Compliance

At JJ&R Medical Data Systems, Inc. (MDS), it is our policy to comply with all the laws and regulations applicable to the medical practice and business of its clients at all governmental levels. MDS is sensitive to the compliance issues raised by HCFA in the agency’s process to eliminate fraud and abuse by both healthcare providers and institutions. We are uniquely responsive because of our role as provider of billing services for client hospitals and medical groups. Since MDS provides its own billing functions, we are in total control of every facet of the coding and billing process. Accordingly, we can be certain that all of our billing operations are in total compliance with HCFA requirements.

To that end, we have developed educational handbooks, documentation guidelines, and tools in order to assist physicians, hospitals, and coders. This ensures that the services for which we bill are coded accurately and properly. Further, we have developed similar guidelines and tools for hospital clients to ensure that a similar level of reliability and accuracy is provided in coding for the hospital’s technical component.

Two JJ&R physicians undertake the responsibility to educate physicians and coders with respect to the compliance requirements. These physicians serve, in effect, as medical directors of our billing service. The coders in our billing department are monitored to assure that their coding is consistent with both industry norms and MDS’ own requirements for accuracy and reliability.

MDS also takes full advantage of our billing information system to monitor the billing trends of individual physicians in order to make certain that their individual habits are consistent with the overall practices of the group. This monitoring function is carried out regularly, with monthly-individualized physician reports presented to the department medical directors. Physicians whose coding practices fall outside the group’s “norms” can be identified and, subsequently, counseled through education in an effort to improve their compliance patterns.