Solid Healthcare Compliance Program Is Key To Preventing Costly Coding Errors, Aiding Profitability

(RIVERWOODS, ILL., June 18, 1999) – Medical service billing and coding errors are costly – and sometimes fraudulant – mistakes that few healthcare providers can afford to make these days. Whether the problem is upcoding Medicare claims that puts a provider at risk of hefty government fines, or downcoding claims that short-changes a provider for services rendered, the solution is the same – a sound compliance program, according to CCH INCORPORATED, a leading provider of healthcare law information and the CCH Healthcare Compliance™ Portfolio. The topic is among the critical dollar issues that healthcare finance professionals from around the country will consider June 20-23 in Anaheim, Calif. during the Healthcare Financial Management Association’s Annual National Institute.

Coding Errors Can Be Expensive

"The federal government’s increased efforts to detect and prosecute healthcare fraud have uncovered upcoding abuses that can result in $10,000 penalties per offense, imprisonment, and exclusion from the Medicare/Medicaid program, and also have caused some providers to become overly conservative and downcode claims. Obviously, both practices are unsound from a financial perspective," said Daniel J. Weissburg, Esq., CCH Healthcare Compliance Analyst and editor in chief of the CCH Healthcare Compliance Portfolio.

"Financial officers, CEOs and compliance officers in healthcare organizations are well aware that they cannot afford to stand by and watch as these needed dollars are drained away," he added, "they need to act."

Cutting through the quagmire of coding regulations and government requirements is no easy task, however, even for the most diligent and well intentioned. In recent years, hundreds of new guidelines, regulations and rulings have been issued, all aimed at medical claims processing.

The High Cost of Noncompliance

In the overall compliance crackdown of recent years, coding practices have received an increasing share of scrutiny, regulation and focus from the federal government. In fiscal year 1998, the government estimates that Medicare overpaid physicians $1.5 billion because of incorrect coding alone.

Fraudulent intent isn’t required, however, to raise the federal government’s ire. The great majority of healthcare professionals are not engaged in fraudulent activity, but even the well-meaning must meet the often-times unclear regulatory requirements designed to stop fraud and abuse.

Any incorrect claim to Medicare can be considered a false claim if the submitter knew or should have known that the claim was incorrect. If a provider knows the submitted claim is false – the case is an easy one – deliberate fraud has been committed.

However, if the charting, coding and billing process is just sloppy or imprecise, and inaccurate claims are discovered, the government can assert that the provider should have known that the systems in place are inadequate. Statutory penalties can be up to $10,000 per false claim, and it adds up in a hurry.

Aside from the direct high cost of penalties and fines, there’s reason to believe that providers are losing even more money as a result of under-representing services rendered, or downcoding claims.

Effective Compliance is Key to Controlling Costs

There are ways, however, for healthcare providers and their financial administrators to minimize the risk of noncompliance and avoid the financial loss and exposure associated with it.

"It’s imperative for financial professionals within a healthcare organization to work with senior management and across the organization to ensure that a sound compliance program is in place," said Weissburg.

The CCH Healthcare Compliance Portfolio helps providers create and maintain effective compliance programs, and meet the challenges of correct coding by navigating through complex laws. The definitive resource for compliance professionals in hospitals, long term care facilities, insurance companies and other related organizations, the Portfolio spans the spectrum of compliance responsibilities, providing full-text reporting of laws and regulations; expert insight, analysis and strategies; and timely reporting on compliance developments industry-wide.

The Portfolio includes CCH Healthcare Compliance Reporter, providing fully searchable primary source information, including the full text of all relevant laws, regulations, cases and more; CCH Healthcare Compliance Guide, a key desk reference featuring proven compliance strategies and solutions to compliance problems, valuable planning aids, model compliance plans and practical advice; and CCH Healthcare Compliance Letter, delivering timely reporting and practical strategies to keep compliance professionals on top of emerging compliance topics.

For More Information

To arrange an interview with Healthcare Compliance Analyst Daniel Weissburg, contact Leslie Bonacum at 847-267-7153 or For more information about the CCH Healthcare Compliance Portfolio, visit the CCH exhibit booth number 526, Anaheim Convention Center, during the Healthcare Financial Management Association Annual National Institute.


CCH INCORPORATED was founded in 1913 and has served four generations of business professionals and their clients. For more than 50 years, the company has regularly tracked, reported, explained and analyzed health and entitlement law for healthcare providers, insurers, attorneys and consumers. CCH is a wholly owned subsidiary of Wolters Kluwer U.S. The CCH web site can be accessed at

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