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Escalation Policies: What Are They and What Is Their Purpose?

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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.

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