Compliance and Coding Management - Assignment Example

Compliance and Coding Management of Compliance and Coding Management Part A Introduction The execution of a proper compliance plan involves the involvement of various departments of hospitals such as legal, financial, billing, admitting and medical records. Coding compliance is a vital part of any compliance program. However, in this scenario the first step as a supervisor of the HIM department is to manage the overall coding process by the coders and implement it throughout the hospital and the places where paper documentation are still used. The second step would be handled of the previous claims by improving the quality of the HIM department through proper implementation of coding software. Part 1 Analysis of Current Staff The current staff of the hospital includes: coders in the HIM department for coding inpatient services; a front office employee phone answering, helping the person who walks in without having an appointment, retrieving and filing the records of the health departments of hospitals; the CFO who does various jobs which includes organizing budgets, organizing accounts, evaluating operational outcomes, and making income tax returns; nursing staff; hospital charge master coordinator who is just enjoying the position and get the information of hospital through phone call while staying at home. Part 2 Uses of Codes Basis of clinical database in hospital is produced by the coded data. Several departments of the clinics and hospitals use the abstracted information that is gathered for every patient. For instance, for clinical analysis, improvement in services of the hospital as well as usage of the provided services the department of quality management uses such information daily. Using Codes for Decision Support A database produced by gathering of financial and clinical data is called a decision support system. Such systems render important data regarding the business of hospital in both financial and clinical conditions. For instance, information could be collected in order to compare the actual money spent and the hospital service charges cost. This information is further utilized by the financial for forecasting and budgeting. Persons with insurance contracts could use this financial and clinical data to discuss contract’s payment. Therefore, the use of codes for decision support provides helpful information regarding the business of the organization in both financial and clinical. This coding process can provide help to the coders that are in the department of health information management (HIM) and enables them to do their jobs with the essential information for exact coding. In the give scenario there are only threes, therefore the manager of the HIM department can act as a coding manager (Wager, Lee, & Glaser, 2009). Coding Staff and Tools This coding can be usually executed by using the software. However, a qualified person must be required for verifying the last coding task grounded on reporting guidelines and coding conventions. Computer-Based Coding Sources Coding materials in the given scenario use printed materials; this should be replaced with sources of coding that are computer-based. Such type of coding sources includes Encoder Software and Code look-up software. a) Code Look-up Software. It is a computer file whose entire codes and indexes are stored on CD-ROM or magnetic disk. This file might consist of 2 fields; one of the fields is comprised of the code and the second one contains the description of the listing. Now a day, code look-up software is not considered as an efficient software application for daily coding because of the correction of code the searching of indexes by the coder and its verification in tabular part of the system is still necessary requirement. Even so, code look-up could be used for filling the text description code if applied as a supplementary file to that software whose code is previously known. b) Encoder Software. In order to assign and find the right codes the professionals of the coding uses the assistance of encoder software. It is a software program which facilitates the coder for allotting codes that are grounded on the usage of the English wording typed within a look-up screen. The coder who is seeking information in printed codebooks can correspond to this component of the encoder. This software is different as it assists the coding process. The main function of this software is that it assigns procedure and diagnosis codes to inpatient of the hospital and records the ambulatory surgery via computerization. c) Charge Description Master Table. It is a “master table file” which consists of the essential components of pricing coding and identifying anything provided to patients, as well as supplies, services and procedures. Through this CDM master file the bill of the patient is charged. Elements of the CDM include: Department number; Service Item Number; Service Item Description; General Ledger Number; UB92 Revenue Code; HCPCS/CPT code; and Price. Part 3 Job Function in Hospital and Clinic In hospitals all types and levels of professionals are present for both non-clinical and clinical jobs. Those jobs which render direct care to patients are included in clinical jobs, for example doctors or nurses, whereas in non-clinical staff, entire administrative roles are included (Finkler, Tassone & Bland, 2007). However, in the hospitals many of the departments are present