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6 pages/β‰ˆ1650 words
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4 Sources
Style:
APA
Subject:
Business & Marketing
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Essay
Language:
English (U.S.)
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MS Word
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Topic:

An Action Plan on Concerns Regarding the Competence of Facility Billing and Coding Staff

Essay Instructions:

Differentiate between the concepts of strategy and strategic management.
Apply analyses of internal and external environments to strategic planning.
Describe a business model and its component parts.
Understand the purposes of strategic alliances.
Describe the relationships among alliance motivation, structure, and outcomes.
Instructions
You are a healthcare executive of a large hospital, serving as director of health information. You have been advised that there are serious concerns regarding the competence of the facility’s billing and coding staff. To address these concerns, you will develop an action plan. Please complete your action plan as indicated below in Parts 1- 3.
Part 1 Instructions
Evaluate at least three (3) types of abuse or fraud that may occur during the course of medical coding and billing activities. Determine at least three (3) organizational policies and procedures that monitor such activities and critique the effectiveness of each policy/procedure.
Part 2 Instructions
Based upon the trends of abuse or fraud that you identified in Part 1, develop both a new employee orientation program and an ongoing training program for medical billing and coding employees. Design outlines of each training program and construct the learning activities involved. You should also indicate a leadership approach that you would use in the implementation of the programs.
Part 3 Instructions
Develop a plan to evaluate the training programs at "time of launch" and again at periodic times over the next two (2) years. Describe the methods used to evaluate the effectiveness of each training program.
Part 4 Background
An information asset is a body of information that is defined and managed as a standalone, single unit that can be shared and exploited to the organization’s benefit. It is referred to as an asset because it has financial value to the organization. Enterprise- wide information assets that are common to large health care organizations include billing systems, EHR/EMR, master patient index, clinical automation systems, patient portals, personal health records, telemedicine, health information exchange (HIE), clinical applications (lab, pharmacy), etc.
The enterprise data warehouse (EDW) is a repository of high value data from different information assets and corporate systems/applications. The data contained in an EDW can be integrated for many strategic uses across the enterprise. Strategic objectives might include activities and initiatives designed to improve quality, safety, cost, productivity, etc.
To complete Part 4, conduct research into the topic of data warehousing in health care organizations and then answer the following:
List the benefits of an EDW to a health care organization.
Prepare a strategic objective and explain how it could be facilitated through use of a data warehouse.
Select two (2) information assets from the list above. Through a data warehouse, analyze and demonstrate how data from those two assets could be used to accomplish the identified strategic objective.
Assignment Requirements
Please complete all parts in a Microsoft Word® document.
The body of your document should be at least 1500 words in length. A title page and a reference page should also be included but do not apply to the length requirement.
Quoting should be less than 10% of the entire paper. Paraphrasing is necessary.
You must cite and reference at least four credible sources from the university library.
Formatting should be double-spaced, 12 point, Times New Roman font. ● Be sure to follow the conventions and mechanics of Standard American English (correct grammar, sentence structure, punctuation, etc.).
The submission should be presented in an organized, logical, and unified manner and consist of superior content that is original and insightful.
You must meet APA style requirements throughout the submission, including title page, formatting, citations in the body of the text, as well as related references. Please be sure to visit the Writing Center to assist you in conforming to APA style.

Essay Sample Content Preview:

An Action Plan on Concerns Regarding the Competence of Facility Billing and Coding Staff
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An Action Plan on Concerns Regarding the Competence of Facility Billing and Coding Staff
Part One
Medical billing and coding involve creating and maintaining patient records to enhance reimbursements or payments. According to the National Health Care Anti-Fraud Association, in the United States, more than $68 million are lost in health care due to billing and coding frauds. This has adversely reduced the nation's ability to acquire and sustain inexpensive medical coverage for its citizens. Several types of fraud occur during medical billing and coding activities (Bush et al., 2017). They include upcoding, fragmentation, and phantom billing. Phantom billing involves the billing and coding staff coping a detailed or generic encounter of everything that happened to a patient from a past medical encounter from other patients and using the generated documentation for the current encounter without engaging in lab tests or examinations. As a result, the patient ends up being charged for services they were not given.
Fragmentation or unbundling fraud involves the coding and billing staff unraveling the billing procedure to create detached billings or special reimbursements directed to gaining a higher amount (Bush et al., 2017). This fraud leads to doubling of the bill affecting patients that fall under the Medicaid and Medicare group. On the other hand, upcoding is another common fraud in many medical facilities (Drabiak & Wolfson, 2020). In this fraud, the coding and billing staff increases a medical action to a more complex medical encounter. The action includes increasing the cost of the supplies, care, and equipment used in a medical encounter. Also, the action can involve increasing the length of the patients' stay in the hospital to increase profits.
Medical and coding frauds through wrong documentation or diagnosis for individual gain are against the Healthcare facility's ethical and moral code. Therefore, ensuring that these frauds do not happen in the facility, several procedures and policies are stipulated to monitor all the coding and billing activities (Drabiak & Wolfson, 2020). They include introducing an open-door policy that will allow the patients or other individuals affected with the medical coding and billing fraudulent actions to share their information with the facility. The facility will ensure that information given by the reporters will be confidential, and no action will be taken against them for reporting. After the reports, the responsible personnel will deeply investigate it and determine its root causes which might fall under several categories such as a desire for enrichment, negligence, or mistake, and take the necessary actions.
Second, the organization will ensure that outside auditors take randomized audits in the billing and coding department quarterly to measure their accountability. Suppose there is a report of fraudulent actions after the audits. In that case, the department involved will be critically analyzed to realize the cause of these actions, and necessary actions will be taken (Drabiak & Wolfson, 2020). Also, the...
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