One Reference source As the HIM director, you have been tasked with the creation
ID: 421388 • Letter: O
Question
One Reference source
As the HIM director, you have been tasked with the creation for the organizational data compliance plan and the organizational reimbursement compliance plan. Your data compliance plan should include a. Policies and Procedures to ensure the accuracy and integrity of health data A b. Education and Training (be sure that you cite sources like the OIG Workplan Issues, NCDs, LCDs, NCCI, etc.) c. Auditing and Monitoring (include controls that will be in place) d. Software and hardware technology that can be used for data integrity and data validity. Address software applications, software testing, and integration tools e. Information Technology concerns like e-security and data recoveryExplanation / Answer
Compliance defines the act of conforming to rules and regulations entailed in the healthcare operations, it is evident that through regulatory compliance plan various rules and regulations are comprehensively outlined to describe various goals a healthcare facility aspires to achieve in their efforts to ensure they are aware of and take necessary measures to take steps in the context of complying with laws, policies and regulations.
There is need to develop a reimbursement plan that is ethical in ensuring fair remuneration and data compliance plan in the healthcare sector.
In regards to healthcare policies and procedures that ensures accuracy and integrity of health data includes the following scopes:
The first step in the healthcare industry should entail maintaining medical record in the context of ensuring each and every patient data are entailed in the healthcare database for easier compliance and quality of service delivery.
The documentation of the data should be in line with both electronic and paper documentation to create easier retrieval of the data. This is where the medical record should consist of patients’ information from multiple electronic health record system sources system.
The second consideration to ensure integrity and integrity of the healthcare operations is the creation and consideration of the confidentiality dimension where the procedure and the policy should clearly outline protection from any unauthorized disclosure by the law.
The third step is the creation of the context that is medical content that should meet all state and federal laws, regulatory and accreditations required.
Medical record should also be the main considerations in the procedure in the context that an individual should have the right to access and amend his or her medical report that is designated record set.
That is in the context of ensuring critical billing records and other records that are used by the medical providers to make decisions about an individual.
The other step in facilitating accuracy and integrity of the health data is completion, timeliness and authentication of the medical data where the data must be entered in regards to day of the medical care and constant updates of the data in case of any changes.
The authentication process should ensure that only the required personalities are accessible to the critical medical information through including methods such as password, access codes or key cards which should be in regards with the UC medical requirements.
In the context of ensuring that the medical data is only accessible to the only required persons to ensure confidentiality of the data the main considerations that are critical includes;
Routine request for the medical records for the purposes of treatment, payment and request for electronic components of healthcare operations.
This is in the context of where only authorized UC as stipulated privacy policy may only access the information.HIPAA. (2017)
Also ownership, responsibility and security of the medical record should be adapted in the context of ensuring original records are retained in the UC operations except through court orders.
The destruction and retention of the medical records should be retained at least as long as required by the state and federal law regulations, and UC policies and procedures as specified in the policy.
Designation of secondary medical data should be facilitated in the context of ensuring clear interpretation, summaries and derivation of the patients’ data to ensure legality of the medical data.
Finally, enforcement, correction and disciplinary action should be taken in the medical data for the purpose of ensuring compliance with medical ethics and standards.
It is also vital for training and development to be facilitated in the medical operations to create effective use of information and technology in the context of paying attention to medical coding, computerized billing and information systems. This is to ensure there is clear achievement of the billing and coding under OPPS and that under impatient PPS.OIG (2005).
In the context of training the medical fraternity will able to adapt and rely on information and technology in the context of ensuring reduction of medical errors, enabled networked information sharing among providers, effective use system to ensure networked information and sharing among others.HIPAA (2005).
It also clears that through effective education and training it clear that the medical operations will achieve new opportunities to advanced healthcare efficiency.
Through effective through effective education and training an effective remuneration is achieved in the healthcare operations this is in the context that a cordial relationship between the healthcare operations and its stakeholders to generate federal health care program.
The medical operations through effective training and education are able to identify potential problematic arrangements or practices that can take a number of steps to reduce or eliminate risks through inti-kickback violations. OIG (2005).
In the context of ensuring effective auditing and monitoring it is clear that the medical operations uses monitoring tools and processes to verify that they have implemented are working on a routine basis through identifying business risks and addressed.
The main auditing dimensions that has been facilitated in the healthcare operations includes; billing and coding operations, exclusion lists as outlined by the OIG guidelines, hotlines and compliance in education and training as stipulated in the healthcare operations.
Other operation that has been focused through the auditing process includes; medical reviews to ensure update with medical polices, auditing of the medical licenses and policies, clinical staff licensure, confidentiality and denial reports. Department of behavior health.(2004)
In the context of monitoring techniques and reviews that I would focus includes dimensions of;
Constant interviewing of personnel’s involved in the management, operations, coding and claim development in the context of ensure effective operations of the outlined departments.
Trend analysis will also be vital in the context identifying positive or negative deviations in various areas to ensure compliance with various medical rules and regulations.
Checking personal records in the context of determining personnel’s compliance scopes thus achieving efficiency.
Finally I would adapt SPM sampling in the context of permitting compliance to identify and review variations from established standards.
In the context of ensuring a software and hardware technology that will be used for data integrity and validation my main focus will entail;
The software application will be used in the managing audit integrity this through ensuring health record documentation which is vital in presenting support in that all payers requirements for the reimbursement are met.
Thus only required authorized users are accessing or making entries to patients’ medical records.
Both the hardware and the software will be applied in the education compliance through integrating best practices to focus on the integrity of the health records. This is through application of the education model through use of the medical software that would ensure thorough monitoring which ensures various individuals have solid understanding of the healthcare practices and measures.AHIMA (2010).
In focusing the software tool it is clear that I would integrate a medical tool that that would be used by medical experts to engage with their patients in the context of achieving accuracy and integrity of the medical data.
I would also use a technology tools based on the internal hardware to create a medical database to keep all medical information pertaining to our operations.
The software testing tools will be used to integrate and use data from various sources of medical operations such as government institutions in the context of ensuring effective operations.
Finally, through software testing it is clear that the software will be vital in testing various treatment operations in regards with dynamic challenges that are vital to compliance.
In the context of ensuring e security it is vital that there is need to integrate and use systems such as system as software to ensure credulity and integrity of the data.
Finally in the context of the data recovery there is need to ensure a creation of the data backup system that is vital in ensuring efficiency and credibility in case of system crash.
References
Department of Health and Human Services. (2005). OIG Supplemental Compliance Program Guidance for Hospital. Retrieved from https://oig.hhs.gov/fraud/docs/complianceguidance/012705HospSupplementalGuidance.pdf
U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. (2003). managing asthma: A guide for schools (NIH Publication No. 02-2650). Retrieved from http://www.nhlbi.nih.gov/
health/prof/asthma/asth_sch.pdf
Boulder Community Health, compliance: auditing and monitoring (2017).Retrieved from https://www.bch.org/documents/compliance-auditing-and-monitoring.pdf
Health Insurance Portability and Accountability Act (HIPAA) (2016). Legal medical record standards Privacy & Security Rule, 45 CFR 160-164
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