One Dozen Practical Billing and Coding Compliance Tips

  1. If it wasn’t documented, it wasn’t done. If it wasn’t done, it won’t be billed.
  2. If the service wasn’t medically necessary, it won’t be provided.
  3. If you weren’t there, your name won’t appear in the medical record or on the claim.
  4. Don’t double bill the payer.
  5. Don’t change the place of service to maximize payment.
  6. Don’t unbundle services that are part of a single service or charge for related services during the global period.
  7. Don’t upcode or downcode services.
  8. Don’t discount care to patients for referring other patients.
  9. If the patient or payer overpays, don’t keep the money.
  10. If the payer denies payment based on a legitimate diagnosis, don’t change the diagnosis to achieve payment.
  11. If offered money or gifts to prescribe drugs, refer patients, or order procedures/tests, decline.
  12. 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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John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 404 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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