Constructing Coding Compliance Policy Assignment Help

Constructing Coding Compliance Policy Assignment Help

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Constructing Coding Compliance Policy Assignment Help

Orientation to your organizational setting:

You have just been hired as a HIM Director of a Acute Care Hospital (80-bed), located in  Alabama. The hospital provides outpatient services and ED  services to a community of 35,000 residents and serves an additional 20,000 residents living in 6 adjacent rural counties.

The hospital has recently experienced a degree of financial insolvency due to several events:

1. Reimbursement penalties assessed by RAC Monitors. Major citations: up coding, unbundling.
2. Numerous medical necessities edit backlogs.
3. Cash flow has been delayed due to a back log of physician queries.
4. Inpatient denial rates are trending upward over the past 6 months.
5. The Joint Commission will be completing a survey (tracer methodology) in 6 months.
6. The payer mix is heavily weighted: Medicare 42%, Medicaid 19%, BCBS, 15%, Tricare, 6%, other commercial carriers, 18%.
7. The current staffing of the HIM Department: 2 FT CCS, 1 FT CCS-P, 1 PT CCA, 2 FT RHIT,  Director (RHIA), 2 APC credentialed (remote),PT.  2 CCS coders recently retired and were not replaced due to financial budgets.
8. Upon hire, you inquired regarding a current coding compliance plan and were told that the former Director managed that, however, you have not been able to ascertain any documentation of any plan.
9. Upon hire, you have not found any evidence of internal or external auditing procedures.
10. The facility is contemplating becoming an Accountable Care Organization.

Construct a Coding Compliance Policy

Construction Begins

The most important part of a coding compliance program are the standards supporting it. The organization’s standards of conduct provide the ethical culture expected of all employees. Coding professionals should also understand and abide by AHIMA’s Standards of Ethical Coding (See “AHIMA Standards of Ethical Coding.”)

Develop Coding Policies and Procedures

Coding policies and procedures serve as guidelines for coding and billing functions and provide documentation of the organization’s intent to correctly report services provided. The policies should include requirements for accurate, complete, and timely documentation and coding practices as well as incorporate the laws and regulations governing coding. Complying with these policies is key in preventing coding errors or reimbursement problems.

13 Steps to Coding Compliance

Below are the steps to developing an effective coding compliance plan.

1. Develop coding policies and procedures.
2. Develop a good working relationship with the billing department
3. Verify the chargemaster is current and accurate.
4. Establish edits for claims.
5. Develop a coding compliance work plan:
6. Identify high-risk areas to audit and monitor
   b. Prioritize the high-risk areas to audit and monitor based on the OIG Compliance Guidelines, the OIG Work Plan, PEPP activities, and organization-specific concerns
   c. Select audits and monitors
7. Conduct audits and monitors and evaluate the results.
8. Determine action plans based on audits and monitors.
9. Conduct coding compliance committee meetings.
10. Track the case mix index.
11. Review denials and submit appeals.
12. Monitor accounts receivable.
13. Assess education needs of coders, physicians, and others.
14. Evaluate and implement process improvements.

Constructing Coding Compliance Policy Assignment Help

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