Providing complete documentation is the essence of accurate auditing and completing legal requirements. Coding accuracy is significant in that it affects the financial attributes of any healthcare organization. However, the issue of not providing the documentation to concerned auditors, even after requesting, is the result of multiple factors. The main issue and reason refers to the practice of up-coding. This is a practice of high-billing codes for charging high amounts for medical treatments and procedures. Ultimately, it leads to increased Medicare payments or enhanced insurance. The federal government took notice of such fraud when it became viral on the media. Such fraudulent activities have become frequent according to official investigations. However, the consequences are bitter and lead to financial losses along with legal repercussions. For example, in 1996 thirty percent of claims were error-based which amounted to fourteen percent of total Medicare payments. It is worth mentioning that half of such errors were related to the missing of documents or their incomplete submission.
However, such drastic situations posing impeccable impacts on financial aspects can be overcome by adopting several strategies. The primary strategy is comprehensive documentation guidelines. It may provide essential information to create efficient documentation. Another strategy is proper training and education to the concerned staff. Its main purpose is to keep them up-to-date about coding rules. Meanwhile, the integration and adoption of modern technology like EHR (Electronic Health Record) may streamline the coding process for completing documentation. Similarly, another effective method is the conduction of regular compliance audits. Such compliance may identify any errors and rectify any billing discrepancies. Additionally, effective communication channels and collaboration among coding professionals, billing staff and healthcare organizations may prove a good strategy. Such a strategy may ensure that every stakeholder is on the same page. Finally, healthcare organizations and respective government departments may improve the documentation process, reduce fraudulent practices and ensure high-level accuracy by adopting relevant measures.
References
Prophet, S. (1998). Coding compliance: practical strategies for success. Coding Compliance: Practical Strategies for Success/AHIMA, American Health Information Management Association.
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