7 2 Final Project Monthly Compliance Report 12162018.docx

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1 7-2 Final Project: Monthly Compliance Report Monthly Compliance Report HIM 360 Anne Murtha December 16, 2018 Professor Kelly Berge Preface
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2 7-2 Final Project: Monthly Compliance Report The following is a monthly compliance report from SNHU Medical Clinic, which contains auditing results, and best practices for billing and coding processes as well as compliance documentation. Due to several deficiencies uncovered throughout the audit process, it has been determined that the SNHU Medical Clinic office policies and procedures need to be monitored closely for compliancy concerns. During the audit process, I evaluated the clinic’s billing and coding process flow, as well their compliancy and have documented my suggestions for best practices to improve efficiency and compliancy within this monthly report. Evaluation The audit results for SNHU Medical Clinic shows that there are several repetitive occurrences of inaccurate CPT coding and billing, which resulted in multiple encounter errors throughout this audit process. In addition, after a thorough review of patient’s encounters multiple inaccuracies were found prior to the submission of the patient’s claim for adjudication. In addition, there were several inaccuracies that were found in the calculation and documenting of the clinic’s office time spent. Upon further review, I also found missing diagnoses codes, the patient’s Chief Complaints, Review of Service, and the patient’s Vitals. Therefore, patient charts were not recorded and documented correctly and out of compliancy. In order to ensure that all charting is compliant, we need to make sure that all physicians understand the clinical documentation process. Patient Charts Several of the patient’s charts contained both under and over coding. I also found several occurrences where data elements were missing off the chart completely, such as Chief Compliant, Review of Service, Vitals, Dates and Diagnoses. Under Family Practice there were
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3 7-2 Final Project: Monthly Compliance Report nine different occurrences of patient over coding alone, which resulted in inaccurate billing and coding which lead to inaccurate pricing. Furthermore, I did not see any processes in place in order to eliminate future occurrences. For example; to ensure accurate billing and coding the clinic could adopt and implement mock/audit policies and procedures. By having each biller and coding cross checking each other’s work against the encounter can eliminate possible occurrences. The CPT, HCPCS and Modifiers were put into place by CMS and the AMA to standardize medical billing and coding process. With the proper utilization of industry wide standardized codes, can ensure proper billing and coding. Failing to comply will result in rejections and denials at the payer level. This will subject the clinic to an elongated revenue cycle management, and delay in payment to the clinic. In addition, if the clinic does not execute
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  • Fall '18
  • Electronic health record, compliance officer, SNHU Medical Clinic

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