Miami Dade College Corporate and Coding Compliance in Healthcare Organizations Paper

Miami Dade College Corporate and Coding Compliance in Healthcare Organizations Paper

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.

REQUIREMENTS

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.