Dealing with Billing and Coding Compliance Issues

by | Published on Dec 27, 2012 | Medical Billing

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Healthcare reform and changing technologies frequently add new tasks for medical coders and billing specialists in the ambulatory surgical centers (ASCs), making compliance a big challenge. Here are some of these key issues and tips to resolve them:

  • Regular updates – Constant changes, updates and alterations in codes are the biggest challenge faced by ASC billers and coders. Compliance violations could occur if a code is altered to include a new one. If coders continue to bill each element separately it would result in compliance violations such as unbundling or upcoding. Experienced coders in an established medical billing company would be up-to-date with changing codes and know exactly which ones should be included when a claim is submitted.
  • ICD–10 – Switching from ICD-9 to ICD-10 in 2014 is the next hurdle for coders. ICD codes will increase from 14,000 to 69,000. To tackle this issue, coders must get 3 to 6 months specific training before the code implementation deadline – October 1st, 2014.
  • HIPAA – HIPAA compliance becomes relevant when other healthcare providers ask ASCs for billing and coding information. Documents containing patients’ medical and surgical information will have to be mailed back and forth. Physicians and their staff must ensure secure, encrypted transfer of these documents over the Internet.
  • Quality codes – Medicare quality codes (G-codes) compliance is going to change. Clinical personnel may apply them to all patients, but billers should see that only Medicare claims are submitted with these quality codes. Failing to do so would result in compliance issues.

Coders should submit claims without errors or missing information, as ASCs would have to incur considerable expenses to correct information. All of these compliance issues can be minimized and claims submitted quickly by rely on professional medical billing and coding services.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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