Medical Billing And Compliance

Aug 16, 2018 by Dominick Pellegrino 0

There are many important components to an effective medical billing compliance program such as implementation of the written policies, procedures and standards of conduct, conducting effective training and education, and conducting internal monitoring and auditing. Medical billing compliance provides many crucial services for the benefits of the medical billing business. MDofficeManager can help assist in the often complex world of compliance and medical billing.


Medical billing companies such as MDofficeManager coordinate with their provider-clients in establishing compliance responsibilities. We send a copy of compliance programs to all the provider clients. We also coordinate with provider clients in the development of the training programs, audit plan and policies for investigating misconduct. Billing companies have the responsibility to code the bills for their provider clients but others only process the bills that have been coded by the provider.

Many benefits can be obtained by implementing an effective compliance program such as improved medical record documentation and improved collaboration. Medical billing compliance programs give better communication and cooperation among the health care providers and those who are processing and using the healthcare information.


Creating a compliance plan can help protect practice professionals from audits (and the resulting lost revenue) and make the difference between fraud and abuse determinations.


To avoid coding compliance problems, the following strategies are recommended:

Review your clinical clarification process

Success with initiatives such as ICD-10, quality reporting and pay-for-performance programs rely on accurate documentation. Implementation might necessitate an increase in the amount of clinical clarification between providers and coders to ensure alignment of clinical documentation and coding. For example, a provider may assume that a coder will apply the visit level to a record, while a coder may assume that the provider will apply the correct coding level to the visit immediately after the patient encounter.


The clinical clarification query process is a way for practices to ensure that clinical documentation is reviewed to be both complete and compliant.  Coders must ensure that coding captures the intent of the physician as well as all details associated with the patient’s condition, observations and treatment, among others. Clinical documentation is the foundation that supports practices’ revenue cycle and clinical understanding and treatment of patients and should be maintained to provide accurate details to support both.


Implement a compliance plan

Creating a documented compliance plan might make the difference between fraud and abuse determinations from auditors.


If you have a clear compliance plan that stipulates how often staff is educated on compliance issues, what type of self-assessments will be performed and how compliance issues will be reported, practices can establish a solid foundation for accurate billing and reimbursement.


Administrators, with the assistance of organizations such as MDofficeManager offers training so that providers review the template information after a patient visit and edit/remove any information that may affect whether the record is represented accurately.


Documenting the implementation of your compliance plan, such as when and who was trained, and the efforts you took to address a potential compliance issue will preclude a potential audit.


MDofficeManager, with its trained and experienced staff of billers and AAPC certified coders, can greatly reduce the stress, anxiety and help eliminate compliance-related issues!

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