Every coding department and billing department should have a…
Every coding department and billing department should have a Compliance Program. During the duration of this course you will need to research organizations such as the Department of Health and Human Services, the Office of the Inspector General, and the Hospital Association of Pennsylvania (or the State that you are in) that will give you guidance to develop a Compliance Program for your selected healthcare setting. Having a complete compliance plan is essential for establishing a solid coding or billing team for your selected healthcare setting. The compliance guidelines that are established will be necessary for the employees in the organization to perform their task successfully. In addition, a successful program will allow the manager to perform quality audits that will identify any risk potentials in the coding or billing process of the department and communicate them to the appropriate Senior Manager. The structure for the Compliance Project is as follows:
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- Identify a healthcare setting that you will be developing a Compliance Program for and if it is coding or billing related.
- Who are the key employees responsible for its implementation and operation?
- What are the goals of this compliance program?
- How does the compliance reporting system work?
- How often does the compliance team report to Senior Management?
- What is the process for reassessment of the program and implementation of any updates or changes to the program?
- Is education related to compliance provided to the teams? If so, is the effectiveness of the training being assessed and are there measures established to enforce training.
- Are there internal measures in place for reporting compliance violations?
- Are there external measures in place for reporting compliance violations?
- What policies are in place, that address the appropriate protection of “whistleblowers” and those accused of misconduct.
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