Coding Guidelines are the foundation for all fair and accurate coding practices around the United States and world. While all coders love to have all the guidelines written clearly in black and white, there are many gray areas that leave room for much discussion. This is where new coders often over code, under code, unbundle, bundle, code too much, or too little. If you’re an outpatient coder, for example, you quickly learn you can’t code anything a provider states with the words ‘likely, should be, would be, could be probable, etc.’ Coding Guidelines are the key to a coder’s success, and the key to a successful practice!
When Tammy started coding, she paid attention to every detail in the patient’s chart. She followed coding guidelines and coded only those conditions that were medically managed. Tammy’s coding department was under a lot of pressure to code high volumes of charts. In order to save time, sometimes Tammy coded a diagnosis that that did not necessarily support a procedure, and at times she unbundled services. While it wasn’t an intentional attempt to commit fraud, Tammy was committing fraud.
If you were the coding manager of Tammy’s department, discuss how you might avoid these fraudulent events.
Put your comments in a word document, I’m looking for between 2 and 3 paragraph
Expert Solution Preview
Introduction:
Coding Guidelines are crucial for accurate and fair coding practices. However, sometimes there can be gray areas that lead to incorrect coding, such as over-coding, under-coding, unbundling, or coding too little. This can result in unintentional fraud, which must be avoided in order to maintain the integrity of the coding process.
Answer:
As the coding manager of Tammy’s department, I would implement a number of strategies to prevent fraudulent events. Firstly, we would provide ongoing training to our coders to ensure that they are fully aware of current coding guidelines and regulations, and that they understand the consequences of fraudulent coding practices. This would include regular reviews and updates to coding policies and procedures.
Secondly, we would implement a system of regular audits to monitor coding accuracy and compliance with regulations. The audits would be conducted by an independent third party, such as an external auditor or a coding consultant, to ensure objectivity and impartiality.
Finally, we would create a culture of openness and transparency within the department, where coders feel comfortable reporting any concerns or issues related to coding practices. This would include ensuring that employees are aware of whistleblower protections and that there are no negative repercussions for reporting concerns.
Overall, preventing fraudulent coding is essential to maintain the integrity and accuracy of the coding process. By implementing training, auditing processes, and a culture of transparency, we can minimize the risk of fraudulent activity and promote fair and accurate coding practices.
