Coding Compliance Essay

615 Words Feb 19th, 2014 3 Pages
Coding Compliance: Practical Strategies for Success by Sue Prophet, RRA, CCS, and Cheryl Hammen, ART
"Fraud," "abuse," "upcoding," "unbundling," and "compliance" have all become buzzwords in the news media. Eliminating healthcare fraud and abuse has become a top priority for the federal government. Government investigations are on the rise and providers everywhere tremble at the thought of becoming the next investigative target. An Office of Inspector General (OIG) audit of the Health Care Financing Administration (HCFA) revealed errors in 30 percent of all claims paid by HCFA in fiscal year 1996.1 These errors account for approximately $23.2 billion
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What can you do to reduce the chance of your employer becoming a target of a fraud investigation related to coding, or if you do become a target, minimize the risk of assessment of maximum penalties? How can you assure and demonstrate that your organization has accurate, ethical coding practices and medical record documentation that supports the diagnoses and services reported on the claim for reimbursement?

Become Familiar with the "Hot" Targets First, become familiar with the major investigative targets. Key sources of information on "hot" targets include the annual work plan for the Department of Health and Human Services (HHS) Office of Inspector General (OIG), fraud alerts issued by

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