Essay on Evaluating Compliance Strategies

properly documented and can be billed to you in the correct manner. Also, another use for medical codes is to protect yourself from false

Coders have to be mindful of how inaccurate coding on their behalf can affect others. Constant training in an organization is a great way to keep coders updated with coding practices and will allow open communication in how to deter errors within the department. Besides affecting patient health and insurance companies returning claims coders should take into consideration that inaccurate coding creates more work for multiple departments within their organization. If more man-hours are needed to correct mistakes facilities lose revenue to spend on resources to improve patient care.

According to Chtourou (2013), a CDI program focuses on enhancing the accuracy of clinical documentation quality which requires a huge input from CDI specialists, heath information management professionals, coders and clinicians to collaborate together to review the quality of documentation reported/captured in order to ensure accuracy and complete of patient’s clinical encounter. As a healthcare provider, medical records that are incomplete or inaccurate often times, compromise the quality of care reporting and inevitably affect the clinical decision support system of the organization including the accuracy of reimbursement. This is reasonable since the CDI program has emerged as a new paradigm to meet the changing needs of maintaining a sound health record documentation across the healthcare industry (Hauger, 2014). Most of the CDI programs have to a great extent concentrated on boosting the Diagnosis-Related Groups (DRGs) installments by securing clinical documentation to support medical complications and co-morbidities (Hauger, 2014).

"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.

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can leads to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.

Read the article Diagnosis Coding and Medical Necessity: Rules and Reimbursement by Janis Cogley located on the AHIMA Body of Knowledge (BOK) at http://www.ahima.org.

The careful documentation and subsequent billing process within the course of a patient’s care is an important piece within the healthcare system as a whole. Proper documentation in a patient’s chart relating to any service or procedure is not only important for this patient’s future medical care, but for the facility to receive an accurate reimbursement for the services provided. Reimbursement is affected by every department within the hospital. Healthcare is a business in the long run, and inaccuracies within the reimbursement process will affect the financial stability of the hospital. If a department is mismanaging reimbursement data it could result

The purpose of this assignment is to review the factual content of and critically reflect upon the legal compliance considerations of eight major areas including, the Joint Commission, HIPAA/HITECH, Health Finances, Revenue Cycles, Medicare Recovery Audit Contractors, OIG work plan, OIG Corporate Integrity Agreement (CIA), the False Claims Act, and compliance and Provider Self Disclosure Protocol. These key elements have been provided by the GRC software Compliance 360 webpage.

In most cases, identification errors lead to ICD and CPT coding that result in dull reimbursement. If the services submitted to the electronic health record system are not written in the patients’ health records, it could also lead to dull reimbursement. Failure to bill records before submission as well as lack of accuracy and wrong use of codes also leads to dull reimbursement (Romano & Stafford 2011). For the claim to demonstrate medical necessity for the exam, the patient’s electronic health records submitted to the system must describe in details the procedure that the patient is to

Responsible coder collects post and manages account payments, submitting claims and keeping in touch with insurance companies. If patient information is coded incorrectly, or incomplete it could leave an impact that can be brought to a claim. Inaccuracy in patient information can lead to denials, none payment and investigation. It is important to get all the details right by verifying insurance coverage properly. Make sure that the patient’s name is spelled correctly, date of birth and sex of the patient are correct; and most important be sure that the policy number is valid.0verall before claims are sent, documentation should be in order and the claim should be checked for completeness and accuracy.

Michael, how would you go about making sure that your office is properly staffed and your coders have all the necessary information in order to properly code and process claims? For starters, "the American Health Information Management Association (AHIMA) grants the Certified Coding (CCA), Certified Coding Specialist (CCS), and the

Accurate and comprehensible medical records documents are crucial for a positive outcome for the patient and health care providers. Health records sequentially convey significant details concerning patient’s health history and future care plans. These records are pertinent when initiating care in the acute and chronic setting for the patient. Medicare, Medicaid, and other personal health care providers necessitate rational documentation to guarantee that a procedure and/or examination is consistent with the individual’s health care coverage. The documentation also authorizes the place of health care treatment, eligible medical requirement and suitability of diagnosis and/or therapy, and that the services rendered were appropriately documented. Precise and reliable medical documentation should be recorded at the time of treatment or shortly after the intervention. Inappropriate documentation can result in erroneous and inappropriate imbursement for provided health care services.

Combat compliance is framed as an analytic puzzle related to the variability of behavior, or responses of combatants, both individuals and as a collective, to the realities and risks of warfare. The underlying assumption here is that there is an intrinsic risk of death in any scenario of combat (Magagna, 2016). The enemy is always rationally assumed to have an interest in your death. What follows is that obeying of commands presents itself as an implicit acceptance of such risks. The puzzle here is figuring out how and why vastly differing reactions occur. At some points soldiers show limited levels of compliance, sometimes even ending up in mutiny, while in other cases units show extremely high levels of compliance, exhibiting tenacity under conditions of overwhelming odds (Magagna, 2016). This essay attempts to explain the factors that give rise to the variability of combat compliance. What is important, as alluded to earlier, is to be able to provide a generalizable argument that is applicable across time and space. The essay will first lay out of varying levels of combat compliance to discuss the characteristics and consequences of variability. Secondly, it will explore and contrast the factors of automaticity as a function of training and institutional design and the factor of the combat contract as a rational cost benefit analysis of material and moral incentives, in an attempt to critically analyze their merits in accounting for the variability of combat compliance.

specialist determine the ICD, CPT or HPCS coding. The coder or biller may have to communicate with the healthcare provider if there are any questions on any of the diagnoses, treatments or duration of the office visit (Dietsch, 2011). Because insurance companies are very strict on correct medical billing and coding, a small mistake can cause the insurance company to deny the claim and will then require the doctor to fix the error and the claim will need to be resubmitted (Cocchi & White, n.d.).

Shared governance is important to compliance in order to keep all staff accountable for compliance measures. Shared governance is an organizational model that gives all management and staff control over their actions and practices and extends the influence of administrative areas (Hess, 2004). Giving all managers a voice can help improve governance compliance and operations by promoting teamwork and accountability among staff throughout the entire organization.