice_Resources/Coding&Billing/coding.billing.monograph.pdf
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