Healthcare Fin & Reimbursement - 8-2 SBAR Analysis (Dr. Arsenault) (1)
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School
Southern New Hampshire University *
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Course
630
Subject
Health Science
Date
Jan 9, 2024
Type
docx
Pages
1
Uploaded by HighnessValor5613
IHP 630 Module Eight Activity: SBAR Analysis Template
Use this template to complete your SBAR analysis in this module. When using this template, be sure to replace all text in brackets with your responses and remove the bracketed text before submitting this completed template for grading.
SBAR
Details
Situation
The coding department manager has identified key issues within the last quarter while completing a preliminary compliance audit of claims submission to Medicare; the issues can affect the healthcare organization financial re-payment. The issues include miscoding of procedure codes on encounter forms; patients visit summaries, and electronic medical records. The issues will not only affect the organization's financial re-payment but also influence their relationship with insurance companies due to compliance concerns. Background
The coding department manager has identified reoccurring coding issues. The healthcare organizations have not updated their documentation and coding policies and procedures in three years; resulting in medical providers mis-coding procedure codes on encounter forms; patients visit summaries, and electronic medical records. This proves a need for organization leaders to update their documentation and coding policies and procedures to mitigate the issues the organization has been experiencing. Assessment
From the submission, I have found that the root cause of the issues within the healthcare organization include compliance and financial compensation. Mis-coding procedure codes can lead to delays and denial of reimbursements to the organization and violations of Medicare policies. This will result in legal fines and damage to the relationship with the organization and Medicare. Recommendation
The overall recommendation I would give to resolve this issue is to review, address, and update the organization's documentation and coding policies and procedures to reflect the current coding policies within the healthcare industry. Training and Education: Health organization leaders should provide regular training sessions for both the medical providers and revenue-
cycle staff to keep all stakeholders updated with any changes in within the organizations documentation and coding policies and procedures.
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