Compliance and Coding Management - Assignment Example

? Compliance and Coding Management 2 Task Introduction Individuals acquire skills through training. These skills are beneficial because they lead to innovations and diversity in the society. Training programs are there to provide useful knowledge to individuals who are interested in pursuing certain disciplines in life. In the case of health science and medicine, health care compliance and medical coding are there to provide the hospital with basic information leading to a quality performance. This paper aptly examines the structural characteristics and coding accuracy in hospitals in relation to the training program, and quality performance within the hospital. Body Health Information Management Compliance Plan An effective plan has various components. A good plan must have objectives, methods, and assessment and evaluation procedure in the planning process. A health information management compliance plan should have an objective of creating proper communication channel between the hospitals management and the employees. This is achievable through extensive training of the employee by the hospitals official. Secondly, the assessment and evaluation procedure within the hospital should be effective. All records of the hospital should be documented by the respective managers handling different departments. The employees assigned the responsibility of implementing the plan should investigate on the various reports within their reach, and create programs to assists in the task. The USDA officers have the responsibility of implementing and maintaining Information System Security Programs. They are also endowed with the task of assessing the IT systems and ensuring that a they are efficient within the hospital. Link Between HIM and Three External Agencies That Monitor Compliance The three external agencies that monitor compliance are the United States Department of Agriculture, office of management and Budget and National Institute of Standard and Technology. The link between these agencies is that there staffs posses skills that are useful to both the companies. An example is that an officer or employee of USDA has the skills and expertise that can be used by NIST. In addition, OMB is responsible for preparing executive budgets and advises on issues affecting the health and efficiency of the hospital services. NIST help in improving information infrastructure for health care. How These Agencies Disseminate Information OMB disseminates information through federal agencies who issue their own implementing guidelines. They include administrative mechanisms that allow affected persons to seek and obtain correction of information maintained and disseminated. NIST disseminate information through their Information Technology Laboratory (ITL). ITL develops tests methods, reference data and technical analyses. USDA disseminates information through Information Quality Official(s) who relay information through all media including printed and electronic. USDA agencies review the quality of information and adopt a basic standard of quality (Ann, & Carol, 2008). Their agencies and offices identify the source of the information so that the public can assess whether the information is objective. Elements to Be Included In the Policies within the Plan Coding and billing based on accurate and timely medical record documentation. Proper and timely documentation of all physician and other professional services is to be obtained prior to billing. The process for pre- and post- submission review is to be put in place. Proper selection and sequencing of diagnoses and there must be correct application of official coding rules and guidelines. Explain How Coding Accuracy Will Be Monitored They are monitored by identifying records with potential coding compliance problems. The coding compliance chart audit should be done before billing as failure to do so can result in excessive number of resubmissions. Coders should be educated in order to prevent recurrence of coding compliance problems. There should be provision of an audit trail of all coding compliance actions. Coding patterns should be compared overtime and with those of external norms. In case of a suspected violation of conduct, an individual should report to the compliance officer. This may be done by reporting the complaint in writing or by using an anonymous method like a written note which is dropped at the compliance officer’s office. Describe the Course Of Action If External Audit Identifies Coding Noncompliance In the event of noncompliance, the action is immediately stopped. External auditors have to understand the internal control system to assess it. The nature and extent of external audit vary by country but generally non compliance identified is reported to the governing board in confidential letters. An appropriate disciplinary action may include; suspension or termination. An appropriate training may be given to prevent recurrence of the misconduct. Monitoring and Evaluation They are monitored by identifying records with potential coding compliance problems. The coding compliance chart audit should be done before billing as failure to do so can result in excessive number of resubmissions. Coders should be educated in order to prevent recurrence of coding compliance problems. There should be provision of an audit trail of all coding compliance actions. Coding patterns should be compared overtime and with those of external norms. In case of a suspected violation of conduct, an individual should report to the compliance officer. This may be done by reporting the complaint in writing or by using an anonymous method like a written note which is dropped at the compliance officer’s office. How Needs Would Be Identified Coding audits identify areas of deficiency that affect the healthcare system profitability. Through detailed audit and summary reports, complaints from clients, introduction of new specialty procedures and evaluation of coding strengths and weaknesses using standard or custom-designed ASC coding exams and through results of the audit report. Who/What/When/Where Of The Training Program On A Brief Sample Agenda For Training` Training is conducted by a coding compliance training officer to staff from all departments in the hospital. It will be carried out using a pilot project from one department and eventually being adapted in the various departments for effective evaluation of training progress. This can be offered in-house in order to use the facilities and resources available in the hospital. Offering regular classes helps ensure coders obtain necessary education and would help them stay updated with latest advances in technology and medical services. Varied teaching methods and content of training should allow employees to understand facility’s standards of conduct, compliance with Medicare requirements, and proper storage of clinical and financial records (Peter, 2012). These can be identified through surveys both in and out of the hospital. Teamwork is important for effective performance of any organization. A brief sample agenda that would be distributed at the compliance and coding training session would comprise of the participants from the agencies mentioned in the report, the time and location where the agenda would be conducted and the set schedule when the agenda will unfold. The program will be evaluated through performance of regular employee appraisal exercises, customer opinion surveys on the service delivery and contracting external auditors to serve the finance department. A Brief Sample Agenda That Could Be Distributed At a Training Session, The Agency participants Heads of hospital departments The public Government representative Time and location: City hall of Midlothian 8.00 am Schedule 8.00 AM—Welcome all participants involved 9:00 AM—Welcome and Introduction of Participants Explanation of the agenda which is merging of the two hospitals. Discussion of (topic areas) by major category Inviting departments to give out their speech Invite individuals opposing or proposing the idea Inviting the two branch managers Questions and Answers (10 minutes) Reiteration of continuing opportunities to engage after the town hall Invite the town’s residents to identify themselves, using the hashtag, air out their grievances. 3:05 PM—Topic 1 Discussing factors affecting information management compliance plans Invite chief financial officer to explain the challenges he had been facing amongst other individuals. References Ann, M. Coulston. & Carol, J. Boushey. (2008). Nutrition in the Preventive and Treatment of Disease. Library of Congress cataloging-in-Publication. New York Lawrence, F. Wolper.(2012). Physician Practice Managements. William Broumiller, Publisher. New York. Peter, R. Kongstvedt. (2012). Essentials of Managed Care. Michael Brown, Publisher. New York. Roy, S. & Debbie, T. (2001). In Search of Health care Compliance. Aspen, Publisher. New York. Shelley, C. Safian. (2009). Essentials of Healthcare Compliance. Library of congress, Publisher. New York. Read More