...Evaluating Compliance Strategies Patricia Estrada HCR/220 November 2012 Deborah Ryan Medical billing and compliance strategies are used to bill for medical procedures and treatments. The compliance strategies are in place to prevent incorrect billing, but mistakes are still made. Answers to the importance of correctly linking procedures and diagnoses, the implications of incorrect medical coding, and how medical coding, physicians and payer fees are related to the compliance process will be discussed. It is very important that procedures and diagnosis are correctly linked together. There are certain steps to follow that help to correctly link the procedure to the diagnoses. By following the correct procedures to apply the correct codes that link procedure with diagnosis, insurance companies can be correctly billed for reimbursements. Correctly connected claims can be analyzed and to make sure charges are for medically necessary services provided to the patient. Correct claims help reduce the chance of an investigation of the practice of fraud and the risk of liability in an investigation does occur. (Valerius, J., Bayes, N., Newby, C., & Seggern, J. , 2008). If the procedures are not linked correctly to the diagnoses, then they will not be covered by the insurance company and therefor will not be paid. The major implication of incorrect medical coding would be fraud. Even though incorrect work may simply be an error, it may also represent a deliberate attempt...
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...Evaluation Compliance Strategies Medical Billing and coding compliance is very important to the billing world. Billing management starts at the first patient contact and ends only when the account has been paid in full. . In between, there are a series of important steps, each of which is critical for accurate billing and proper reimbursement. In this essay we are going to discuss the importance of the linkage code, implications of incorrect medical coding, and how physicians and payers fee are related to the billing compliance. We are also going to discuss what steps we can take to meet the compliance standards. When claims are filed correctly they will show the connection between the service being billed and the diagnosis code. The linkage code helps determine which procedure goes with which diagnosis code. If the linkage codes are not correct this will cause the claim to be denied. Linkage codes help the payer to determine the medical necessity for the service provided. Payers will determine the coverage by medical necessity. Services that are considered to be of nonmedical necessity are not covered under an insurance policy. It is important that the billing specialist be aware that different payers will have their own set of medical necessity edits. The implications of incorrect medical coding can cause issues for both the medical provider and the patient. Coding incorrectly can cause denial of claims. Providers would lose their patients trust, causing them to...
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...Running head: Evaluating Compliance Strategies Assignment: Evaluating Compliance Strategies Name Axia College of University of Phoenix HCR 220 Date “Guidelines established by the healthcare staff and laws established by HIPAA are what make up the compliance process. These laws and guidelines were established to protect the patients, physicians, and staff members” (U.S. Dept. of Health and Human Services, n.d.). Errors in the office can be avoided by having a compliance process in effect. Using updated billing and coding software will help reduce errors made in the billing process. I agree with having a guide consisting of codes to aid in the billing process. I do regard this as cheating rather, to be used as a guide. Many offices currently have sheets that are located on the front of the patients’ file with the diagnosis and the code next to the diagnosis which the physician fills out. This eliminates an unnecessary step in the billing process and is a quicker, easier, and more accurate way to avoid errors. “In order to avoid rejection of the claim, it is important that the diagnoses and procedures are correctly linked” (AAFP, 1999). This also ensures that the claim is paid for the correct procedure performed by the physician. If an incorrect procedure was billed this could result in a loss of money by the physician for the type of procedure that was performed. The claim will have to be adjusted and resubmitted...
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...divisional levels. Tasked with putting together the financial statements (in accordance with GAAP, etc.) and other typical accounting type processes (journal entries, etc.). - Tax: Usually sits at the corporate level. Tasked with managing tax structure, etc. (very boring but pretty straight forward) - Investor Relations: Usually sits at the corporate level. Tasked with managing the earnings release process, talking to the press and shareholders, etc. - Corporate Development (M&A): Usually sits at the corporate level. Tasked with identifying, evaluating, and negotiating acquisitions, divestitures, joint ventures, etc. across the company. - Corporate Strategy: Usually sits at the corporate level. Tasked with developing the company's long term strategy and evaluating strategic issues across the company (effectively internal MBBconsultants) - Internal Audit: Usually sits at the corporate level. Tasked with managing enterprise risk, controls & compliance, auditing processes across the company, etc. - Treasury: Usually sits at the corporate level. Tasked with managing the firm's capital structure, dividend program (if they have one), cash management, collections (accounts receivable), foreign exchange hedging, short-term and long-term portfolio management (some do it in house in a trading room; some outsource to major BBs with some potentially an...