therefore; every department of the hospital provides various job opportunities. As in the given case the CEO is opening a new clinic as well as the Health Information Manager is trying to improve the existing hospital they need an efficient team of information technology whose mission evaluate, prepare, sense and support the existing system and active the system required in the new clinic. For this purpose IT Project Manager is required for the maintenance and activation of information technology system of both hospital and clinic. Under his job description detail his responsibilities include the integration of need of user, cooperation with technical specialists, and implementation of project plans for upgrading and improving the system. Whereas the as a part of the role of health information system manager his responsibilities includes leading a project team which might include clinic and non-clinic staff, physicians, and other members of hospital staff. Part 4 Plan for Recruiting, Hiring and Retaining Employee Recruiting, hiring and retaining an efficient, skilled and talented employee are fundamental for the success of business. Talented individuals who keep on developing expertise and increase their importance to hospital and clinic and to the patients are the most significant resource. The main components of a plan to improve the staff’s quality that are employed in hospital and clinic include improving the structure of the fresh hires, identification and retaining of those employees that are superior and valuable, and growing employees (particularly those having high possibility for growth). The hiring and recruitment of employee start with a clear job description which elucidates necessary responsibilities and duties. The latest job descriptions and forms for available job request help the Human Resource Manager in recruiting qualified and competent candidates. The promotion of available job announcements could be done by using different electronic postings. On the basis of required qualification, skills, certification and references also the talent of the candidate brings to the hospital and the position applied for. All of the candidates who meet the job description must be interviewed personally. For improvement of the system, hospital and clinic should require more focused and structured the process of orientation i.e. it’s not a short-run activity instead it provides on-going support for fresh employees. Thos organizations which create a culture of non-disciplinary in which employees could grow and learn are known as “learning organizations.” In such a learning organization, employees flourish their capability, thinking with expansive patterns is raised, and employees learn together and continuously. After the selection of employee in the hospital and in clinic their performance should be evaluated, this is the method in which the feedback is given to employees by summative (evaluation annually and at the orientations’ end) or formative (developmental) evaluation. Such process of development of staff provides employees’ chances of improvement in their practice, their focus on self interested areas and growths in their level of competency. The hospital will provide 4 areas of professional and personal development to their new employees. These 4 areas include career development, in-service education, formal education and continuing education. Retaining experienced and qualified employee betters the morale of staff and minimizes turnover costs. Retaining of experienced staff and new employee in the hospital and clinic is improved through the promotion of a culture of safety and respect, interdisciplinary collaboration, autonomy, and models for delivery of professional care. a) The HR, front office employee, coders for the maintenance of the record and the CEO are the helpful members in planning on hiring and recruiting of new employees and the retaining of experienced employees. b) Challenges that are faced by the health information manager during staff member include the lack of communication, search of talented staff in short time for the new clinic, and arrangement of learning opportunities for the new employees. Part B 1) The concerns related to the quality of the HIM department and the quality of the work and interest of the staff should be handled by through proper planning and the efficient use of staff members. Instead of shrugging the CFO should support the HIM supervisor for the improvement as he is the new in the hospital. 2) Concerns in the Given Scenario Some of staff workers that are working in the hospital are not committed to their like the charge master coordinator, and lack of support of the CFO to the HIM supervisor such type of worker should be warned and asked them to work properly in the hospital. The hiring of the qualified person for the clinics should be maintained through the proper procedure and under the guidance of the supervisor. The issues of present staff should be removed through proper listening and working on their concerns as these are the qualified staff and are much familiar with the work in this hospital so these employees should be retained. References Finkler, S.A., Tassone, C.K., & Bland, C.J. (2007). Financial Management for Nurse Managers and Executives. Elsevier Health Sciences. Wager, K.A., Lee, F.W., & Glaser, J.P. (2009). Health Care Information Systems: A Practical Approach for Health Care Management. John Wiley & Sons. Read More