Coding & Compliance Tip
here are so many factors to consider when billing for healthcare services today. Yes, documentation and coding compliance is a must. However, if you do not follow appropriate billing practices as well, you might end up with a hefty over-payment recovery demand, or worse. It is a providers responsibility to understand what is in their agreement, and to follow payer policies. It is a great idea to have these agreements reviewed prior to signing them. Knowing the requirements of participation, in and out of network, rendering vs billing provider is critical to getting it right. Payer audits have a look back period of 6 years, or longer if a plan suspects fraud. Make sure you know what you are billing for. If you have questions on the correct code to use, get help. Don't just wing it and hope the ball doesn't drop because when it does, the financial impact can be devastating.