BLOOMFIELD, MICHIGAN, UNITED STATES, June 9, 2017 /EINPresswire.com/ -- 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. 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 appear on the bill to your insurance company like Medicare, Medicaid, Blue Cross or any third-party payer. 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 reviews and interprets complex clinical data and regulations in collaboration with law firms to assist them in better defending healthcare providers against false claims.

Coding Compliance Solutions also offers consulting services to educate their clients on better record keeping and billing procedures to remain in compliance.

“Hospitals have compliance plans that require annual audits; they want to make sure they’re doing the right thing. We’ll come in and do an audit,” says Edford. “Some of them we teach them how to do the right thing. Sometimes, we have to be the external, objective reviewer.”

Still, Edford says what she’s most proud of is creating a work environment where women can have a professional career and maintain a family at the same time. Coding Compliance Solutions has been in business a little more than 17 years and its shortest tenured employee has been with the company for 15 years.

CUTV News Radio will feature Georgeann Edford in an interview with Jim Masters on June 12th and June 19th at 10am EDT.

Listen to the show on BlogTalkRadio.

If you have a question for our guest, call (347) 996-3389.

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

Lou Ceparano
CUTV News
(631) 850-3314
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