Reporting noncompliance is part of medical coder's job
There is no question that medical coders need to adhere to compliance standards. Perhaps less understood is that coders are expected to report noncompliant activities at their employers, according to Rose Dunn, a past president of the American Health Information Management Association.
Organizations should have a reporting mechanism in place for noncompliance reports. It's better that they get the reports and fix problems instead of forcing noncompliance reports to go to healthcare payers or government agencies.
Noncompliance may not always include fraud but it still needs to be addressed. Among the reportable issues Dunn lists are:
Documenting services long after the service was provided
Failure to code to the highest level of specificity supported by documentation
Leading physician queries
Adding codes that change the diagnosis-related group (DRG) to a higher reimbursement level and are not supported by documentation.
Coders should have the option to report noncompliance anonymously or not. And they need to be protected. It's better to fix compliance issues than pretend they don't exist.