discussion

responses to these 2 discussion board:
1. As the revenue cycle manager, it is vital to know the billing practices inside and out. It is also essential to audit the claims to look for potential trends in denials or compliance issues. If we did not have a formal process, I would recommend performing quarterly internal and external audits. I would higher a compliance officer to perform these audits. Once the audit is complete, the compliance officer would go over the data and see what trends they can identify. I then would write the different policies and procedures needed to correct any billing issues and prevent future claim errors. From there, I would initiate an employee training program to ensure all billers and coders are aware of any compliance concerns and go over the new policies and procedures. Once the team is trained, I would implement a disciplinary policy to ensure the billers and coders learn from each audit and avoid future mistakes. The Ahima article below is out of date but did provide interesting insight on how to create a compliance program and statistics on the most popular coding errors in 1998.

Prophet, Sue. “Coding Compliance: Practical Strategies for Success.” Journal of AHIMA 69, no.1 (1998): 50-61

2. An important task of the revenue cycle manager is to develop a process to identify potential areas of compliance concerns and link the organization’s policies and procedures accordingly. I would recommend establishing an internal audit committee to perform periodic audits of the revenue cycle process. The committee should meet monthly and be chaired by an executive from the hospital administration. This committee should include physicians or clinicians from different departments to provide a variety of perspectives. Audits could be performed by internal auditors or external consultants and should follow an accepted standard for assessing compliance risk. The executive responsible for supervising revenue cycle operations mustn’t be a member of this audit committee. This will ensure no conflict of interest in addressing issues identified during the audit process. This committee would address any problems found in weekly audits and case reviews. The committee should also review identified compliance issues and determine which ones should be addressed immediately and which can be deferred later. After a few months, you may find that some compliance issues are recurring problems. These recurring problems should be placed on a quarterly or biannual meeting agenda for discussion by the committee. The committee could develop policies and procedures for these recurring issues to ensure that they are identified and addressed promptly in the future. The revenue cycle manager must understand the organization’s mission statement, vision, goals, values, and objectives. This knowledge will help identify potential compliance risk areas within the revenue cycle process.

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