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...De La Salle University Ramon V. del Rosario College of Business Management and Organization Department Case Analysis No. 5 Oxford Plastics Company Management Principles and Dynamics Mr. Raymund Habaradas 3st Term, S.Y. 2011-2012 Group 2 Balinas, Diberjohn Carigara, Llany Lopez, Annie Santiago, Kristoffer Villapando, Leizl 12 March 2012 Case Analysis No. 5: Oxford Plastic Company. -The Power of Two. 1 Table of Contents Page No. I. II. III. Synthesis Point of view Statement of the problem 3 3 3 3 3 6 7 9 11 11 IV. Statement of objectives V. Areas for Considerations VI. Alternative courses of action VII. Recommendation VIII. Implementation plan IX. Learning points X. Reference Case Analysis No. 5: Oxford Plastic Company. -The Power of Two. 2 I. Synthesis Oxford Plastics is a manufacturer of high quality plastics and resins. The plant employs 3000 workers in a 75-acre facility in Beatty town. It has plans of expanding the facility to accommodate a color laboratory and paint shop that will enable better and faster operations to meet customer requirements and increase competitiveness. The Governor is in full support of the additional facility for economic development. He encouraged the plant manager to coordinate with officials to address and avoid problems in relation the expansion. Oxford Plastics is faced with a challenge of positioning the additional 25-acre facility considering industrial zoning boundaries and the need to comply with...
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...procedures, and analyzing financial statements. KPMG LLP – Goals and Objectives As a senior partner of KMPG LLP, my goal in creating an audit strategy for a corporation is to accomplish objectives within the companies’ business environment. Outsourcing services will include; advise of implementing effective controls and compliance processes, identifying better business practices, profit improvement opportunities and reducing operation costs. Audit Principles There will be steps to determine what approach will be taken in evaluating a potential client. This reduces the risks to the firm and improves the effectiveness of the audit. Internal controls are procedures inside the company that are used to identify and deal with specific risks. To determine the proper procedures that need to be reviewed requires looking at the entire organization. This will assist me in identifying polices that are out of date and must be changed. The substantive test will be used to determine if the current strategy will be effective in addressing the risks facing the firm. This is accomplished through examining the Accounts Receivables. The final report is then processed and released to upper management, Board of Directors, the accounting firm and regulators for review and approval. Audit Strategy To decide if a client should be selected requires focusing on a number of criterions which includes how the accounting standard is utilized and if they have been changed...
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...Plan and implement administration system Submission details |Candidate’s Name | |Phone No. | | |Assessor’s Name | |Phone No. | | |Assessment Site | | |Assessment Date/s | |Time/s | | The assessment task is due on the date specified by your assessor. Any variations to this arrangement must be approved in writing by your assessor. Submit this document with any required evidence attached. See specifications below for details. Performance objective In this assessment task you will demonstrate skills and knowledge required to plan or review administration systems and implement new or modified administration systems. Assessment description Within a real or simulated business context, you will plan a new administration system or review an existing system. You will need to: ● consult with users or stakeholders to develop a detailed specification for the new or revised system, which must meet both organisational needs and external requirements such as codes of practice or legislation ● follow organisational procurement policies to select an appropriate developer or supplier ●...
