Free Healthcare Compliance and Coding Management Essay Sample

After reading the attached “Healthcare Compliance and Coding Management Effectiveness Scenario,” that gives a description of several problems that I might face as a newly hired health information management (HIM) department manager. First of all I will come up with a way of determining the types of coding functions that are necessary to make the HIM department effective. I will also evaluate staff qualifications, criterias for hiring and downsizing personnel. Through all this, I will attempt considering the HIM workflow along with productivity and departmental quality concerns, hence improving decision making process.

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To systematically come up with solutions to the challenges presented in the scenario, I would organize a number of meetings with the concerned people in their respective departments. This will help in pinpointing some of the challenges and creating a roadmap on how to tackle some of the problems in these departments.

The various job functions of the current staff definitely vary .Starting from the top, the chief financial officer who is charged with coordinating all the activities of the now merged hospital. The health information manager has to keep all the details and information regarding patients admitted in the hospital. Then we have the outpatient clinic billing department which basically performs the coding and billing functions for the patients treated at the outreach site. The oncologist sees patients on a regular basis and the nurses work around the hospital, others are attached to the oncologist’s office, where they administer chemotherapy.

According to Safian, S, some of the concepts and processes behind code look-up soft ware-an automatically updated and set up CPT codes is to help in ensuring easy and CPT Code Lookup functionalities. The encoder software is for converting information into the required format for storage in the hospital systems. Charge description master table is for is a comprehensive listing that comprise of all items that could be billed any patient, to the payer or to healthcare provider.

To determine job functions that are needed at the hospital and the new clinic a task force has to be put in place immediately to come up with some of the necessary functions. I would structure a plan for recruiting, hiring, and retaining staff in these departments on purely merit and productivity basis. Some of the other people who may be helpful to me in the planning would include the human resource manager and some of the top officials in his department. All the challenges that may arise during the planning process will be handled immediately to avoid them impeding progress.

When it comes to matters to do with productivity and quality standards as they appear to be common if the presented scenario is anything to go by, first I would install in place a task force to immediately collect all the data and information that is required to help bring change. The concerns that would emerge will have to be ranked in order of preference and seek advice and assistance from relevant authorities.

Like it is said, the health information management (HIM) compliance program, including the coding function, is very critical to a healthcare organization. Third-party-payer reimbursement is dependent upon accurate coding. The HIM compliance program should be in alignment with the organizational compliance principles and standards required by regulatory agencies. First of all in this scenario, an outline of a HIM compliance plan that emphasizes the coding function has to be in place. Some of the very important components of the plan will have to include values of the hospital and many more like responsibilities of each worker. Explain the responsibilities that each staff has to carry out will be well stated to ensure that there is accountability. The HIM has to be linked to most of the external agencies that are charged with monitoring compliance. These agencies will only disseminate information formally upon consulting.

For the sake of outlining guidelines for implementing this plan, some vital elements have to be included in the policies within the plan. For instance accuracy has to be strictly adhered to and this has to be ensured by doing double coding which will be duplicated elsewhere. For the sake of transparency, noncompliance will have to be reported and any breach of this policy will be punished severely. Incase of any form of noncompliance being noticed by an external audit, the individual responsible will lose his or her job. This plan has to be evaluated by a panel of in depended auditors and evaluators.

A coding compliance training program has to have some vital elements that must be looked into .For instance a way has to be reached of identifying the needs. And for all this to be possible an area that has to be keenly looked into is how the training program should be evaluated. This will have to be very thorough so as to avoid problems such as unprofessionalism.


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