Building an Effective Coding Compliance Program in Medical Practices.

Abstract

In simpler times, it made sense for medical practices to hire unskilled, noncre- dentialed clinical coders. The trend continued with the introduction of electronic medical records-where software seemingly made the physician's coding de- cisions after a few points and clicks. However, with the confluence of ICD-10 changes, more fraud and abuse audits, and increasing fines for noncompliant coding, the time has come for medical groups to rethink their clinical coding strategy. Employing a certified coder and building an effective coding compli- ance program is no longer an option-it is a necessity. Credentialed coders make decisions that nearly always result in stronger reimbursement and also stand up under scrutiny by the Office of Inspector General. This article explores common myths about clinical coding, identifies ways practices get into compli- ance trouble, and provides specific avenues to implement an effective coding compliance program.