Define Coding Quality and Compliance Standards Flashcards
Why was the National Correct Coding Initiative (NCCI) implemented?
To correct procedural coding problems on government claims.
Reduce Medicare Part B claims expenditures by detecting inappropriate outpatient coding methods and address concerns with unbundling.
What is unbundling?
Process of reporting multiple codes to increase reimbursement from the payer, when one code would have been sufficient.
Where are the NCCI policy terms incorporated?
In the outpatient code editor (OCE), where all ambulatory claims are reviewed.
What does the CMS publish each year to prevent payment errors due to incorrect code combinations?
National Correct Coding Initiative Coding Policy Manual for Medicare Services (Also known as Coding Policy Manual).
What is an audit for?
To detect any discrepancies in the elements examined and identify areas for corrective actions.
What can an audit suggest?
Coders needing additional education in a particular area due to coding errors pinpointed in audit findings.
Policies and procedures need to be revised
Physicians or other healthcare workers need training on documentation practices
Notation of diagnoses rendered and procedures performed during the patient’s encounter must be specific.
Billing practices need to be updated.
How to avoid errors as a coder?
1: Stay updated with regulations, news, and other information
2:Educate physicians, nursing, and other concerned staff.
- Educate other health care employees that play a role in reimbursements.
What are the elements of a coding compliance program?
Developing Written policies and Procedures
Training and Communication
Auditing and Program Monitoring
What is involved with developing written policies and procedures?
Requirements for accurate and comprehensive documentations for policies and procedures.
Needed:
Internal coding practices
Documentation practices
Review of the chargemaster
Payment policies.
