CheckPoint: Errors and Compliance in Coding
HCR 220

CheckPoint: Errors and Compliance in Coding
Double billing, typos, and incorrect dates are among the most common causes of billing and coding errors that can happen. Double billing is when you have a procedure done by your provider and they try to charge you for two procedures. It could also be something as simple as a hospital billing you for taking two pills when you were only given one. Typo’s is another common billing and coding error, and can be found in the patients name or address. The last is incorrect dates entered into the file. It could be that you stayed in the hospital for four days but the hospital has you listed as staying for seven days and they end up charging you for those seven days. Solutions for the coding and billing errors are to make sure you double check you statements when they come in to make all the information are correct. If a mistake is found then you need to write a detail letter and send it to the facility or to a patient representative to make sure the error is corrected.
The Medicare National Correct Coding Initiative (CCI) controls improper coding that would lead to inappropriate payment for Medicare claims. CCI has coding policies in place that are based on the coding conventions in CPT, Medicare’s national and local coverage and payment policies, National medical societies’ coding guidelines, and Medicare’s analysis of standard medical and surgical practice. CCI has thousands of CPT code combinations that are by computers to check claims in the Medicare system. CCI helps to prevent facilities for billing for two procedures when only one procedure was performed. CCI requires all physicians to report only the more extensive version of the procedure that is performed and does not allow the reporting of both extensive and limited procedures.