Page 4 - Coder's Choice Magazine - Aug 2020

August 2020 UPCODING:

"AN OLD THIEF WITH A
RUMOR HAS IT!

NEW WAY"

here are Claim Adjudicators whose respons ibl e is determini ng how muc h
money should be paid out once a claim is subm itted. The y woul d us ua lly
request for supporting documents for claims withi n a certain dol lar amount and
examine the insurance policy to determine suc h factor s to ens ur e no fraudul ent
activity. In addition to Claim Adjudi cator s, the re are Certified Medi cal

Auditors or Compliance Auditors that perfor ms audi ts revi ew of clini cal
documents, billing record, administrative da ta, and codi ng recor ds . Audi tor s
also ensure employers are in complianc e with the indus try rul es and
regulations.

Here are some common healthcare provide r f raud s che mes t o l ook out f or :
1.Billing for patient services not rendered

2.Billing for services that are not covered

3.Incorrect dates of service, location of servi ces r ende r, a nd s ervi ce pr ovi de r

4.Waiving of deductibles and/or co-payment s
5.Incorrect diagnosis or procedures

6.Over usage of services

7.Bribery

8.Falsifying issuance of prescription drugs
Healthcare Associates Training & Temp C ent re pr ovi de s t raini ng a nd a udi ting s ervi ces t o

ensure that upcoding doesn’t happen. Call t he m toda y a t 242- 826- 2951 or by e mail a t
healthassociatescentre@gmail.com. You can a lso c he ck out t he ir w ebs ite a t
www.healthassociatescentre.com

S
T
Y
A
STAY
W O K E BE
WOKE
BE

BRAVE
BRAVE

ROXY B.

PAGE EDITOR