What is considered inappropriate in healthcare billing practices?

Using assumption coding is considered inappropriate in healthcare billing practices because it involves coding based on assumptions rather than concrete documentation and evidence from the patient's medical record. Assumption coding can lead to inaccurate billing, which not only violates ethical standards but also can result in legal consequences for both the healthcare provider and the organization. Accurate coding should be based solely on the information provided in the patient's chart, ensuring that claims are reflective of the services rendered and medically necessary.

In contrast, following established guidelines, consulting with providers regularly, and auditing claims before submission are all practices that promote accuracy, compliance, and ethical standards in billing. These practices ensure that billing processes are transparent, that claims are supported by appropriate documentation, and that any potential issues are addressed proactively, ultimately safeguarding the integrity of healthcare billing and reducing the risk of audits or penalties.