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Dear Healthcare Professionals,
In an era where regulatory scrutiny is intensifying, the significance of governmental coding audits within the healthcare sector cannot be overstated. These audits serve as a cornerstone for maintaining compliance, ensuring the integrity of medical billing and coding practices. It is crucial to understand the complexities of these audits so you can ensure your practice will be prepared and not be taken by surprise.
I. Introduction to Governmental Coding Audits
At their core, coding audits are systematic reviews conducted to verify the accuracy of medical records coding. These assessments are crucial for compliance and are performed by various governmental agencies, including the Office of Inspector General (OIG), Centers for Medicare and Medicaid Services (CMS), and designated Recovery Audit Contractors (RACs) across specific regions. Their primary aim is to ensure healthcare providers adhere strictly to coding guidelines, thereby guaranteeing correct service level reporting and appropriate reimbursement.