One Dozen Practical Billing and Coding Compliance Tips
- If it wasn’t documented, it wasn’t done. If it wasn’t done, it won’t be billed.
- If the service wasn’t medically necessary, it won’t be provided.
- If you weren’t there, your name won’t appear in the medical record or on the claim.
- Don’t double bill the payer.
- Don’t change the place of service to maximize payment.
- Don’t unbundle services that are part of a single service or charge for related services during the global period.
- Don’t upcode or downcode services.
- Don’t discount care to patients for referring other patients.
- If the patient or payer overpays, don’t keep the money.
- If the payer denies payment based on a legitimate diagnosis, don’t change the diagnosis to achieve payment.
- If offered money or gifts to prescribe drugs, refer patients, or order procedures/tests, decline.
- If a test or procedure is needed, don’t direct patients to the facility in which you have a financial interest, without disclosing that interest.
—Mary Pat Whaley, FACMPE
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