1) Discuss some common causes for coding errors and the preventative measures you can use to avoid them. 2) What are some other measures you can add to the list that might not be in the course materials? 3) What is the Fraud and Abuse Control Program? What is the HHS OIG and what is it's major concern?   (Be sure to watch the video below.) Watch Video A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse http://www.youtube.com/watch?v=0yRo-YmITus The video summarizes the five main Federal fraud and abuse laws (the False Claims Act, the Anti-Kickback Statute, the Stark Law, the Exclusion Statute, and the Civil Monetary Penalties Law) and provide tips on how physicians should comply with these laws in their relationships with payers (e.g., the Medicare and Medicaid programs), vendors (e.g., drug, biologic, and medical device companies), and fellow providers (e.g., hospitals, nursing homes, and physician colleagues). Please review the discussion board rubric found under "Start Here".  Use  in-text citations  appropriately and provide  full citations for your initial post and at least one of your response posts.   One of your citations needs to be  outside  of your text.   The idea is that you would not only comment on your classmate's post but also do some additional research furthering the discussion. To begin discussing in this forum, click the forum title, "Week 3 Discussion". Then, click Create Thread on the Action Bar to post your initial reply. To reply to a fellow participant, click the title of the initial post, then click Reply. Quetsy Garcia discussion week 3 Collapse Total views: 1 (Your views: 1) These are some of the most common causes for coding errors: Incorrect coding Upcoding Unbundling of services Billing for medically unnecessary services Billing for services not covered under health plan Duplicate billing What are some other measures you can add to the list that might not be in the course materials? Reviewing to assure there is no incorrect information for the patient (name, sex, date of birth, insurance ID information, etc.) Assuring insurance provider information is accurate (policy numbers, address, contact information, etc.) Inputting the wrong codes or confusing codes such as CPT codes, point of service codes, or ICD-9-CM codes Entering too few or too many digits for ICD-9-CM codes Inputting mismatched treatment and diagnostic codes Forgetting to input codes at all for services performed by a physician or another healthcare official Not having access to EOBs on denied claims Not verifying a patient’s insurance coverage What is the Fraud and Abuse Control Program? What is the HHS OIG and what is it’s main concern? HHS is a Fraud and Abuse Control Program OIG carries out nationwide audits and investigations. They have the authority to investigate basically any healthcare facility. There primarily concern is to make sure business comply with principles of business practice and avoid he ...

1. 1)
Discuss some common causes for coding errors and the
preventative measures you can use to avoid them.
2)
What are some other measures you can add to the list that
might not be in the course materials?
3)
What is the Fraud and Abuse Control Program? What is the
HHS OIG and what is it's major concern?
(Be sure to watch the video below.)
Watch Video
A
Roadmap
for New Physicians: Avoiding Medicare and Medicaid Fraud
and Abuse
http://www.youtube.com/watch?v=0yRo-YmITus
The video summarizes the five main Federal fraud and abuse
laws (the False Claims Act, the Anti-Kickback Statute, the Stark
Law, the Exclusion Statute, and the Civil Monetary Penalties
Law) and provide tips on how physicians should comply with
these laws in their relationships with payers (e.g., the Medicare
and Medicaid programs), vendors (e.g., drug, biologic, and
medical device companies), and fellow providers (e.g.,
hospitals, nursing homes, and physician colleagues).
Please review the discussion board rubric found under "Start
Here".
Use
in-text citations
appropriately and provide
full citations for your initial post and at least one of your
response posts.

2. One of your citations needs to be
outside
of your text.
The idea is that you would not only comment on your
classmate's post but also do some additional research furthering
the discussion.
To begin discussing in this forum, click the forum title, "Week
3 Discussion". Then, click Create Thread on the Action Bar to
post your initial reply. To reply to a fellow participant, click the
title of the initial post, then click Reply.
Quetsy Garcia
discussion week 3
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Total views: 1 (Your views: 1)
These are some of the most common causes for coding errors:
Incorrect coding
Upcoding
Unbundling of services
Billing for medically unnecessary services
Billing for services not covered under health plan
Duplicate billing
What are some other measures you can add to the list that might
not be in the course materials?
Reviewing to assure there is no incorrect information for the
patient (name, sex, date of birth, insurance ID information, etc.)
Assuring insurance provider information is accurate (policy
numbers, address, contact information, etc.)
Inputting the wrong codes or confusing codes such as CPT
codes, point of service codes, or ICD-9-CM codes
Entering too few or too many digits for ICD-9-CM codes

