Errors in Compliance
Errors and Compliance in Coding Lisa rosier HCR/220 August 20, 2010 Linda Murray Errors and Compliance in Coding Billing and coding is very important in medical facilities, not only to the facility but also the patients and their insurance carriers. Sometimes, mistakes are made during this process that can cause delay in payment or denial of a claim. One mistake made in coding is assumption coding. When assumption coding is done, the coding person reports items or services that is not documented but is assumed by the coder (Valerius, Bayes, Newby, & Seggern 2008). An example of this type of coding would be when the patient has a routine exam, but the insurance company receives a bill for a complete physical. Billing for an uncovered service is another example of coding and billing errors. When this happens, the insurance company is sent a bill for a service that is not covered under the patient’s policy. For instance- billing an insurance company for a cosmetic procedure, which is not covered by most insurance plans. Assigning the same level E/M code repeatedly is another example of errors in coding. When a coder constantly chooses the same level code regardless of the correct level. For example would be choosing the same code for an established patient and for new patients. A different code is used for new patients than for established patients so the same code should not be used with both types of patients. The Medicare National Correct Coding Initiative helps to prevent payments from being made for uncovered services, like dentures.
References: Valerius, J., Bayes, N.L., Newby, C., & Seggern, J. (2008) Medical Insurance An Integrated Claims Process Approach. New York N.Y: McGraw Hill.