Coding Compliance Policy Case Study

American Health Information Management Association has eleven different codes of ethics that they like to have their members and credentialed nonmembers to follow. Some of those ethics are:

"Medical coding professionals provide a key step in the medical billing process. Every time a patient receives professional health care in a physician’s office, hospital outpatient facility or ambulatory surgical center (ASC), the provider must document the services provided. The medical coder will abstract the information from the documentation, assign the appropriate codes, and create a claim to be paid, whether by a commercial payer, the patient, or CMS." (Aapccom, 2015) It is very important that billing coders have a full understanding of how to properly use medical codes to prevent denial of claims submitted.

Compliance 360 has identified a number of areas which it can augment healthcare organizations to improve the audit process for Joint Commission audits. The program intuitively links contractors to regulations as evidence of compliance and monitors risk trends to

The first spoke, “adherence to code for nurses,” represents the need for nurses to follow the rules laid out for them. These could be scope of practice, rules associated with certain workplaces and following proper procedures. To be professional, a

The ANA's Code of Ethics (1-2) consists of several ethical statements called provisions. There are a total

As a supervisor, introducing and emphasizing the Standards of Ethical Coding during our meetings is critical and would be done on a regular basis. During the meetings explaining the disciplinary actions that would take place if misconduct would arise. (Ritter, 2016) As a supervisor, understanding mistakes will happen but, intentional mistakes are not acceptable. Coders have to realize that their mistakes cost the patient, hospital, physicians, and stakeholders money. (Miscoe,

Could you please assist me? My associate was reviewing appeal # APP-2018599 that was completed by Priscilla Wilkerson. She notice that all the claims checks were suppressed when they were not advised in the SOW to processed this way. In order for all 18 claims to be reprocessed, Danielle has been advised to redo the SOW. Since, this was not her error, I think that these claims need to be reprocessed again correctly by Priscilla or another claim analyst. Could you please review and advise? Attached is communication from Danielle trying to get assistance from Priscilla regarding the mistake that was made and Kishma advising of next steps.

I have reviewed the M&T request that you referred to in the Board’s electronic case folder along with a copy of the claimant’s counsel’s letter dated 07/20/17. They are requesting out of pocket expenses, although they do not specifically clarify what expenses the claimant had occurred.

Having an effective ethics and compliance in health care training course for employees within a company is a positive effort to keep not only the company running strong and efficient, but also developing standards for other companies to follow who are trying to create a more applicable format for corporate regulations. According to federal guidelines, designated and regulated by the Office of Inspector General (OIG), a company in compliance to federal healthcare standards will have effective education of employees, investigation measures, discipline and enforcement measures, intervention of violation standards, strong internal audit standards, compliance officers and staff, and lastly, written company standards and policies that is freely available to all employees.

Evaluation and management coding is a medical coding process in support of medical billing. The health care providers must use the evaluation management coding system in order to be reimbursed by Medicare, Medicaid, and private insurance. The medical record documentation is critical to providing patients with quality care and is required for the providers to receive accurate and timely payments for furnished services. The six different steps of the evaluation management section are: Step 1: Identify the Category and Subcategory of Service. Step 2: Review the Reporting Instructions for the Selected Category and Subcategory. Step 3: Review the Level of E&M Service Descriptor Examples. Step 4: Determine the Extent of History Obtained Step 5: Determine

In the prior weeks, I had noted that many health care professionals utilize many different methods of practice, as well as implement a certain something to each of the medical cases that reflects that clinician’s style. No matter the endless routes to get to a diagnosis or the many diverse recommendations of treatment for that diagnosis, codes are the same. The medical field having a universal set of codes for diagnoses and procedures/interventions is very important because this set of codes keeps all clinicians, medical facilities and insurance companies on the same page. From what I read, the universal set of codes consists of two volumes

Computer-assisted coding is defined as the “use of computer software that automatically generates a set of medical codes for review, validation, and use based upon clinical documentation provided by healthcare practitioners”

unambiguous, and easily applied in practice. Moreover, since the field of informatics is in a

The security weakness of old style garage door opener remotes that use a fixed code has been known for decades. This weakness is normally exploited by using a code grabber that records the code while the home owner opens their garage door. However, a more convenient method exists for criminals to get the fixed code. It's called the OpenSesame hack which involves using a modified child's toy to guess the code using a brute force technique.

Of the coding topics discussed in this unit, I think all of the topics are important but if I just had to pick only one I would say specificity because it is very important to get the code right for any diagnosis. Coding correctly is how the hospital or company will get paid for the procedure that was performed during the patients time of visit. The other topics are important also so I can't say that they are irrelevant.