decisionhealth Newsletters, Part B News - 1999 Issue 10 (October)
What to do if your utilization profile uncovers problems
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Article Overview
This article discusses what to do when a utilization profile reveals potential overcoding or undercoding in a medical practice. It focuses on the practical and legal response process, including involving counsel, reviewing the findings, and considering whether repayment or corrective action is appropriate. The content is aimed at physicians, practice managers, and coding consultants who need general guidance on handling internal coding compliance issues.
Why This Topic Matters
Utilization reviews can surface compliance concerns that affect audits, repayment decisions, and a practice’s risk exposure. Understanding the general response path helps readers recognize when to escalate concerns and seek qualified advice.
What You Will Learn
- How practices may respond when utilization profile analysis suggests coding irregularities.
- Why legal review may be involved after potential coding problems are identified.
- The general role of consultants and attorneys in addressing compliance concerns.
- Why practices may consider corrective action or repayment after findings are reviewed.
Who Should Read This
- Physicians
- Practice managers
- Coding consultants
- Compliance staff
- Healthcare attorneys
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