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Developing a Coding Compliance Policy Document Healthcare…
Developing a Coding Compliance Policy Document
Healthcare organizations using diagnosis and procedure codes for reporting healthcare services must have formal policies and corresponding procedures in place that provide instruction on the entire process—–from the point of service to the billing statement or claim form. Coding compliance policies serve as a guide to performing coding and billing functions.
For the HSM 410 project, you are to develop a well-thought out and well-organized coding compliance plan. You must include the following:
A general policy statement about the commitment of the healthcare organization (pick any specialty office) to correctly assign and report codes.
The source of the official coding guidelines used to direct code selection.
The parties responsible for code assignment.
The procedure to follow when the clinical information is not clear enough to assign the correct code.
Specify the policies and procedures that apply to specific locations and care settings.
Applicable reporting requirements required by specific agencies.
Procedures for correction of inaccurate code assignments
Areas of risk that have been identified through audits or monitoring
Identification of essential coding resources available to and used by the coding professionals.
Process for coding new procedures or unusual diagnoses.
A procedure to identify any optional codes gathered for statistical purposes by the facility.
Appropriate methods for resolving coding or documentation disputes with physicians.
A procedure for processing claim rejections.
A statement clarifying that codes will not be assigned, modified, or excluded solely for the purpose of maximizing reimbursement. (very important)
The use of and reliance on encoders within the organization.
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CODING COMPLIANCE PLAN TEMPLATE
The following Compliance Plan is a template, not a final document. You should
edit it to include your specific processes, procedures, policies, and information as
appropriate.
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[NAME OF YOUR HEALTHCARE ORGANIZATION]
CODING COMPLIANCE PLAN
TABLE OF CONTENTS
I. INTRODUCTION
II. COMPLIANCE PROGRAM ELEMENTS 1 – 7
Element 1. Written Policies and Procedures
Element 2. Designation of a Compliance Officer and a Compliance Committee
Element 3. Conducting Effective Training and Education
Element 4. Developing Effective Lines of Communication
Element 5. Enforcing Standards through Well-Publicized Disciplinary Guidelines
Element 6. Auditing and Monitoring
Element 7. Responding to Detected Offenses and Developing Corrective Action Initiatives
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I. INTRODUCTION
insurance claims processing procedures to ensure that reported codes reflect actual services
provided, through accurate information system entries.
II. COMPLIANCE PROGRAM ELEMENTS 1 – 7
Element 1: Written Policies and Procedures
Add content
Element 2: Designation of a Compliance Officer and a Compliance Committee.
Add content
Element 3: Conducting Effective Training and Education.
Add content
Element 4: Developing Effective Lines of Communication.
Add content
Element 5: Enforcing Standards through Well-Publicized Disciplinary Guidelines.
Add content
Element 6: Auditing and Monitoring.
Add content
Element 7: Responding to Detected Offenses and Developing Corrective Action Initiatives.
Add content
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III. CONCLUSION.
The compliance program as presented in this document establishes a framework for effective
billing and legal compliance by the
The
future policies will be a part of its overall compliance enforcement program.
