Coding Component Is an Important Feature of Compliance Plan

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In recent times there has been a rise in fraud and abuse of rights and regulations in the healthcare community. Those healthcare providers which got prosecuted in the past have been excluded from the Medicare programs. They have also faced monetary penalties for failure in complying with regulations and ensuring risk management.

Therefore, it is an essential best practice to have a compliance plan. A compliance plan is a set of systematic procedures which have been introduced by the organization. These procedures are meant to comply with regulations imposed by the government as a best practice.

Coding component is an important feature of a compliance plan. It is an effective approach to preventing Federal fraud and abuse of investigations of healthcare claims. It requires healthcare providers to ensure compliance with regulatory laws appropriately.

Coding Practices: These are a set of best practices in which software applications are developed in a simplified manner. The software is broken down into many levels and codes are used to make it easy to keep track of every level. These are based on various features, like platform, target environment and coding language. Implementing best practices for specific situations greatly reduces the risk of errors regardless of the software development model being used.

To ensure this there are three specific coding compliance strategies which need to be implemented as best practices. These include:

  • The 72 hour Cases: Coding components make billing procedures for outpatient diagnostic services occurring within 72 hours of patient admission quicker and effective.
  • Billing Practices: Coding components ensure that billing is appropriate and not misused. That means consultations with resident doctors must not be wrongly entered as physician consultations.
  • False Claims: There is need to ensure there is compliance with the False Claim Act. Using coding components makes it possible to monitor fraud at every sublevel. Additionally, false claims of patient transfers as discharges must be detected and investigated.

Reasons for Healthcare Facilities to Install a Coding Compliance Plan

Firstly, developing effective internal controls is an important best practice. A coding compliance plan ensures that effective internal controls are developed. This is a major requirement when it comes to ensuring compliance with the False Claims Act.

Secondly, there is need to identify problematic coding practices to ensure best practices. Therefore a comprehensive coding compliance plan is recommended for healthcare providers. This will help in identifying practices which are questionable. The provider can also take the initiative of submitting a voluntary disclosure to the government or remit the overpayment to the intermediary. This will minimize criminal or implicative actions against the provider.

Thirdly, using a compliance plan will not only help in identifying problematic data, it will also identify opportunities. That is to say, that the provider can get notified about under-coding and have the opportunity to correct the problem. More specifically, a provider may have the opportunity to legally claim high level service.

Lastly, if a healthcare provider has its own compliance plan, the government will not have to impose a mandatory plan of its own. For example, healthcare providers must have specific features such as requirements when interviewing an employee. There must be a counsel present.

Therefore, having a compliance plan with a coding component is a basic best practice for healthcare providers.

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