Coding & Billing Risks [Healthcare Compliance Tips]

Examine top coding and billing risks within your practice.

Did you know that studies show approximately 55 percent of evaluation and management (E/M) visits are coded incorrectly?

In the opening of our series called “Compliant or Complacent: How to Upgrade Your Routine,” I shared why being uncomfortable will push your practice to the next level, which includes reviewing:

Top Risk Areas: Coding & Billing

This risk area is not surprising since coding and billing have always been a top concern for the government.  And, if 55 percent of office visits are incorrectly coded, is this due to complacency?

As a team, you must step back and analyze whether this statistic applies to the practice.  You can’t assume, just because you have received no warning letters or medical record review requests, all is well.

As suggested in my previous tip, incorporating audits into your compliance program will help you understand coding and billing risk areas and how they apply to your practice.

Here are suggested resources you can bookmark to educate yourself about coding and billing risk areas:

• OIG Work Plan and Compliance Program Guidance
• Centers for Medicare and Medicaid Services (CMS)
• Commercial insurance companies
• Professional medical or compliance organizations

Errors will be made within your practice.

The OIG is even aware of this.

But when errors are not rectified, this puts a significant drain on federal and state health care programs.  It is your job to catch coding and billing errors to send any overpayments back within 60 days (of the findings).  Ensure coding and billing risk reviews and audits are a priority within your practice.

Click here for the next tip in the series.

**The opinions and observations from the group/author are not a promise to exempt your practice from fines and penalties.  Research, modify and tailor the advice to fit your specialty.