Use the Healthcare Compliance and Coding Management Effectiveness Scenario below to complete the following assignment:A. Outline a HIM compliance plan that emphasizes the coding function by doing the following:
1. Describe the necessary components of the plan.
2. Explain the responsibilities of the staff who implement each component of the plan.
3. Explain the link between HIM and three external agencies that monitor compliance.
a. Explain how these agencies disseminate information.B. Outline guidelines for implementing this plan by doing the following:
1. Describe elements to be included in the policies within the plan.
2. Explain how coding accuracy will be monitored.
3. Discuss processes for reporting noncompliance internally.
4. Explain a corrective action plan in circumstances of noncompliance.
5. Describe the course of action if external audit identifies coding noncompliance.
6. Discuss how the plan should be evaluated.Note: In your discussion, identify who evaluates the plan.C. Outline the elements of a coding compliance training program by doing the following:
1. Explain how needs would be identified.
2. Describe the who/what/when/where of the training program on a brief sample agenda for training.
3. Explain how the training program should be evaluated.D. When you use sources, include all in-text citations and references in APA format.Note: When using sources to support ideas and elements in a paper or project, the submission MUST include APA formatted in-text citations with a corresponding reference list for any direct quotes or paraphrasing. It is not necessary to list sources that were consulted if they have not been quoted or paraphrased in the text of the paper or project.Note: No more than a combined total of 30% of a submission can be directly quoted or closely paraphrased from sources, even if cited correctly. For tips on using APA style, please refer to the APA Handout web link included in the General Instructions section.Include web links for all sourcesHealthcare Compliance and Coding Management Effectiveness ScenarioThe city of Midlothian had a population of approximately 57,000 residents and two hospitals that had served the community for generations. The community was not pleased when the hospitals chief executive officers held a joint news conference to announce that the hospitals were merging. Most people liked having choices for their healthcare, and they believed the merger would impact their right to choices in services. There had been rumors circulating within both organizations for months, but now that the news had become official, staff was concerned about downsizing and their future employment.Juliette was the health information management (HIM) department manager of the larger of the two hospitals and found herself called to the office of the chief financial officer (CFO) several days after the merger was announced. The CFO explained that there would be staff cutbacks because of the merger. Juliettes face betrayed her worst fears, showing she thought she was losing her job. Her expression made the CFO smile. Leaning forward, the CFO told Juliette administration wanted her to assume management of all HIM personnel from both facilities, as the reorganization moved forward.Her role in the merger and reorganization would be an important one. The expectation was that within six months she would reorganize the staff from both HIM departments into one unit, restructuring departmental functions for efficiency and greater effectiveness.Juliette was delighted to take on the challenge and thanked the CFO for the opportunitybut the CFO had more to say. There had been several coding compliance problems that occurred over the past 18 months at the smaller hospital, and the CFO directed Juliette to meet with the compliance officer from the smaller hospital to discuss the specifics of these issues. It was important to administration to address any concerns as this change was occurring so as to facilitate better practices and processes. Administration was aware of public concerns about services, and they were carefully selecting a management team to meet any challenges directly and effectively.They needed Juliettes expertise in HIM to identify the root of the problems and prevent them from happening again. Several of the issues were as follows. One of the primary care providers visits a rural outpatient clinic twice monthly and treats between 15 and 20 patients each visit. The outpatient clinic billing department performs the coding and billing functions for the patients he treats at the outreach site. Recently, the nurses at the hospital office in Midlothian have been receiving calls from patients, where they have been questioning numerous bills. Patients are being billed twice for the same services at the outpatient clinic. Juliette needs to investigate why this is occurring and solve the problem.
A hospital oncologist spends Friday afternoons seeing patients at a VA hospital about 100 miles away. Two nurses work in the oncologists office, administering chemotherapy. Patients are billed for chemotherapy treatments at the same rate for each of their treatments. Most of the patients are seen Monday, Wednesday, and Friday for their treatments. A nurse who is new to the oncology floor at the hospital has questioned if this billing is appropriate.
Through internal audits, it was found that one of the cardiologists had unusually high E/M levels. Documentation revealed the patients who were coded at a higher level were being seen on the same date of service by the social worker.
Through internal audits, it was found that one of the urologists had unusually low E/M levels. The urologists nurses complain the urologist is always behind schedule because of all the time spent with patients.
The CFO explained to Juliette that her immediate goals for the new HIM department should include the initial development of an HIM compliance plan, which would be in alignment with the hospitals compliance plan. Since the organizations were merging, she would need to meet with both current compliance officers to obtain an overview of their goals and to begin to develop the elements of the HIM compliance plan. At this point, administration is unsure which officer will remain. They will be evaluating both officers for their ability to manage the merger events, and they will make their choice within a few months.Administration expected the HIM compliance plan to focus on coding compliance and standards required by external agencies. It would include internal processes within the daily workflow to minimize risks and include a detailed audit process. Juliette would be expected to review current guidelines for how noncompliance incidents are addressed and review the current process for confidential reporting of concerns to determine its effectiveness.Policies and procedures documents would be written, approved, and implemented. Staff would receive initial education, and Juliette would be expected to develop a method for ongoing training. She would need to immediately focus on identifying deficiencies in coding skills and implement training to bring the competencies of all coders to appropriate levels.The CFO stood, indicating the meeting was nearing completion. The CFO shook Juliettes hand and summed up their discussion. Juliette was being offered a leadership position in moving the HIM department and staff forward as the hospitals merged their services. There were three areas for immediate focus.The first was to identify the root causes of the coding compliance issues that were reported to her and to develop workable solutions. The second was gathering information on the components of an HIM compliance program and beginning to lay the foundation for its implementation. Finally, as she was discerning current problems and developing plans for the HIM compliance program, she needed to assemble a HIM workforce comprised of the best and the brightest personnel both facilities had to offer.