Physician Practice Model Compliance Plan / Specific Risk Areas / Coding and Billing

Why This Topic Matters

Coding and billing errors can create compliance exposure, trigger audits, and lead to payment problems for physician practices. Understanding the major risk areas helps practices build policies that support accurate claims and documentation.

Article Sections

1. Specific risk areas in coding and billing

   This section outlines common categories of billing and coding risk identified in compliance reviews. It focuses on the types of practice behaviors that are often scrutinized by auditors and enforcement agencies.

2. Standards and procedures for proper coding

   This section discusses the need for practice standards that align with applicable reimbursement rules and official coding guidance. It also addresses documentation-based coding and the importance of internal review processes.