3. Inputting mismatched treatment and diagnostic codes
Forgetting to input codes at all for services performed by a
physician or another healthcare official
Not having access to EOBs on denied claims
Not verifying a patient’s insurance coverage
What is the Fraud and Abuse Control Program? What is the
HHS OIG and what is it’s main concern?
HHS is a Fraud and Abuse Control Program
OIG carries out nationwide audits and investigations. They have
the authority to investigate basically any healthcare facility.
There primarily concern is to make sure business comply with
principles of business practice and avoid healthcare providers
committing fraud.
Aalseth, P. Second Edition Medical Coding 2015
http://www.medicalbillingandcodingonline.com/medical-billing-
errors/
Dorothy Browning
week 3 discussion
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Total views: 7 (Your views: 1)
Coding Errors
Hospitals, physicians, and medical clinics depend on medical
coding and billing to generate their income. Therefore, the
coding specialists are the principal means of communication
between medical providers and the insurance companies
(Venezian, 1985). When errors are recorded during coding,

4. claims may be uncompensated for, or a hospital may be forced
to refile an application(s) before payment is initiated.
Causes of Coding Errors
Incorrect Medical Diagnosis
Incorrect medical diagnosis occurs when a code that is not
compatible with a procedure is recorded. The error mainly
ensues when there is a failure by the specialists to offer a
diagnosis to the highest level or when there is an omission of
the 4th or 5th digit during data entry (Venezian, 1985).
Error in the Medical Documentation
It occurs when there is a misunderstanding of the medical
records and documents. Alternatively, this may happen when
there is a missing billable procedure or the details required for
billing.
Failure to Code to the Highest Level
The coding expert must encrypt a medical event or process to its
highest degree of specificity, which requires abstraction of
information from the medical reports and taking of accurate
notes. Moreover, the professional should understand both the
testing and diagnosis procedure of the ailment to be coded.
Strategies to Avoid Coding Errors
The most preeminent tactic that can be espoused by firms to
impede errors is ensuring that the coding personnel is current on
coding changes (Venezian, 1985). To achieve this, updated
encryption manuals, publications, and organizing refresher
training sessions for the staff members have to be provided.
Moreover, the employees should be diligent since the coding job
is detail-oriented and requires a thorough analysis of data
presented. The errors can also be avoided by double checking
the work upon completion to eliminate careless mistakes and
possible omissions. Additionally, it is vital to ensure that there
is communication between the coders, health professionals, and
the insurance providers to facilitate clarification of ambiguous
medical reports before coding is commenced. Finally, the

5. coders should avoid the use of truncated codes; they should
present the patient's diagnosis to the highest level of specificity
(Venezian, 1985).
Other Approaches for Preventing Coding Errors
Apart from the above-highlighted measures of avoiding coding
errors, the following methods can also be used to minimize the
risks of inaccurate coding:
Follow up on claims. It is possible for an individual to avoid
and anticipate errors by following up on the previous claims
filed with the insurance company (Venezian, 1985). A
representative from the insurer may help to single out an error,
hence providing an opportunity to resubmit an application
before it is processed and denied. Secondly, coders should read
the entire progress reports rather than just skim through the
header to capture diagnostic information and the nature of
services provided. Though the header may summarize the
procedure conducted, the treatment may change as the physician
gathers more information about the patient during a diagnosis
(Venezian, 1985).
Fraud and Abuse Control Programs
Health Care Fraud and Abuse Control Programs are a stratagem
that conceived to combat scams in health care by monitoring the
delivery of services, medicals supplies, and equipment across
the local, state, and federal governments (Wood, 2015). The
program is directed by both the Attorney General and the Office
of Inspector General, OIG. These departments are responsible
for submitting annual progress reports to the Congress. HHS
OIG is an acronym that is used to refer to the Office of
Inspector General Department of Health and Human Services
(Wood, 2015). This department is charged with the
responsibility of identifying fraud and abuse of resources in
Human Health Services, HHS, which harbors more than 300
health and safety programs. The main aim of HHS-OIG is to
protect the beneficiaries of these programs while maintaining
the integrity and delivery of health services (Wood, 2015). The
program also indicts individuals who breach the law on federal

6. insurance or embezzle health care funds.
References
Venezian, E. C. (1985). Coding errors and classification
refinement.
The Journal of Risk and Insurance,
52
(4), 734. doi:10.2307/252318
Wood, C. (ed.). (2015).
The Health Care Fraud and Abuse Control Program: Issues,
assessments and effectiveness
. New York, NY: Nova Science , Inc.