Question

Discuss any involvement you have or have had at some point in your career in regard to coding compliance. This can include proper documentation, coding of procedures, electronic charge ordering, or other components of charge capture and coding.

Answer 1

For some nurses like me medical coding becomes a natural career progression that wasn’t planned. The nurse sees there is a need to help patients through accurate coding and billing of medical claims, learns how, and fills in to help.

While the transition to ICD-10-CM/PCS has the potential to put revenue at risk, adding staff to the revenue cycle is rarely an option in today’s cost-cutting environment. There are no extra hands to review charges, double-check bills, or safeguard claims. To mitigate risk, preventive measures should be put into place at every juncture within the revenue cycle to ensure bills are correct and claims are paid.

Increased postpayment reviews of medical necessity and medical record documentation supporting claim

Overpayment recovery

Providers identified by the audit as submitting improper claims will be targeted for more extensive investigation

Increased review of evaluation and management claims Demand for more documentation from providers who submit claims

Increased security measures to prevent submission of claims from improper providers