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首页> 美国卫生研究院文献>Journal of the National Medical Association >Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.
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Addressing medical coding and billing part II: a strategy for achieving compliance. A risk management approach for reducing coding and billing errors.

机译：解决医疗编码和账单第二部分：实现合规性的策略。一种用于减少编码和账单错误的风险管理方法。

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摘要

Medical practice today, more than ever before, places greater demands on physicians to see more patients, provide more complex medical services and adhere to stricter regulatory rules, leaving little time for coding and billing. Yet, the need to adequately document medical records, appropriately apply billing codes and accurately charge insurers for medical services is essential to the medical practice's financial condition. Many physicians rely on office staff and billing companies to process their medical bills without ever reviewing the bills before they are submitted for payment. Some physicians may not be receiving the payment they deserve when they do not sufficiently oversee the medical practice's coding and billing patterns. This article emphasizes the importance of monitoring and auditing medical record documentation and coding application as a strategy for achieving compliance and reducing billing errors. When medical bills are submitted with missing and incorrect information, they may result in unpaid claims and loss of revenue to physicians. Addressing Medical Audits, Part I--A Strategy for Achieving Compliance--CMS, JCAHO, NCQA, published January 2002 in the Journal of the National Medical Association, stressed the importance of preparing the medical practice for audits. The article highlighted steps the medical practice can take to prepare for audits and presented examples of guidelines used by regulatory agencies to conduct both medical and financial audits. The Medicare Integrity Program was cited as an example of guidelines used by regulators to identify coding errors during an audit and deny payment to providers when improper billing occurs. For each denied claim, payments owed to the medical practice are are also denied. Health care is, no doubt, a costly endeavor for health care providers, consumers and insurers. The potential risk to physicians for improper billing may include loss of revenue, fraud investigations, financial sanction, disciplinary action and exclusion from participation in government programs. Part II of this article recommends an approach for assessing potential risk, preventing improper billing, and improving financial management of the medical practice.
机译：如今的医学实践比以往任何时候都更加需要医生去看更多的病人，提供更复杂的医疗服务并遵守更严格的监管规则，从而几乎没有时间进行编码和计费。然而，对于医疗实践的财务状况而言，充分记录医疗记录，适当应用账单代码以及准确地向保险公司收取医疗服务费用的需求至关重要。许多医生依靠办公室工作人员和计费公司来处理他们的医疗账单，而无需在提交付款之前对其进行审查。如果某些医生没有充分监督医疗机构的编码和计费方式，则可能没有收到应得的报酬。本文强调了监视和审核病历文档和编码应用程序作为实现合规性并减少计费错误的策略的重要性。如果提交的医疗账单中缺少和不正确的信息，则可能导致未付的索赔要求和对医生的收入损失。解决医学审计，第一部分-实现合规性的策略-CMS，JCAHO，NCQA，于2002年1月发表在《美国国家医学协会杂志》上，强调了准备医学实践进行审计的重要性。文章重点介绍了医学实践可以为审计做准备的步骤，并介绍了监管机构用于进行医学和财务审计的准则示例。引用了Medicare完整性计划作为监管机构用来在审计过程中识别编码错误并在发生不正确计费时拒绝向提供商付款的准则的示例。对于每一个被拒绝的索赔，还欠医疗执照的款项也将被拒绝。毫无疑问，对于医疗保健提供者，消费者和保险公司而言，医疗保健是一项昂贵的工作。对于医生来说，计费不当的潜在风险可能包括收入损失，欺诈调查，财务制裁，纪律处分和被排除在政府计划之外。本文的第二部分建议了一种方法，用于评估潜在风险，防止计费不当并改善医疗实践的财务管理。

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