Fill This Form To Receive Instant Help
Fill This Form To Receive Instant Help
Homework answers / question archive / Part 1 You are the chief compliance officer for Tybee Healthcare
Part 1
You are the chief compliance officer for Tybee Healthcare. You have only been in this position for 6 months. One of the things that you have learned is that there is no system in place to monitor the compliance efforts. You have decided to identify 10 indicators that you will monitor on a routine basis.
Coding Compliance is insuring that the coding of diagnoses and procedures complies with all coding rules and guidelines. The Idea behind a Compliance Plan is to detect, correct, prevent, verify, and compare with the use of policies, procedures, education, training, audits and monitoring. Consider the Core Areas of a Compliance Plan (Ch. 2 PPT slides #71-74)
1. What are the 10 Indicators? (Be specific and detailed)
2. What threshold do you recommend that the organization should strive to meet? In other words, what result do you recommend that the organization strive to meet relative to each indicator? Be specific and detailed in your response.
3. Justify your recommendations. Write clear and concise statements supporting each recommendation.
Part 2
As compliance coordinator, you spend a lot of time looking for compliance issues that need correcting. Today, you are looking at various reports and charts. You cannot tell from the information provided to you if there is a compliance problem, but you can identify areas that need further investigation.
Potential Compliance Issue
As compliance coordinator, you spend a lot of time looking for compliance issues that need correcting. Today, you are looking at various reports and charts. You cannot tell from the information provided to you if there is a compliance problem, but you can identify areas that need further investigation.
Review the table below for potential compliance issues:
(The first compliance issue was completed for you to use as a guide)
|
Medicare reviewed 100 heart cath charts. The MS-DRG was changed on 2 of the cases |
N.
This is a very small number of MS-DRG changes, which therefore does not show a pattern |
|
Principal Diagnosis: Septicemia Secondary Diagnosis: Urinary Tract Infection Procedure: None |
|
|
National percent of simple pneumonia: 76% Your hospital’s is 77% |
|
|
98% of all physician queries ask questions that would increase reimbursement. |
|
|
Principal Diagnosis: Contusion, chest Secondary Diagnosis: Fracture, femur Procedure: Open reduction, internal fixation (ORIF), femur
|
|
|
The number of advanced beneficiary notices (ABNs) for the past year is 1. |
|
|
A review of remittance advice shows 50 denials over the past month, with 42 of those denials for medical necessity. |
|
|
The annual Report of compliance activities shows the following:
|
|
|
A new compliance software package was installed in January.
In March, HR evaluated salary ranges for all jobs in the hospital.
The admission coordinator position’s salary was dropped by 25%.
The new hires have a high school education and strong typing skills. |
|
|
The coding supervisor reviews a random sample of inpatient, outpatient, and ER records for correct coding. The sample is taken from all services, all physicians, and all coders. |
|
|
An audit performed on rebills showed that 62% were higher weighted MS DRGs, and 38% were for lower. |
|
Already member? Sign In
