The importance of the following government initiatives as they pertain to the coding function: Medicare and Medicaid patient and program protection act of 1987- the importance of coding function in this case is to ensure that there is proper documentation which will be used by a contracted contractor in carrying out audit to prevent fraud. The coding system is important when it comes to medical review by independent contractors in order to discover the authenticity of the claims made by individuals. It helps for quick medical review when there is a suspected accuse by both the patient and the medical facility.
The medical facility may participate in fraud by billing the patient when services are not rendered. The medical review will review this: coding will help in carrying out progressive corrective action in case they have not been used properly. In case there is no proper coding funds released will be recovered Operation Restores Trust. - The coding system in this case is important as it will enable those individuals who have reported cases of fraud get rewarded. It encourages governance, accuracy, and proper documentation.
Any party who has reported a fraud case will be rewarded by the facility and ensure that fraud does not occur again. Te coding system ensures that there is accuracy in the other codes especially those related to services for patients and medics given. Medicare integrity programme- Medicare integrity programme aims at ensuing there is proper documentations provided to patients in order to have high integrity. Without proper coding the funds can not release funds for any claims. It helps to prevent fraud and the abuse practices from dishonest individuals.
Without this programme, inappropriate payments will be made which may lead to the insolvency of the organization. Therefore it helps reduce fraudulent and abusive claims, easier identification of fraud and easier detection of fraud. Alterations will also be noted if proper coding is not used. Medicare prescription drug improvement and modernization act of 2003: recovery demonstration project – the coding system here is critical to the success of the programme. It helps reduce outdated in formations and materials by making the medical facility remain current. It ensures that the medical facility are compliant with the rules, if the facility is not compliant with the rules then it means the medical facility is not following Medicare prescription drug improvement and modernization act of 2003: recovery demonstration project. The role of a quality improvement organization contracting under the Centers for Medicare and Medicaid Services as it applies to the coding process. The main purpose of contracted organizations is to help in carrying out audit which will help in reducing misuse of the funds.
In other words it should identify and stop fraudulent and abusive claims which are made by its honest individuals.
They should also be in a position to reduce fraudulent cases. It is also supposed to establish standards and guidelines that will be used to govern medical review of claims. The standards and guidelines which are prepared by this organization are supposed to help in monitoring the compliance of rules and guidelines governing Medicare and Medicaid services.