Medical coders have the responsibility of translating diagnoses and treatment into codes to be used in billing and records-keeping. To ensure the accuracy and integrity of medical coding, it is important to comply with all applicable laws, rules, and standards. Office of Inspector General of U.S. Department of Health and Human Services offers various tools and resources to help healthcare organizations comply with applicable laws, regulations and standards.
One example of a resource from the OIG Compliance Resource Portal is the “Compliance Program Guidance for Individual and Small Group Physician Practices” toolkit. The resource offers practical advice for developing and implementing a compliance program within a physician’s practice, as well as specific recommendations to address medical coding concerns. This toolkit includes topics like documentation, billing and coding, audits, and monitoring.
Medical coders will learn from this guide how to avoid potential fraud risks and ensure compliance with regulations. The toolkit, for example, emphasizes that accurate documentation and coding are essential to prove medical necessity, avoid excessive payments, and to ensure compliance with coding regulations. It also stresses the importance of regular auditing to detect and correct any coding mistakes or discrepancies.
This information can be incorporated into medical coding practices by implementing best practices, strategies and audits recommended within the resource. It would be possible to maintain accuracy and integrity of medical coding and reduce the risks associated with fraud and abuse.