NAMAS Compliance Webinar Series
May 11, 2021 | 2:00 pm EDT
Escalation Policies: What Are They and What Is Their Purpose?
Speaker: Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC
Policies are more than just words on a paper and in order to
demonstrate a “Culture of Compliance” they have to be effective and actionable
and that includes “Escalation Policies”, which are used within an organization
to highlight any issues that need correcting. In relation to coding, an initial
audit is performed to gauge the accuracy of providers. Those providers falling
below the organization’s accuracy threshold, face consequences ranging from
education and re-audit to pre-bill review of all of their claims. The idea is
not punishment but to rectify coding/billing issues and protect the
organization from False Claim Act allegations.