Questions 1:

Discuss the importance of choosing the additional digits for ICD-diagnostic coding system when necessary. Include the problems that will occur if the additional digits are not chosen for the codes.

Debate pros and cons of having one employee do all the billing and also perform his or her own audits. The jobs include coding, billing, payment posting, and auditing.

Explain the difference between diagnostic and procedure coding including information about monetary value.

Discuss the results of the undercoding and the overcoding of CPT & HCPCS codes. Include the possibility of fines, jail time, and shutdown of the health care facility.

Questions 2:

Explain how the Office of Inspector General (OIG) work plans can assist in the auditing process. Use the current work plan referred to in this chapter to explain the relationship.

Discuss the documentation required for a surgical procedure. Include information about the preoperative and postoperative documenting requirements. Reimbursement for a surgery requires complete documentation.

Identify ways to be proactive with auditing techniques and with information that will allow them to be successful in their audits from all insurance carriers, including Medicare.

Debate pros and cons of recovery audit contractors (RAC) who have been hired by Medicare to audit providers of Medicare patients.