APA Style Sheet 1

Medical Records and Documentation and Records

Medical Records Documentation and Records

Carolyn Maxine Hughes

University of Phoenix

HCR/220

APA Style Sheet 2

Abstract

In this 250- 300 essay/written document, I will be attempting to describe how compliance

plans correlate to different medical records, documentation standards. I will then describe or

explain in detail how the 10 steps in the medical billing process relate to compliance plans,

medical records, and documentation standards. I will then myself have a better understanding

and knowledge gained in the process of medical records being documented and what goes on in

the billing cycle through the 10 steps of the medical billing process.

APA Style Sheet 3

Medical Records Documentation and Billing

Compliance plans correlate to different standards of medical records and documentation

by finding, correcting and preventing illegal medical office practices. When the facility or

organization has a compliance plan in place, implemented all policies and practices, provide an

ongoing staff training for early detection of any problems; they can be pretty much sure that they

are not violating any compliance when it refers to medical records or documentation.

In steps five, compliance plans are included in reviewing coding compliance to ensure the

guidelines are followed when the codes are assigned correctly in the patients’ medical records. In

step six, the checking billing compliance ensures the charge, fee, for the visit is related to a

specific code according to the rules of the billing compliance

Compliance plans correlate with medical records by making sure the correct diagnose, and

patients care is outlined in their medical records as described in steps four of the medical billing

process Medical records are a patient legal document that contain very important health

information. It must be accurate and kept up to date by all physicians and the employees of the

facilities involved in the patients privacy to lessen lawsuits and provide a better service for their

patients.

Compliance plans correlate to documentation standards by outlining the ten steps in the

medical billing process. Each one of these steps correlates or has some significance to

compliance plans in billing and reviewing compliances, monitoring the payer adjudications, even

to the follow- up of the patients’ payments and handling collections. These three steps of

compliance plans, medical records, documentation standards helps all medical facilities to again

like I mentioned early on in one other statements; to correct, find, and prevent any complicated

problems and issues to avoid their facility from any risks or causes of liability suits.

APA Style Sheet 4

APA Style Sheet 5

References

Valerius- Bayes- Newly- Siegen: Medical Insurance: An Integrated Claims Process

Approach, Third Edition, the McGraw- Hill Companies, 2008.

p. 16-21, Chapter 1

Chapter 2, HIPAA and Medical Records

p.63