Question

I can't edit the questions that you told me to edit this is the rest of the information to the questions. I post this question more than 5 times I really need help with this question.

The potential issues are based on the most recent claims audit report. Fraud and abuse are similar, but defined by different intentions. Fraud is the intentional deception or misrepresentation of information by an individual or organization. Abuse involves actions that are inconsistent with accepted, sound medical, business or fiscal practices. Abuse directly or indirectly results in unnecessary costs to the program through improper payments. Examples of both include upcoding and downcoding.

Using the coding audit of sample records below, analyze the results and provide a 1-page report of your findings. Your report should:

• Provide a summary of the audit results.
• Identify potential abuse or fraudulent trends, with examples.
• Recommend and describe at least one action item based on potential abuse or fraudulent trend.  

Claims Audit Report
MR#	Reason for Claims Denial	Physician
MR#39487	Lack of documentation to support code(s) or claim	Dr. Avery
MR#75843	Missing information – incomplete form	Dr. Avery
MR#91873	E&M coding discrepancy	Dr. Jones
MR#00282	Missing information – incomplete form	Dr. Freeman
MR#44817	Missing information – incomplete form	Dr. Smith
MR#11028	Lack of documentation to support code(s) or claim	Dr. Jones
MR#42678	Lack of documentation to support code(s) or claim	Dr. Jones
MR#89234	E&M coding discrepancy	Dr. Jones
MR#12843	E&M coding discrepancy	Dr. Jones
MR#33459	E&M coding discrepancy	Dr. Jones
MR#99087	Lack of documentation to support code(s) or claim	Dr. Jones
MR#51679	E&M coding discrepancy	Dr. Jones
MR#31678	Lack of documentation to support code(s) or claim	Dr. Smith
MR#00925	Missing information – incomplete form	Dr. Freeman