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...1. How does the organization achieve “compliance” from its members? As our organisation is unionised, it is harder for managers to receive positive compliance from it’s employees as the reward power is minimized. Due to the unionization, decisions about promotions and giving raises are not allowed to be made by supervisors and managers. This restricts the amount of control the managers have over the compliance of its employees. However, I believe that my organization still exploits some power over the interest of my team members. One attempt of my supervisor’s to keep compliance amongst our ‘team’ is to reward hard work with a ‘party halfa’ once every month. This included half an hour out of one shift every month dedicated to “pigging out” on party food including lollies, chips, cake and coke etc. We did not receive the “party halfa” if we do not meet the packing standards. Everyone knew each individual had to perform to the standard and not have any one team member let the rest down and therefore increasing productivity and establishing compliance. As shown above, my fellow employees are referred to by our supervisors and managers not as employees or staff, but a ‘team’ which symbolises this reality that we should operate not only for our own individual gain, but also the gain of the individuals in that team. Another act of compliance can be implemented by coercive power. This example is a more subtle version of coercive power; the threat from the supervisor to stay back...
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...1. How does the organization achieve “compliance” from its members? As our organisation is unionised, it is harder for managers to receive positive compliance from it’s employees as the reward power is minimized. Due to the unionization, decisions about promotions and giving raises are not allowed to be made by supervisors and managers. This restricts the amount of control the managers have over the compliance of its employees. However, I believe that my organization still exploits some power over the interest of my team members. One attempt of my supervisor’s to keep compliance amongst our ‘team’ is to reward hard work with a ‘party halfa’ once every month. This included half an hour out of one shift every month dedicated to “pigging out” on party food including lollies, chips, cake and coke etc. We did not receive the “party halfa” if we do not meet the packing standards. Everyone knew each individual had to perform to the standard and not have any one team member let the rest down and therefore increasing productivity and establishing compliance. As shown above, my fellow employees are referred to by our supervisors and managers not as employees or staff, but a ‘team’ which symbolises this reality that we should operate not only for our own individual gain, but also the gain of the individuals in that team. Another act of compliance can be implemented by coercive power. This example is a more subtle version of coercive power; the threat from the supervisor to stay back...
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...CPA Program The Practical Experience Guide EVE CHENG CPA SENIOR ANALYST BHP BILLITON Contents Practical experience requirement How to identify if your role is relevant Where do you fit? What skills areas do you need to demonstrate? Your mentoring relationship How to record your experience in the logbook The skills guide Personal effectiveness skills Leadership skills Business skills Technical skills 3 4 6 7 8 10 11 12 13 14 15 MICHELLE ROACH CPA 2 Practical experience requirement Did you know? Our studies show that members consistently perform better in their segments when they are enrolled in the practical experience requirement The practical experience requirement of the CPA Program gives you the opportunity to use the knowledge and skills gained in your education and apply them in your workplace. Combining your education with mentored practical experience will give you the opportunity to develop and demonstrate highly sought after technical and soft-skills that will benefit your entire career. Starting your practical experience requirement means that you are one step closer to your goal of becoming a CPA. CPA Australia recommends that you start the practical experience requirement and the professional level segments at the same time, if you are employed in a relevant role. What are the requirements? • complete a minimum of three years of relevant full-time or equivalent part-time work experience • demonstrate competence in 16 personal effectiveness...
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...management is a process for identifying, assessing, and prioritizing risks of different kinds. Once the risks are identified, the risk manager will create a plan to minimize or eliminate the impact of negative events. A variety of strategies is available, depending on the type of risk and the type of business. Outline Risk Management and Patient Safety: The Synergy and the Tension Integrating Risk Management, Quality Management, and Patient Safety into the Organization Benchmarking in Risk Management Risk Management Strategic Planning for a Changing Health Care Delivery System Using Never Events to Reduce Risk and Advance Patient Safety Governance and Board Responsibility to Assure Safety in Health Care Organizations 1. Introduction What is the goal or the idea behind risk management one of their focus is to reduce the financial risk other areas that may seem not important is the regulation. One of the principal issues facing health care risk management is governmental regulation. Over the last few decades, there has been a growing public demand for accountability in health care delivery. The consequent tightening of governmental regulation has led to a greater allocation of an organization's resources to regulatory compliance. Some states, including New York, enacted stringent incident reporting requirements for hospitals, requiring additional staff to investigate and prepare such reports. Additionally, competition among...
