CodeMap Compliance Briefing: 10/14/05
Many providers that accept referrals from other healthcare practitioners will sometimes provide the referring provider with regulatory information such as coding recommendations, reimbursement amounts, and policy explanations. Clinical laboratories and other diagnostic providers, such as pathologists and radiologists, distribute such information in order to create greater efficiencies in billing and claim submittal processes. If all participants are aware of the billing and coding rules, hopefully greater compliance will occur resulting in cleaner claims and fewer denials. The idea makes sense, however, providers must be careful when distributing such billing and coding information. Without due care and thorough research, a provider may inadvertantly violate federal fraud and abuse laws. The following CodeMap Compliance Briefing will offer suggestions on how to distribute this information while avoiding significant regulatory pitfalls.
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