30 March 2022 14:03

What can be consequences of coding fraud and abuse?

Penalties: Criminal penalties and administrative sanctions for violating the AKS may include fines, imprisonment, and exclusion from participation in the Federal health care program.

What are some consequences of inaccurate coding and incorrect billing?

Inaccurate medical coding will cause your reimbursements to get delayed, denied, or only partially paid. Build up a cache of delayed reimbursements and you’ll have mounds of paperwork, stress, and lost revenue for your emergency medicine practice to deal with.

What consequences could result from following the instructions of the coding supervisor?

If the supervisor’s instructions are carried out, the clinic risks “financial and reputational harm, possibly resulting in sanctions by external forces,” says McWay. “Damage is also done to individual coders who are asked to sacrifice correct coding standards to comply with this inappropriate request.

What are the consequences of failing to perform code linkage?

Code linkage is the verification that the diagnosis code and procedure code match up to support medical necessity for the procedure. Failure to link the codes can result in claim denials.

How can coding impact the quality of care?

Better coding, it turns out, helped identify high-risk patients and enabled significant clinical impact quickly. The research showed that newly coded patients who improved on two or more relevant clinical measures increased their use of outpatient care by 0.9 visits per year, on average.

What are the penalties for Upcoding?

False Claims Act Penalties

Under the False Claims Act can most upcoding crimes lead to incarceration up to five years and fines worth up to $250,000.

What are some of the ethical issues related to coding?

Ethics Are Critical to the Billing and Coding Profession

  • Honesty is the best coding and billing policy.
  • Shift the blame for bad coding.
  • To bill more than is documented is a no-no.
  • Break patient confidentiality at your peril.
  • Don’t follow the lead of an unscrupulous manager.

What is the impact to coding due to the incomplete clinical documentation?

One of the most significant effects of incomplete documentation in a patient’s medical record is inaccurate reimbursement that results in inaccurate gross revenue to the provider. In the absence of accurate documentation, a provider should assume that revenues are not accurate, as well.

What are coding errors?

Coding errors could take the form of typos, flawed logic, or an accidental oversight. And how they manifest and impact the program determines which type of error they are. So, here’s a refresher course of the main types of coding errors.

What happens if you don’t code to the greatest specificity?

Without the fifth digit, the claim is lacking enough information to be processed and therefore will be denied. If you are unsure if the diagnosis is coded to the highest level of specificity, you can look it up in an ICD-9 codebook or on the web. There are several websites with current ICD-9 codes available.

How would you prevent coding errors if you or someone you manage were responsible for coding in the medical practice?