Details

Introduction:
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 informatics professionals may have responsibilities in implementing and participating in these programs.

Requirements:
A.  Summarize a corporate compliance plan by doing the following:
1.  Describe the necessary components of a corporate compliance plan.
2.  Explain the responsibilities of the staff who implement the plan.
3.  Describe the roles and objectives of two healthcare enforcement agencies or programs that influence corporate compliance programs.

B.  Outline guidelines for developing a coding compliance plan by doing the following:
1.  Describe elements to be included in policies of a coding compliance plan.
2.  Discuss the key points to be included in a coding compliance code of conduct.
3.  Discuss the process a staff member would follow to report a coworker for coding non-compliance.
4.  Describe how an organization should handle an audit by an external reviewer, pertaining to coding claims, documentation, or provider claims.

C.  Outline the elements of a coding compliance training program by doing the following:
1.  Explain how needs for a coding compliance training program would be identified.
2.  Explain how a coding compliance training program would be evaluated.

D.  When you use sources, include all in-text citations and references in APA format.