Task 2: Corporate and Coding Compliance
Today’s healthcare organizations follow regulatory guidelines established by federal, state, and payer program requirements by developing corporate compliance programs. Corporate compliance programs promote a culture in which conduct aligns with ethical behaviors and business integrity. In addition to an enterprise-wide compliance program, a facility may also choose to develop a coding compliance program, which focuses on continuous improvement in the quality of documentation and coding. Health information management professionals may have responsibilities in implementing and participating in these programs.
Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. Use the Turnitin Originality Report available in Taskstream as a guide for this measure of originality.
You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.
A. Analyze a corporate compliance plan by doing the following:
1. Describe the seven necessary components of a corporate compliance plan.
2. Explain the roles and responsibilities of the staff who implement a compliance plan.
3. Explain the roles and objectives of two healthcare enforcement agencies or programs that influence noncompliance reporting.
4. Explain the procedure for reporting coding noncompliance.
B. Analyze the coding compliance auditing process by doing the following:
1. Describe how a healthcare organization should respond to a formal request for an audit by an internal reviewer, and how it relates to coding claims, documentation, or provider claims.
2. Describe how a healthcare organization should respond to a formal request for an audit by an external reviewer, and how it relates to coding claims, documentation, or provider claims.
3. Explain how a healthcare organization should respond to audit results that show a coding practice resulting in overpayment.
C. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.
Corporate and Coding Compliance
Corporate and Coding Compliance
Most health care organisations today have made it a mandatory requirement for federal care providers to have corporate compliance programs. These are plans that help organizations comply with the set laws and regulations in a bid to offering quality services to their clients and employees. The program has helped many businesses improve their public images, reduce non-compliance risks, boost an organisation’s efforts in recruiting and retaining highly qualified staff (HYPERLINK "https://www.google.co.ke/search?tbo=p&tbm=bks&q=inauthor:%22Debbie+Troklus%22"Troklus & HYPERLINK "https://www.google.co.ke/search?tbo=p&tbm=bks&q=inauthor:%22Sheryl+Vacca%22"Vacca, 2015). Accordingly, this paper presents the components of a corporate compliance plan, responsibilities of the staff in implementation of the compliance plan and the procedure for reporting coding compliance.
The establishment of a corporate compliance program requires some components to be incorporated so that it is successful. These components include management’s commitment and support where the managers should be willing to inculcate a compliance culture by supporting such initiatives through instituting a competitive an...