A medical practice should regularly review its billing practices to identify possible problem areas that need to be corrected. Failure to correct these problems can result in lost revenue or a Medicare investigation.


(1) using codes and descriptors that are out of date or not approved

(2) failure to bill for certain services

(3) under-coding or over-coding for services

(4) excessive number of denials or requests for more information



(1) failure to train regularly about charging rules and regulations

(2) difficulty finding up-to-date information related to coding

(3) difficulty finding answers to specific problems with coding

(4) inadequate planning for changes in reimbursement or regulations

(5) failure to audit coding

(6) audits find an undesirable levels of inaccuracy or inefficiency

(7) using a billing consultant who gives questionable advice



(1) lack of feedback about coding performance

(2) insufficient documentation in medical record to support charges

(3) errors in charging for non-physician services


The presence of one or more of these problems indicates that need to take corrective action.

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