How does proper provider credentialing relate to coding accuracy?

Proper provider credentialing is crucial for ensuring that services are billed in accordance with the qualifications of healthcare providers. When a provider is credentialed, it means they have been vetted for their qualifications, training, and licensure, which establishes their legitimacy to perform specific procedures and offer particular services. This verification process directly impacts coding accuracy because the code submitted for billing must align with the services that the credentialed provider is authorized to render.

If a provider is not properly credentialed, there is a risk of submitting claims for services outside of their qualifications, which can lead to billing inaccuracies. Therefore, the connection between credentialing and coding accuracy is significant; accurate coding hinges on the adherence to the scope of practice defined by the provider's credentials. This compliance not only upholds the integrity of the billing process but also safeguards the healthcare facility from potential legal issues related to improper billing practices.