ANP 650 TOPIC 2 DQ2

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School

Grand Canyon University *

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Course

650

Subject

Medicine

Date

Oct 30, 2023

Type

docx

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Uploaded by PresidentKouprey3370

Discuss ways that the documentation of diagnosis, differential diagnoses, and comorbidities affect reimbursement. What are possible implications of inaccurate documentation for the patient, the health care staff, and reimbursement? Support your answer with a minimum of two APRN peer-reviewed resources. How the provider's documentation of diagnosis, differential diagnoses, and comorbidities does affect their reimbursement. Medical documentation is required to record relevant facts, findings, and observations about a patient’s health history, including past and present illnesses, examinations, tests, treatments, and outcomes. The medical record sequentially documents the patient's care and what is necessary to commit to high-quality care. It also displays the ability of the physician and other health care professionals to evaluate and plan the patient’s immediate treatment and to monitor his/her health care over time in communication and continuity of care among physicians and other health care professionals involved in the patient’s care. It is critical that documentation needs to be precise and timely for claims review and payment. An adequately documented medical record can reduce many problems associated with claims processing and may serve as a legal document to verify the care provided, if necessary (McKean et al., 2016). According to the AMA Journal of Ethics, the upcoding and falsification of clinical information, known as fraud, has cost the U.S. more than $100 billion yearly in healthcare and can result in unnecessary procedures and prescriptions. Whether physicians are trained or encouraged to commit fraud within associated organizational cultures through pledged incentives or mandates to boost billing and process, the number of patients is unknown (Drabiak & Wolfson, 2020). In the most recent Health Care Fraud and Abuse Control Program Annual Report, in one case, a management company pressured and incentivized dentists to meet specific production goals through a system that disciplined unproductive dentists and awarded cash bonuses tied to the revenue from procedures that included many medically unnecessary services they performed. The result has come at a price, causing increasing costs, fraud, abuse, medically unnecessary services, adverse effects on patient safety, and physician burnout. The intention is to break the cycle of negative behaviors that are driven in part by financial incentives speaks to core ethical issues in the practice of medicine that can be focused through a combination of organizational and cultural enrichments and more transparent practice-based compliance and risk management systems that rely on front-end data analytics designed to identify, flag, and focus investigations on fraud and abuse at the practice site (Drabiak & Wolfson, 2020).

Good documentation is essential to protect the patients and providers in the healthcare profession. It promotes patient safety and quality of care, but at the same time, it is a complete and accurate legal medical recordkeeping that can help ensure that the patients get the proper care at the right time. In turn, the insurance ways of reviewing what kind of services the provider has delivered for the patient for reimbursement essentially. References: Drabiak, K., & Wolfson, J. (2020). What should healthcare organizations do to reduce billing fraud and abuse? AMA Journal of Ethics. https://journalofethics.ama-assn.org/article/what- should-health-care-organizations-do-reduce-billing-fraud-and-abuse/2020-03 McKean, S. C., Ross, J. J., Dressler, D. D., & Scheurer, D. (2016). Principles and practice of hospital medicine, (2nd ed.). McGraw Hill LLC.

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