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what are some tips to avoid overcoding, and to prevent fraud through billing? how to handle the unlisted diagnosis & unlisted procedures?

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Question added by edison gonzalo , Outpatient Medical Coder , Tawam Hospital
Date Posted: 2013/09/19
Melgar Gultiano - CPA,  CIA,  CFE
by Melgar Gultiano - CPA, CIA, CFE , Group Internal Audit and Internal Control , GAC

one way to know the appropriate billing to the patient is through confirmation from the patient itself. Thing is some of the patients were not necessarily concern on the procedures done as compared to claims of hospital to the insurance since the patient knew that the insurance will pay for it anyways. 

Educating the insurance holder, advicing on the end effect to over used claims and possibility of higher premium upon renewal is the best way to inform the insurer on their obligation to their insurance.

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