C-807 Task 1 use 2
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Western Governors University *
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C807
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Health Science
Date
Dec 6, 2023
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docx
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5
Uploaded by DeanLapwing6244
C-807 Healthcare Compliance
11/7/2023
.
Healthcare Compliance – Task 1
2
Contents
A1. Inpatient and outpatient coders
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3
A2. CDI Program
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3
A3. Applicant Evaluation
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4
A4. Retention Strategies
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4
B. CDM Committee
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5
C. Coding Strategies
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6
D. Resources
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7
Healthcare Compliance – Task 1
3
A1. Inpatient and outpatient coders
The responsibilities of inpatient and outpatient coders within a healthcare organization varies but both
plays a crucial role in ensuring accurate and efficient coding. Inpatient coders are responsible for
reviewing and assigning codes to diagnoses, procedures, and treatments for patients admitted to the
hospital. Inpatient coding, the circumstance of admission governs the selection of what is termed as the
principal diagnosis, and the inpatient coder also utilizes the Inpatient Prospective Payment System (IPPS)
and Diagnosis Related Groups (DRGs) (inpatient and outpatient coding, n.d). They typically work with
medical records and coding systems to accurately capture and report patient information.
Outpatient coders, on the other hand, focus on coding medical procedures and services provided for
patients who are not admitted to the hospital. Their responsibilities include reviewing patient medical
records for confirmed diagnoses and assigning the appropriate code. Outpatient coder uses Current
Procedural Terminology (CPT) for procedures. Inpatient and outpatient medical coders must abide by
AHIMA’s code of ethics. Additionally, both settings utilize ICD-10-CM for proper diagnosis code
assignment (Inpatient and Outpatient Coding n.d).
A2. CDI Program
The purpose of clinical documentation improvement is to enhance the accuracy and
completeness of clinical documentation in healthcare organizations. The aim of this program is
to bridge the gap between healthcare providers’ documentation and the coding professionals.
The first and ultimate reason for excellent documentation is improved patient care through
clear communication between providers and an accurate picture of the patient’s medical
situation and course of treatment. Medical coders must review the medical record
documentation to assign appropriate diagnosis and procedure codes completely and accurately.
If documentation is missing pertinent to properly code assignment, the coder will have to hold
the chart until the information becomes available in the medical record or issue a query to the
physician (Oachs & Watters,2020). Improving the quality of clinical documentation will help
ensure accurate and specific coding, facilitate proper billing and reimbursement, reduce claims
denials, and provide a comprehensive patient record.
A3. Applicant
Evaluation
When evaluating the qualifications of a potential coding candidate for employment, there are several
factors that should be considered. First, the candidate should understand medical terminology, anatomy,
and coding systems such as ICD-10-CM, HCPCS, and CPT. The candidate should understand coding
guidelines, regulations, and compliance requirements well. Verify the candidate's license or credentials
and prior coding experience in a healthcare setting. Lastly, the candidate should demonstrate proficiency
in using coding software and electronic health records systems.
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Healthcare Compliance – Task 1
4
A4. Retention Strategies
Staff retention is crucial for the success of any organization there are several strategies that can be
implemented in any organization that can help.
1.
Creating a positive and supportive work environment is essential, where employees feel valued,
recognized, and have opportunities for growth and development. Everyone has potential, and
people develop into that potential when they feel supported and safe. If you provide that
environment, they'll be much more likely to stay (9 Employee Retention Strategies That Work,
n.d.).
2.
Offering competitive compensation and benefits packages can contribute to staff retention.
Offering benefits that support the whole person is a form of employee appreciation (9 Employee
Retention Strategies That Work, n.d.).
3.
Providing a work-life balance, flexible scheduling options, and promoting a culture of teamwork
and collaboration can enhance job satisfaction and reduce turnover.
4.
Regularly communicating with the team, accessing concerns, and actively listening to employees'
feedback is very important in staff retention.
5.
Recognizing and rewarding high-performing employees can boost morale and encourage them
to stay with the organization.
B. CDM Committee
The responsibilities of the charge description master (CDM) committee play a crucial role in bringing
coders, medical staff, and CDM staff together to ensure revenue cycle success. The CDM committee is
responsible for maintaining and updating the CDM, which is a comprehensive list of all services and
procedures provided by a healthcare organization along with their associated charges.
Firstly, the CDM committee collaborates with coders to ensure accurate and up-to-date coding practices.
Coders provide the committee with coding updates, including new codes, deleted codes, and changes in
the coding guidelines. The CDM committee ensures that the usage of all CPT, HCPCS, and revenue codes
follow Medicare guidelines or other existing payer contracts (Oachs & Watters,2020). This collaboration
between professional medical coders and the CDM committee ensures that the CDM accurately reflects
the coding changes, helping to prevent coding errors and denials in the billing process.
Secondly, the CDM committee works closely with billing staff to ensure proper charge capture and
billing. They review and analyze the charge associated with each service or procedure in the CDM,
ensuring that they are accurate and compliant with regulatory requirements. The CDM committee
reviews all charge codes for uniqueness and validity (Oachs & Watters,2020). This collaboration between
the billing department and the CDM committee helps to minimize billing errors, maximize revenue
capture, and reduce the risk of compliance issues.
Lastly, the CDM committee supports and collaborates with the CDM staff, who are responsible for
maintaining the CDM in the organization’s billing system. The committee provides guidance and
expertise in understanding coding changes and updates, enabling the CDM staff to accurately update.
Healthcare Compliance – Task 1
5
C. Coding Strategies
To improve coding accuracy and productivity, the coding manager must provide training sessions and
educational resources to coding staff to stay updated with the latest coding guidelines and practices. The
goal of training and education is to ensure staff understand what they are being asked to do, what they
can do, and ultimately that they will do it accurately (Goulart, 2020). This will help improve accuracy by
reducing coding errors and ensure coding productivity by enhancing coding skills and efficiency. Having
an established and standardized documentation guideline and ensuring that coding staff are well-
informed about them. Written standards are critical for communicating your improvement strategies
(Goulart, 2020). This helps ensure accurate coding by providing clear instructions on how to interpret
and code various types of documentation. Regular coding audits and feedback sessions will allow the
coding manager to identify and address coding errors promptly, provide targeted coaching to improve
accuracy, and maintain consistent coding productivity.
D. Resources
9 employee retention strategies that actually work. BetterUp. (n.d.).
https://www.betterup.com/blog/employee-retention-strategies
Goulart, J. (2020). The 8 key elements of effective HIM/coding compliance program. Libman Education.
https://libmaneducation.com/the-8-key-elements-of-an-effective-him-coding-compliance-program/
https://yes-himconsulting.com/inpatient-and-outpatient-coding-differences-and-similarities-and-how-to-
get-the-most-out-of-both-settings/#:~:text=In%20the%20Inpatient%20setting%2C%20coders,is
%20usually%20short%20and%20sweet. (n.d.).
Oachs, P., & Watters, A. (2020). Health Information Management, Concepts, Principles, and Practice (6th
ed.). American Health Information Management Association (AHIMA).
https://wgu.vitalsource.com/books/9781584267577