Understanding why a culture of compliance in coding and documentation is so important.
Compliance is a large part of our duties in healthcare. It is especially true for coding. With so many regulations, the audit atmosphere and payment nightmares, quite simply we are a moving target. For those of us in the compliance world, we can recite the seven elements of an effective compliance plan in our sleep.
It’s easy for us to set policies and procedures. We are so used to following all of the coding rules and regulations that it is almost second nature to us. But beyond the technicalities, are we creating a culture of compliance in our organizations? It’s not enough for us to simply have rules and rulers.
Culture is extremely important in our practices. Good culture promotes doing the right thing without fear of retribution. It’s empowering our employees to be able to freely express concerns and have open conversations regarding those same concerns. We must go beyond the black and white rules to create an environment where our teams can help us steer the course.
According to the book, “Five Dysfunctions of Teams” by Patrick Lencioni, there are common issues that tear down our teams. As we discussed earlier, building trust will remove these dysfunctions and allow us to create the positive tension we need for improvements.
We need to make sure we work on these five items so that we have a good strong culture in our offices. In 2017 more than $260,000,000 was paid out to whistleblowers or those identifying fraud in healthcare. A disgruntled employee can cause major damage to a practice or facility. Even if in the long run if your practice is targeted by a whistleblower and you prove yourself innocent it takes years to resolve via a ton of work and money. In fact, many providers found in this situation simply throw in the towel due to the costs and stress of defending. Not to mention the negative press.
The best thing you can do is not to put yourself in that situation. While you can’t stop reporting or control the actions of others you can protect yourself by being proactive and creating a culture of compliance in your practice. For example:
The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has some great resources out there that offer free training and help. They also offer these tips for creating a culture of compliance:
At the end of the day, you need enforceable policies that are consistent and monitored. Be sure to take all complaints seriously and act on those without retaliation. Make sure your staff feels empowered enough to speak freely. It’s these small steps that can help you build the culture necessary in your practice.
Let’s admit it: the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM) official conventions, guidelines, and advice involving sepsis and its consequences have been
The Centers for Medicare & Medicaid Services (CMS) is continuing its multi-year push toward payment accuracy, documentation integrity, and value-based care. While the most visible
Please log in to your account to comment on this article.
Breast biopsy procedures may be clinically straightforward but accurately translating them into compliant billing can be anything but. In this focused webcast, Shawn Blackburn, CPC, CPMA, CIC, CRC, CCS-P breaks down how imaging guidance, lesion count, laterality, and payer expectations all impact how these procedures should be reported. Through clear explanations and real-world scenarios, you’ll gain practical insight into aligning clinical workflows with billing requirements, avoiding common pitfalls, and ensuring your documentation supports accurate reimbursement and compliance.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Sherri L. Clayton, RHIT, CSS. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Traditional utilization management models can no longer keep pace with regulatory shifts, payer scrutiny, and operational pressures. In this webcast, Tiffany Ferguson, LMSW, CMAC, ACM, ACPA-C, introduces an Adaptive Model strategy that modernizes UM through role specialization, technology-driven workflows, and proactive, team-based processes. Attendees will learn how to restructure programs to improve efficiency, strengthen clinical collaboration, and enhance financial performance in a rapidly changing healthcare environment.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Happy HIP Week! Sign up to win free access to our 2026 Coding Clinic Update Webcast Series! Click here to learn more →
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
