decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
Compliance / Coding and billing
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Article Overview
This article covers common coding and billing compliance risk areas identified by the OIG, along with broad expectations for documentation, standards, and internal review processes in a medical practice. It is relevant to coders, billers, compliance staff, and practice leaders who want to understand the general categories of billing concerns addressed in audits and investigations, as well as the organizations and coding systems referenced in the guidance.
Why This Topic Matters
Understanding these compliance themes helps practices recognize broad audit risk areas, align internal billing processes with documentation, and support accurate claim submission across payer environments.
What You Will Learn
- The major categories of billing and coding risk highlighted in compliance discussions
- How documentation and internal standards relate to claim submission
- Which organizations and coding systems are referenced in the article
- Why practices may review rejected claims and coding patterns as part of compliance efforts
Who Should Read This
- Medical coders
- Medical billers
- Compliance officers
- Physician practices
- Practice administrators
- Revenue cycle staff
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