Wiki Coding Policy

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reneegrass

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Good morning!
Does anyone have a general coding policy for their organization that they would like to share (or at least share parts of it)? We are trying to put together a policy so that everyone is on the same page. Ex: what is required from the physicians/providers and what is required from the coders.

Any help would be greatly appreciated!

thanks
Renee Grass, CPC
 
Ours is pretty simple

Physician should document what they do.
Coders should code what is documented.

Hope that helps.

F Tessa Bartels, CPC, CEMC
 
In A perfect world!

Yes, physicians should document what they do, and yes, coders should code what they read, but that is a duty, a task, and it is not a written policy. The Office Policy Manual, the Office Compliance Plan Educational Component should have the Compliance Officer's signed assurance that each skill level is on track with MU2. I am a consultant and right now, the biggest problem I am seeing is that doctors are contracting with large Hospital-like Compliance Officers who are mainly offsite, and not being accountable. The fact that a coder would come on and ask about a policy, knowing it is right to have, tells me the Compliance Officer in your facility/practice is not compliant. If you are told "we're looped in with such-and-such a hospital", well any individual working in any manner of health care clinical/administratrive, is non-compliant if they do not know who their CO is.

If you were to receive a reactive OIG or CMS audit at this site, all the coders' qualifications, certifications, and Continuing Education. The MLN has detailed on-line courses on how to ensure compliance, but it is up to your CO to make sure you have ongoing, like daily training.,

Joanne McNamara, CPMA, CPC, CMA (AAMA)
ARIESforcompliance.com
 
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