CUTV News Radio spotlights Georgeann Edford of Coding Compliance Solutions

Bloomfield, MI – When the Health Insurance Portability and Accountability Act (HIPAA) of 1996 was enacted, in addition to data privacy and security safeguards for medical information, it established funding for oversight and investigations into improper billing. This initiative has been very successful. In 2015, the Department of Justice obtained more than $3.5 Billion in settlements and judgement involving health care fraud and false claims.  Since January 2009, they have collected $26.4 billion.

Georgeann Edford is the founder of Coding Compliance Solutions, a consulting firm that specializes in working with healthcare providers around the country to code and bill services correctly. 

Like bar-coding on products, everything a provider – physician, hospital, nursing home – does, is translated into codes and these codes that appear on the bill to your insurance company like Medicare, Medicaid, Blue Cross or any third-party payer. Very simplistically, one set of codes say this is what I did and other set says this is why I did it.

“What we do is we make sure that the documentation in the medical record is consistent with the requirements associated with the codes on the claim.” explains Edford. “If the documentation says you did “X” and you billed for “Y”, then there can be an issue."

For providers around the country who have either been accused of Medicare fraud or are concerned that there may be some improper billing that could lead to noncompliance, Coding Compliance Solutions offers consulting services to educate their clients on better record keeping and billing procedures to remain in compliance.

For more information on Coding Compliance Solutions, visit www.codingcompliance.com