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...1. Introduction What is the goal or the idea behind risk management one of their focus is to reduce the financial risk other areas that may seem not important is the regulation. One of the principal issues facing health care risk management is governmental regulation. Over the last few decades, there has been a growing public demand for accountability in health care delivery. The consequent tightening of governmental regulation has led to a greater allocation of an organization's resources to regulatory compliance. Some states, including New York, enacted stringent incident reporting requirements for hospitals, requiring additional staff to investigate and prepare such reports. Additionally, competition among hospitals has also fostered a greater concern over the community's perception of quality of care. Many hospitals have had to compete harder for patients as inpatient lengths of stay decrease and more procedures are performed on an outpatient basis. Risk management in the health care In the past risk management and quality improvement job was separate in the health care organization. Even though, the job function may have been different the goal was the same. Managing risks is the quality of services provided & the safety of patients, their careers & visitors. To manage risks to staff & subsequent risks to service quality. To manage risk of failing to meet national & local priority targets to manage risks to the efficiency of services...
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...of the risk management program is to protect patients, staff members and visitors from inadvertent injury. The program is also designed to protect the organization’s financial assets and intangibles, such as reputation and standing in the community. The risk management plan is a primary tool for implementing the organization’s overall risk management program. It is designed to provide guidance and structure for the organization’s clinical and business services that drive quality patient care while fostering a safe environment. The focus of the risk management plan is to provide an ongoing, comprehensive, and systematic approach to reducing risk exposures. Risk management activities include identifying, investigating, analyzing, and evaluating risks, followed by selecting and implementing the most appropriate methods for correcting, reducing, managing, transferring and/or eliminating them. Scope (When) Under the direction of the risk manager, the risk management program provides for collaboration among all departments, services, and patient care professionals within the organization. The risk management program provides policies, procedures and protocols to address events which may create business-related liability, professional liability, general liability, workers compensation, and motor vehicle liability exposures. The identification, investigation and management of accidents, injuries and other potentially compensable events are a primary responsibility under the risk...
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...Evaluating and Improving Internal Control in Organizations Internal control is a crucial aspect of an organization’s governance system and ability to manage risk. It is also fundamental to supporting the achievement of an organization’s objectives and creating, enhancing, and protecting stakeholder value. High-profile organizational failures typically lead to the imposition of additional rules and requirements, as well as to subsequent time-consuming and costly compliance efforts. However, this obscures the fact that the right kind of internal controls—enabling an organization to capitalize on opportunities while offsetting the threats—can actually save time and money and promotes the creation and preservation of value. Effective internal control also creates a competitive advantage, as an organization with effective controls can take on additional risk. Despite the existence of sound internal control guidelines, it is often the application of such guidelines that fails or could be further improved in many organizations. With the publication, the Professional Accountants in Business (PAIB) Committee aims to provide a practical guide focused on how professional accountants in business can support their organization in evaluating and improving internal control as an integral part of its governance system and risk management. The guidance is complementary to existing internal control guidelines and is based on those internal control matters that often cause difficulties...
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...facilities, clinical laboratories, health care networks and hospice. Numerous of accreditation organization is also taking place within the United States, but the Joint commission remains the largest The Joint commission accredits 20,000 organization” which” one third are Hospitals. The joint commission is assigned a special task to improve health care by evaluating health care of organization as well as encouraging health organizations to provide safe and effective care at the highest level. The Joint Commission believes that the only way to improve the quality of health care is to join together with other stakeholders and evaluate each health care organization. The Stakeholder consists of 29 broad members of commissioner and cooperate members such as the American Hospital Association, and the American Medical Association. In this paper I will analyzes key topics such as the Joint Commission source and its scope of authority, the structure of the Joint commission and how its responsibilities. The Joint Commission Structure The Joint commission broad members of commissioner provide leadership and oversight by evaluating healthcare organizations and encouraging health care organization to practice safe and effective care at the highest level. The broad members have seven standing broad committee and each member have diverse experience in health care, public policy, and business. The Joint commission structure relies...
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