AMA CPT® Assistant - 1998 Issue 6 (June)
Coding Compliance: The Coder's Role (June 1998)
June 1998 pages 8-9 Coding Commentary Coding Compliance: The Coder's Role The latest buzzwords in the news media related to healthcare include fraud, abuse, upcoding, unbundling and compliance. Eliminating healthcare fraud and abuse has become a top priority for the federal government. Government investigations are on the rise. The 1997 OIG audit of the Health Care Financing Administration estimated $20.3 Billion in improper payments. Of the $20.3 Billion, $5.9 Billion was for the physician provider type. The largest errors noted were documentation errors including no documentation, no documentation due to extenuating circumstances and insufficient documentation. What...
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Article Overview
This article reviews how coding professionals can support compliance efforts in the context of federal fraud and abuse oversight. It covers major government audit and work plan topics, the role of coding compliance programs in physician offices, staff education and communication practices, and related AHIMA educational resources.
Why This Topic Matters
It helps coding supervisors and coders understand the compliance environment and the kinds of operational areas that may draw scrutiny, while outlining broad program components that support ethical, well-documented coding practices.
Article Sections
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Coding Commentary
Introduces the compliance and oversight environment affecting healthcare coding and frames the coder’s role in reducing risk.
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Step 1
Identifies key sources of information used to monitor investigative priorities and compliance focus areas.
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Step 2
Summarizes broad coding-related topics highlighted for review in government oversight materials and program guidance.
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Step 3
Describes general elements of a coding compliance program, including risk assessment, multidisciplinary coordination, policies, and training.
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Communication
Discusses procedures for sharing regulatory updates and points readers to professional education opportunities and association resources.
What You Will Learn
- Where to look for federal compliance and audit priorities relevant to coding.
- What broad compliance issues are discussed in connection with coding oversight.
- How coding compliance programs are positioned within larger corporate compliance efforts.
- What general staff education and communication practices are emphasized.
- Which professional education resources are mentioned in connection with coding compliance.
Who Should Read This
- Coding supervisors
- Medical coders
- Compliance staff
- Physician office administrators
- Health information management professionals
Modifiers Discussed
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