Problem
Scenario
Lake County Hospital is participating in an internal compliance audit next month. The audit is being conducted by the hospital's compliance officer and the staff that were appointed to help. The purpose of the audit is to determine how well the hospital is complying with external and internal guidelines and standards. Each department within the hospital will participate.
You are Lake County Hospital's HIM director, and you have scheduled a departmental meeting to address the compliance audit with your staff. You have decided to do a short HIM compliance manual to distribute to the staff during the meeting. The manual will cover external regulations and accrediting bodies that impact HIM, compliance preparedness activities, high-risk compliance areas, and healthcare fraud and abuse. The handbook will serve as a compliance reference for staff to keep at their desks and workstations.
Task
In a HIM Compliance Reference Manual. In a Word document and be sure to use citations and to credit your sources. The handbook should address the following:
A. Identify and interpret federal regulations that impact an HIM department.
B. Identify key regulatory agencies and provide an assessment of the role they have in providing guidelines for an HIM department.
C. Provide an evaluation of the Joint Commission's role in healthcare and a discussion on how its standards impact an HIM department.
D. Describe some effective compliance preparedness activities an HIM department can use and assess how these activities help to ensure compliance with regulatory and accrediting bodies.
E. Explain how an HIM department manages compliance in the high-risk area of reimbursement.
F. Describe the effects of fraud and abuse in healthcare and assess the methods an HIM department can use to prevent fraud and abuse in medical coding.