Question

You have been tasked with creating a Policy & Procedure for ensuring that the coding staff remain up-to-date on coding guidelines. For both inpatient and outpatient coding areas in ABC Hospital. Create a policy and procedure and an audit schedule to accomplish this task.

Answer 1

The policy and procedures ensure the audit guidelines that will implement organization reasonable and workplace process for the performance of such audits,applicable in medical records and bills comply with applicable coding,billing and documentation requirements..

There will be reasonable audit process for the organization practice and it's important to avoid medical billing errors..ABC hospital can covered by this policy are intended to provide performance of self- audits by each clinical department of billing and documentation practices and procedures..it eradicate the intra departmental errors which make risk in billing .coding and documentation timely identified and properly addressed..

Internal audits will focus on individual assigned the duty of performing and it should be certified professional coder or can have same skills,training and certification to satisfactory to the compliance..audit should follow the policy for audit samples, development and implementation of audit guidelines and forms and processes relating to post- audit reporting..

Issues with documentation,code assessment or related concern audit can communicated to the department through practice administrator and senior departmental biller and can provide education to the provider with training plan..Followed by verification of skills after training and it can be continued till ensure the valid code selection and adequate documentation has occured..

Post audit reporting process with remedial action Identify and plan for deficiency..compliance officer interview and communicate their findings to the departmental administrator..if there is overpayment identified it can be done with finality.. repayment can be done with 30days of overpayment..