Inventi Rapid: Service Sector

Inventi:mrss/19481/21

Sometimes It’s Good to Breach the Rules but Not in Medical Coding

Medical Profession is one of the most respected and noble of all. The governing bodies of the respective state/country control the activities involved as well as practice performed by the respective professionals. Medical profession involves performing activities associated with the health of diseased person or populace, with respect to which, they perform activities such as diagnosis, prevention, management, treatment or cure of particular condition. However, like there are many loopholes in practice of any profession, so as there exists in medical profession too. It depends upon the governing body of the respective country to control the menace associated with it. In USA, good news is that each profession is regulated by an astute apex body. The committee of the Apex body regulates the practice in the country through set of guidelines which are updated on regular basis. Same as in pharmaceuticals as well as in medical practice in USA, which are governed and regulated by FDA (Food and Drug Administration), Centers for disease control and prevention etc. In USA and some additional countries even, the payments for healthcare service rendered by HCP (Healthcare practitioners) gets regulated. AAPC is the main certified body which along with regulating the billing issues also offers certification courses to the budding future professionals. Medical coders or Certified Medical Coders in short CMC are the people who help in drafting the medical procedures /documentation conducted by healthcare practitioners into the set of detailed codes to make it permissible enough to send to the payers. Many issues pop-up while carrying out the process, such as, wrong codes submitted resulting to denials, wrong coding leading to even fraud allegations. In competitive market such as of today, even a small coding error could result into spoiling of the image as well as reputation of the hospital or the practitioners/provider himself despite being punished of hefty amounts from the regulatory body. The present review, thus, has been written in perspective, that, “Sometimes it’s good to breach the rules, but not in Medical coding”, or, I would say, not even in pharmaceuticals, medical profession or in the present case, in the Medical coding....