What happens if variances are found between the codes supported and those submitted?

When variances are found between the codes supported by the documentation and those submitted, it is essential to address the discrepancies in a systematic manner. The correct approach is to make decisions regarding necessary corrections, which may include issuing refunds for any overpayments that were made as a result of the incorrect coding. This is fundamental to ensuring compliance with coding regulations and maintaining the integrity of the medical billing process.

Identifying variances indicates that there may have been an error in the coding or a misinterpretation of the clinical documentation. Following up on these discrepancies is crucial not only for rectifying the financial aspects but also for ensuring that the provider's documentation accurately reflects the services rendered. This helps maintain proper financial controls and assures compliance with regulatory standards.

In contrast, claiming that nothing occurs when variances are found undermines the importance of accurate coding and could lead to significant financial repercussions for healthcare providers. Additionally, simply issuing warnings or automatically denying future claims without addressing the underlying issues would not effectively resolve the discrepancies or improve coding practices. Thus, the correct course of action requires taking steps to amend the identified issues, including potential refunds for overpayments.