When Auditing Determining Assignment Help: How to Answer This Question

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Original Question

When auditing and determining that a physician is utilizing the wrong billing code, a discussion must occur with the physician. “Inaccurate medical coding can interrupt that goal, leading to frustration and confusion and a potential breakdown of the relationship you have built with valued patients. Even the consequence of incorrect coding rarely falls onto a patient, it does happen, and it is most important consequences to try to prevent” (Consequences of coding errors, n.d.). Inaccurate coding and billing not only effects the patient, but can also delay or prevent reimbursement from insurance companies. Therefore, it is essential for a conversation and education to occur with the physician who is coding incorrectly. Many times, it is as easy as providing simple education to the provider to correct their inaccurate coding. However, if the physician continues to code incorrectly, this can lead to more severe consequences. “The consequences could be a monetary penalty or legal issue if the claim is named fraudulent. To prove fraud occurred rather than abuse, the upcoding or miscoding must occur over time and across a large number of patients” (Consequences of coding errors, n.d.). Therefore, it is essential that the physician or provider has a discussion with compliance to ensure that coding is accurate.

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