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Billing and coding compliance is the role of everyone involved in the delivery of healthcare. Compliance monitors coding and billing strategies and audits medical records to guarantee that documentation supports the information reported in medical claims.

 

Compliance with the standards of accurate coding and claims submission is paramount to the success of the medical practice to ensure that the health care reimbursement system functions transparently without fraud or abuse. Fraud is defined as billing for services that were not delivered. Abuse is defined as billing for services that are billed inappropriately.

 

Billing and coding compliance revolves  around making sure that what is in the patient’s medical record is accurately transcribed into industry-standard medical code. The medical practice is ultimately responsible for the accuracy of claims filed for services provided and physicians are held responsible for the accuracy of information coded on a claim or bill. Therefore, services must be reported in accordance with reporting guidelines and instructions and every effort made to ensure that coding is accurate.

 

Morehouse School of Medicine and Morehouse Healthcare comply with all applicable federal and state health care billing laws and regulations. We ensure that services provided are consistent with applicable statutes, regulations and program requirements involving federal and state health care programs including guidance issued by the Office of Inspector General, Department of Health and Human Services, and other government regulatory agencies including guidance and the requirements of the Health Insurance Portability and Accountability Act (“HIPAA”).

 

Morehouse School of Medicine and Morehouse Healthcare are committed to preventing fraud and abuse in billing and act responsibly in submitting only charges that are truthful and accurate, and reflect medically necessary or appropriate services that are fully supported by health care record documentation.

 

Additional Resources 

Center for Medicare and Medicaid Services-Internet Only Manuals (IOM)

Teaching Physician Guidelines

Documentation Guidelines for Evaluation and Management (E/M) Services

National Correct Coding Initiative

Cahaba GBA- Medicare contractor for Georgia

Medicaid Policy Manuals- Georgia