A comprehensive understanding of the healthcare reimbursement systems and methodologies is critical for the effective work of the health information management (HIM) professionals who play an important role in providing health care services in the United States.
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The data retrieved from the two audits which were performed at Anywhere University Hospital (AUH) can be used by a coding team for evaluating the effectiveness of the current processes in this clinical setting and offering measures for improving them by developing an ongoing review and monitoring schedule for the following year. The coding manager should recognize the complex interrelationships between the compliance of the coded data with the standard rules, the reimbursement system and the level of the provided health care services in general (Casto and Layman 29).
For this reason, the two audits were performed by the coding team, including the Coding Quality Review by MS-DRG and MS-DRG Relationship Analysis for not only detecting the weak and strong points of the coding system, but also viewing them in the organizational context as an important element affecting the rest of the sectors in the health information management domain.
Analyzing the results from the outside review, the coding team can develop a specific schedule for the following year and fill the existing gaps in the hospital operations for enhancing their effectiveness and improving the outcome. The internal and external reviews need to be included into the monitoring schedule for uniting the efforts of the hospital staff and the outside expert audit firms. Moreover, proper attention should be paid to training and physician workshops inside of the hospital setting. Taking into account the fact that $ 45, 000 can be spent on external reviews, it can be concluded that approximately 333 inpatient records can be fully reviewed by the external team.
The schedule for the following year will start with appoint g the compliance committee and conducting a compliance seminar in January.
In February, the compliance team will meet with the hospital personnel for discussing the technical issues and some organizational moments (Coding Clarity Meeting).
In May, the meeting for discussing the results of the implemented changes and the outcomes of the improved coding for the clinical setting in general will be conducted. The Internal audit will be conducted for evaluating the outcomes and the main difficulties the coders experienced in the course of their activities.
In August – September, the Internal Audit will be conducted for monitoring the improvements in coding of individual physicians.
In December, the External audit will be performed for monitoring the physicians’ charts at random choice.
The reimbursement and rewards for the outstanding performance in the sphere of identifying and correcting the coding mistakes can be helpful for improving the motivation of the personnel to review the records and improve their coding skills. In general, the improvement of the coding procedures requires improvements in the hospital culture and organizational system. The following internal and external audits would allow evaluating the improvements made by the hospital as well as the financial benefits of these improvements.
Analyzing the information collected through the coding quality audit and relationship analysis is important for developing an effective training and monitoring plan for evaluating the impact of coding errors, correcting some of them if it is possible and enhancing the competence of the personnel for preventing the future mistakes
Casto, Anne and Elizabeth Layman. Principles of Healthcare Reimbursement. American Health Information Management Association, 3rd ed., 2006. Print.