Reference no: EM133675850
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:
1. A general policy statement about the commitment of the healthcare organization (pick any specialty office) to correctly assign and report codes.
2. The source of the official coding guidelines used to direct code selection.
3. The parties responsible for code assignment.
4. The procedure to follow when the clinical information is not clear enough to assign the correct code.
5. Specify the policies and procedures that apply to specific locations and care settings.
6. Applicable reporting requirements required by specific agencies.
7. Procedures for correction of inaccurate code assignments
8. Areas of risk that have been identified through audits or monitoring
9. Identification of essential coding resources available to and used by the coding professionals.
10. Process for coding new procedures or unusual diagnoses.
11. A procedure to identify any optional codes gathered for statistical purposes by the facility.
12. Appropriate methods for resolving coding or documentation disputes with physicians.
13. A procedure for processing claim rejections.
14. A statement clarifying that codes will not be assigned, modified, or excluded solely for the purpose of maximizing reimbursement. (very important)
15. The use of and reliance on encoders within the organization.