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Briefing: Managing a Successful Coding Program Date: 20 March 2007 Time: 1010 - 1100

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Briefing: Managing a Successful Coding Program Date: 20 March 2007 Time: 1010 - 1100. Objectives. By the end of the class, the students will Learn what compliance plans contain Know how to develop methods of overseeing the coding Provide clinicians a feedback loop. Compliance Plan.

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slide1

Briefing: Managing a Successful Coding Program

Date: 20 March 2007

Time: 1010 - 1100

objectives
Objectives
  • By the end of the class, the students will
    • Learn what compliance plans contain
    • Know how to develop methods of overseeing the coding
    • Provide clinicians a feedback loop
compliance plan
Compliance Plan
  • Before you can manage a coding program, you need to insure that you have a compliance plan.
  • All staff should know the plan, what is required of them, and what assistance is available to them.
questions
Questions
  • What?
  • When?
  • Where?
  • Why?
  • Who?
  • How?
slide5
What?

All facility types

  • Facility
    • Inpatient
    • APV
    • Emergency Room *
  • Professional
    • Inpatient
    • APV
    • Outpatient
slide6
When?
  • Daily
  • Weekly
  • Monthly
  • Quarterly
  • Constantly
where
Where?
  • Coders
    • Onsite
    • Offsite
    • Remote
  • Clinicians and provider coders
slide8
Why?
  • Coding accuracy
    • Workload reporting
    • RVU capture is optimized
  • Cost comparison with network providers
    • Are we providing services in-house cost effectively?
    • Can we provide services more effectively than the network providers can?
slide9
Who?
  • Clinical staff
    • Independent licensed providers
    • Support staff
      • Registered nurses
      • Corpsmen
      • Techs
  • Coders
    • Non-certified
    • Certified
slide10
How?
  • Baseline:
    • Audits
    • Reports
  • Ongoing
    • Education
    • Audits
    • Reports
elements of compliance plan
Elements of Compliance Plan
  • Coding compliance policy statement
  • Ethical coding
    • Code of conduct
    • Confidentiality statement
  • References
  • Training and education
    • Clinical documentation training record
    • Schedule for each coder type
  • Coding audit plan
  • Data quality management control compliance
    • Corrective action
    • Command notification
  • Clinical documentation requirements
  • Personnel responsible for coding compliance
slide14
Who?
  • GS Coders
  • Contract Coders
slide15
What?
  • MEPRS
  • Location
  • Site of service
  • Provider
slide16
When?
  • What time period?
    • Daily
    • Weekly
    • Monthly
where1
Where?
  • Location
  • MEPRS
  • Site of Service
slide18
Why?
  • ICD-9-CM Diagnoses
  • ICD-9 Procedures
  • E/M
  • HCPCS
  • What is the purpose of the audit?
    • Accuracy of codes?
    • Accuracy of provider documentation?
slide19
How?
  • Audits using CCE data
  • Information from M2
  • Trends using bell curves
  • Trends using PEPPER
  • Information from productivity reports
best practices
Best Practices?
  • What is your best practice?
  • Is there one single process that makes the accuracy better than before?
slide21
QUIZ
  • 1 – Name two elements of a compliance plan

a

b

  • 2 – What computer program(s) can the coding program manager use to identify a provider who is overcoding?
  • 3 – What process or document is available to assist a staff member who has been identified as being out of compliance with coding standards?
  • 4 – The coding staff should always work out documentation and coding issues with the local command. T/F
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