Compliance plans are a process for finding, correcting, and preventing illegal medical office procedures (Valerius, Bayes, Newby, & Seggern, 2008). Therefore; all steps in the medical billing process correctly carried out, would apply as part of a compliance plan. In order to prevent illegal medical office practices, every step should be carried out as it was designed. In collecting accurate demographic and insurance information in step one; you are preventing illegal use of someone’s identification and insurance (Valerius, Bayes, Newby, & Seggern, 2008). In establishing financial responsibility in step two; you are verifying eligibility for coverage of present and future services and procedures (Valerius et al., 2008).
In step three; by verifying patient identification and insurance, acquiring signatures for consent to treat, all other administrative and clinical forms (Valerius et al.), as well as, providing the patient with HIPAA regulations and provisions; you are complying with federal, state, and local laws; HIPAA requirements, and preventing fraud or abuse (Valerius et al.).
In step four; checking out the patient, along with applying and entering proper codes (Valerius et al., 2008); you are complying with federal regulations for coding and billing. In step five; the process of reviewing coding compliance (Valerius et al., 2008), you are, again, satisfying official requirements. When checking billing compliance in step six; you are assuring the proper charges have been billed and correcting any errors (Valerius et al., 2008). This reduces the risk of liability to the practice for improper billing or fraud, thereby maintaining a proper compliance plan within the practice (Valerius et al., 2008).
For step seven, preparing and transmitting claims properly and in a timely manner (Valerius et al., 2008); you are, as an employee of the practice, helping the practice to comply with billing regulations (Valerius et al., 2008). This step prevents illegal charges being made to the insurance company which assures billing compliance and helps to protect the practice when monitored or audited (Valerius et al.) Monitoring patient adjudication in step eight, keeps the practice in compliance with all billing regulations and standards, as well (Valerius, Bayes, Newby, & Seggern, 2008).
It assures proper charges being applied for the correct procedures, all charges are explained, and all codes match. Step nine, generating patient statements complies with the proper documentation procedures and assures all payments are applied to patient’s accounts (Valerius et al., 2008). Finally, in step ten, by following up patient payments and collections (Valerius et al., 2008); the practice is complying with the documentation standards by maintaining the patient medical record and keeping it up-to-date (Valerius et al.).
In conclusion, by assuring that each of the ten steps are carried out properly; you are, in effect, maintaining and complying with all compliance plans set in place, maintaining proper and legal patient medical records, and upholding all documentation standards (Valerius et al., 2008). These ten steps also assure compliance with all federal, state, and local regulations, and protect the practice, the patient, in addition to the insurance company; thereby reducing the risk of fraud or abuse liability (Valerius et al., 2008).
ReferencesValerius J Bayes N L Newby C Seggern J I B 2008 Medical Insurance: An Integrated Claims Process ApproachValerius, J., Bayes, N. L., Newby, C., & Seggern, J. I. B. (2008). Medical Insurance: An Integrated Claims Process Approach (3rd Ed.). : McGraw/Hill Higher Education.