Introduction

Compliance in medical billing and coding is of prime importance in ensuring the ethics and integrity of the healthcare system. The spotlight on ethics in the healthcare business has partly been due to the crisis in confidence about online websites and a lack of public trust. Furthermore, a complex healthcare organizational environment where administrations are required to juggle a ‘multitude of competing regulatory obligations and interests’ has provided fertile ground for ethical dilemmas. The trend is evident in the growing concern over the inappropriate conduct of coding and billing and raising claim denial and rejection issues.

That is why medical coding and billing effort should fully comply with the guideline of regulatory authority because ethical problems will eventually lead the health professional and healthcare business to potential or immediate legal troubles. Ethical issues also contribute to losing goodwill and public image and ultimately reduce business profitability. Thus why, a process is required for strict adherence to regulatory guidelines to protect the patients, payers, and healthcare providers. The article will discuss the role of compliance in medical billing and coding.

Accuracy and integrity compliance

Compliance in medical billing and coding is how to make moral choices applied when pursuing various business practices. It does not mean that all ethical decisions are clear-cut. There is always a presence of significant breaches; consequences can be disastrous. In business, integrity, and ethics standers are based on objectivity, honesty, commitment, and impartiality. Compliance with the regulatory authority regulations tends the medical billing and coding professionals to present the information accurately, except that information comprises the business’s financial information in an independent report.

Compliance with Patient security and privacy

You as a coder and must maintain your compliance with HIPAA. It might be because, as a coder, you have access to both patient medical data and personal information. It has become your responsibility to guard patient information as you must safeguard your own. Otherwise, you will consider the culprit for violating HIPAA. Consequently, you may be subject to steep fines and, in some cases, go to prison. So, the protection of patient information not only helps to maintain the trust between payers, patient, and healthcare providers but also help you protect yourself from potential legal penalties. Read More...