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

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

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

  2. 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

  3. 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.

  4. Questions • What? • When? • Where? • Why? • Who? • How?

  5. What? All facility types • Facility • Inpatient • APV • Emergency Room * • Professional • Inpatient • APV • Outpatient

  6. When? • Daily • Weekly • Monthly • Quarterly • Constantly

  7. Where? • Coders • Onsite • Offsite • Remote • Clinicians and provider coders

  8. 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?

  9. Who? • Clinical staff • Independent licensed providers • Support staff • Registered nurses • Corpsmen • Techs • Coders • Non-certified • Certified

  10. How? • Baseline: • Audits • Reports • Ongoing • Education • Audits • Reports

  11. 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

  12. New Patient Bell Curves

  13. Established Patient Bell Curve

  14. Who? • GS Coders • Contract Coders

  15. What? • MEPRS • Location • Site of service • Provider

  16. When? • What time period? • Daily • Weekly • Monthly

  17. Where? • Location • MEPRS • Site of Service

  18. 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?

  19. How? • Audits using CCE data • Information from M2 • Trends using bell curves • Trends using PEPPER • Information from productivity reports

  20. Best Practices? • What is your best practice? • Is there one single process that makes the accuracy better than before?

  21. 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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