Evaluating Compliance Strategies Essay Example for Free

Evaluating Compliance Strategies EssayThe accord process is critical when it pertains to the billing and secret writing process. It is imperative for Medical Insurance Specialist to tarry current on the patients participation in contract as well as the medical insurance policies, so there testament not be any billing errors. Maintaining a communication with the payer will also prevent billing errors. Such regulations and laws are in smirch for to protect the patients financial state, prevent errors of billing and coding, and to link social occasions and diagnoses congeally. Becoming knowledgeable of the billing rules should also help prevent billing errors as well. In this assignment, I will discuss how important it is for medical staff to be knowledgeable of the billing and coding deference strategies. The first outline to compliance is to carefully define bundled codes and know global periods. This is important, medical insurance specialist must be knowledgeable of wha t global periods are for surgical procedures and what specific procedure is included in the bundled codes.The second strategy is to benchmark the practices E/M codes with national averages. This strategy helps when conducting comparisons with the national averages, because it helps to monitor upcoding. The third strategy is the use of appropriate modifiers. This strategy helps prevent double billing or unbundling. Modifiers such as -25, -59, and -91 are most important when billing in compliance. The quartern strategy is becoming clear on professional courtesy and discounts to uninsured/ humbled income patients.Unfortunately, providers can no longer provide professional courtesy to patients per OIGs Compliance Program Guidance for Individual and Small Group Physician Practices. However, if the patient may qualify for discounts if they are either uninsured or has low income. According to textbook Medical Insurance An Integrated Claims Process Approach, The practices method for selecti ng people to receive discounts should be documented in the compliance plan and in its policies and procedures information (Valerius, 2008).Lastly, maintaining a compliance job reference aid and documentation template can help with compliance. In other words, having a cheat sheet of commonly used CPT codes or diagnoses codes could help smooth the billing process. There are establishments in place to ensure that there is correct and appropriate coding. Programs such Medicares national Correct Coding Initiative (CCI) Policy Manual for Medicare Services provide manuals to help correct improper coding when billing for Medicare services.