Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:Introduction to Health Care and Public Health in the U.S.
Unit:Regulating Health Care
Lecture:The Role of Medical Records in U.S. Health Care
Slide content:Quality Clinical Documentation to Avoid Fraud and Abuse Accusations Clinical documentation improvement programs support high-quality documentation Train providers High-quality documentation supports accurate coding and reimbursement Accurate coding is needed to avert accusations of fraud and abuse 10
Slide notes:No legitimate individual provider or health care organization wants to be accused of fraud or abuse. Examples of fraud or abuse include billing for a higher level of service than was provided, or billing for a service that was not provided. Ethical standards must be upheld for reporting claims for reimbursement at all levels of health care. This is best done by developing clinical documentation improvement programs, in which providers are trained to provide high-quality documentation in the health record. Reimbursement of claims is based on documentation in the health record. A coding specialist reviews the health record and provides code numbers that are then linked to a payment system for the payer responsible for the claim. 10