Instructions
You are a healthcare executive of a large hospital, serving as director of health information. You have been advised that there are serious concerns regarding the competence of the facility’s billing and coding staff. To address these concerns, you will develop an action plan. Please complete your action plan as indicated below in Parts 1- 3.
Part 1 Instructions
Evaluate at least three (3) types of abuse or fraud that may occur during the course of medical coding and billing activities. Determine at least three (3) organizational policies and procedures that monitor such activities and critique the effectiveness of each policy/procedure.
Part 2
Instructions
Based upon the trends of abuse or fraud that you identified in Part 1, develop both a new employee orientation program and an ongoing training program for medical billing and coding employees. Design outlines of each training program and construct the learning activities involved. You should also indicate a leadership approach that you would use in the implementation of the programs.
Part 3 Instructions
Develop a plan to evaluate the training programs at “time of launch” and again at periodic times over the next two (2) years. Describe the methods used to evaluate the effectiveness of each training program.
Part 4
Background
An information asset is a body of information that is defined and managed as a standalone, single unit that can be shared and exploited to the organization’s benefit. It is referred to as an asset because it has financial value to the organization. Enterprise- wide information assets that are common to large health care organizations include billing systems, EHR/EMR, master patient index, clinical automation systems, patient portals, personal health records, telemedicine, health information exchange (HIE), clinical applications (lab, pharmacy), etc.
The enterprise data warehouse (EDW) is a repository of high value data from different information assets and corporate systems/applications. The data contained in an EDW can be integrated for many strategic uses across the enterprise. Strategic objectives might include activities and initiatives designed to improve quality, safety, cost, productivity, etc.
To complete Part 4, conduct research into the topic of data warehousing in health care organizations and then answer the following:
- List the benefits of an EDW to a health care organization.
- Prepare a strategic objective and explain how it could be facilitated through use of a data warehouse.
- Select two (2) information assets from the list above. Through a data warehouse, analyze and demonstrate how data from those two assets could be used to accomplish the identified strategic objective.
Assignment Requirements
- Please complete all parts in a Microsoft Word® document.
- The body of your document should be at least 1500 words in length. A title page and a reference page should also be included but do not apply to the length requirement.
- Quoting should be less than 10% of the entire paper. Paraphrasing is necessary.
- You must cite and reference at least four credible sources from the university library.
- Formatting should be double-spaced, 12 point, Times New Roman font. ● Be sure to follow the conventions and mechanics of Standard American English (correct grammar, sentence structure, punctuation, etc.).
- The submission should be presented in an organized, logical, and unified manner and consist of superior content that is original and insightful.
- You must meet APA style requirements throughout the submission, including title page, formatting, citations in the body of the text, as well as related references. Please be sure to visit the Writing Center to assist you in conforming to APA style.
Expert Solution Preview
Introduction:
The competence of the billing and coding staff is a significant concern for a large hospital’s healthcare executive, who serves as the director of health information. In this scenario, an action plan is to be developed to address such concerns. The action plan will consist of three parts, evaluating the types of abuse or fraud, developing training programs, and evaluating the training programs. Additionally, the benefits of enterprise data warehousing will be discussed, along with its strategic objectives and two from the list of common information assets used in healthcare organizations.
Part 1:
Several types of abuse or fraud may occur during the medical coding and billing activities, including unbundling, up-coding, and unbilled services. Unbundling involves billing separately for procedures that are typically billed as a package deal. Up-coding refers to the practice of billing for a more severe form of the medical condition than the one diagnosed. Unbilled services refer to the procedures and services that were provided but were not billed. To monitor such activities, three organizational policies and procedures may include conducting regular audits, employing a certified medical coder for all coding activities, and implementing an effective control system to track every billing activity. These policies can help prevent billing fraud and abuse, ensure accurate coding, and detect any errors.
Part 2:
A new employee orientation program may include training on the types of medical billing fraud and abuse, the healthcare organization’s policies and procedures, and the importance of maintaining accurate records. Additionally, a training program can educate healthcare employees about the challenges that impact the industry’s medical coding and billing practices. Leadership approach that can include setting measurable goals, providing effective training and ample resources, and continuously monitoring progress. The ongoing training program may include regular updates on industry regulations, changes to coding standards, and priorities.
Part 3:
The evaluation plan for a launch training program may include collecting feedback from trainees and trainers and conducting an assessment of skill development. Post-launch, periodic evaluations could be conducted through conducting self-assessments, conducting third-party audits, and regular review of all results monitors. The evaluations can help support continuous quality improvements and employee development plans and identify areas of strength and opportunities for progress.
Part 4:
An EDW ensures the health care organization has a systematic and universal platform for sharing valuable information across the enterprise. Benefits of EDW to a healthcare organization include improved data quality, data integration, business analytics, and timely access to data across the enterprise. A strategic objective that can be facilitated through the use of a data warehouse is the seamless integration of all organizational data assets. The two information assets that could be analyzed and used to accomplish the identified strategic objective could be master patient index and EHR/EMR. The data from these two assets can be used to identify critical areas to improve healthcare outcomes by identifying at-risk patient populations.
Conclusion:
In conclusion, the proposed action plan consists of three parts evaluating types of abuse or fraud, development of training programs, and evaluation of training programs. The use of EDW in healthcare organizations has been identified as a valuable approach to improving quality outcomes. The enterprise data warehouse provides a universal platform for sharing valuable data and insights that can be tailored to meet the health care organization’s unique needs. The strategic objectives for healthcare organizations can be accommodated through the EDW platform, making it a valuable and cost-effective investment for many healthcare organizations.
