Posted: December 20th, 2022

Week 1- Assignment: Compliance And Leadership

Week 1- Assignment: Compliance And Leadership
Write a three- to four-page paper in APA format that addresses the following topics in a cohesive manner:

· How you will develop a coding audit plan (frequency and percentage of charts)?

· How you will use the OIG work plan and other resources available to prepare and update your audit plan?

· What policies and procedures will be needed to monitor abuse or fraudulent trends and how those relate to your audit plan?

· Explain the interrelationships between the providers and payers in audits and monitoring fraud across the health care delivery system.
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A coding audit is a process in which the accuracy and completeness of the coding used in medical records is evaluated. It is an important tool for ensuring that healthcare providers are accurately billing for services and that payers are accurately reimbursing providers for those services.

To develop a coding audit plan, it is important to consider the frequency and percentage of charts that will be audited. The frequency of the audits will depend on the size and complexity of the organization, as well as any identified areas of risk. It is generally recommended to conduct coding audits on a regular basis, such as quarterly or annually. The percentage of charts that will be audited will also depend on the size and complexity of the organization, but it is generally recommended to audit a representative sample of charts.

To prepare and update the audit plan, it is important to use a variety of resources, including the OIG (Office of Inspector General) work plan. The OIG work plan is a document that outlines the focus areas for the OIG’s audits and Assessments for the year. It is a valuable resource for identifying areas of risk and ensuring that the audit plan is aligned with the OIG’s priorities. Other resources that can be useful for preparing and updating the audit plan include industry best practices, regulatory requirements, and internal policies and procedures.

To monitor for trends in abuse or fraud, it is important to have policies and procedures in place that outline the process for detecting and reporting such trends. These policies and procedures should be incorporated into the audit plan and should be reviewed and updated regularly to ensure that they are effective in detecting and preventing abuse or fraud.

The interrelationships between providers and payers in audits and monitoring fraud are complex and multifaceted. Providers and payers often have different interests and motivations when it comes to billing and reimbursement, which can lead to conflicts and misunderstandings. It is important for both parties to have a clear understanding of the coding and billing processes and to have systems in place to identify and address any potential issues. Audits and monitoring can help to ensure that providers are billing accurately and that payers are reimbursing fairly, which can help to strengthen the relationships between providers and payers and improve the overall efficiency of the healthcare delivery system.

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