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The rising number of the world’s population has a lot of pressure and influence our daily activities. Many hospitals are expanded or constructed to function under the conditions of the rising demand of healthcare. High revenues are generated from both public and private hospitals; therefore with high pressure from regulators to enhance compliance while seeking to capitalize on all income in a tough economy, effective coding becomes a solution to the overall strategy. Based on this, experts suggested six strategies for setting up the best possible program. Moreover, Gold and HIM expert points out that for an effective internal audit, staff expertise must be considered; the accuracy lies from 90% to 95%.
First, the establishment of measurable goals should be taken into consideration so that the program defines its present position and establishes a baseline coding quality expectation according to Dunn. An individual must ask why the program is being established to enable consideration of strategies that improve quality of data for physicians, facility, and address issues emerging from external audits.
Choosing good team is taken into account because working as a team enables members to come up with constructive ideas. Dunn recommends involvement of the upper management like case management, compliance officer, the CFO and HIM. At the end, the board and CEO should be aware of the results. The author emphasizes on the involvement of chief nurse to ensure that the staff caring of patients adds documents of a patient into a patient file and secure documents that support discharge disposition ensuring that everything is accurately recorded in the information system.
A layered approach should be considered while implementing the approaches to consider one model at a time as Gold cautions pointing to organization that either looks to external groups that tell them what is inappropriate or wrong or to use internal staff model only. He adds that a coding expert manager may face limitations relating to personal issues or their knowledge base, while external groups are usually self-proclaimed experts. Therefore, an external auditor is hold to task. Deube also believes that internal auditors doing the job are unrealistic for a lot of healthcare organizations; they need outside assistance more often to seal the gap because it is good for both perspectives.
Defining an audit to determine the sample size and quantity of records available, Gold points out that on the average one does not need over ten records per coder. He adds that there is a need to focus on some most frequent cases. Dunn adds that known and potential weaknesses should determine sampling. Pointing on indicators like denial conditions, she emphasizes on high reimbursement, high error rates, and conditions requiring elements of specific documentation.
Equipping the team with the right tools is crucial, because experts suggest investment in software facilities to equip their team. The return is worth the purchase even though there is an up-front cost. To those that do not want investment, Dunn stresses on the importance of a spreadsheet to record result and demonstrate the value of the auditing program.
One needs to educate and follow up because it ensures no wastage of resources and effort put in coding. The result must have a purpose; Dunn agrees that when the results are audited, they should be trended and compiled until the quality of coding is achieved consistently. The result should be shared with the members of coding team, used to describe educational chances for the members, and should also be utilized to construct the next level of auditing efforts.
In conclusion, these strategies will enable the easy access to informational data and control of all the transactions happening in hospitals. Without records and un-visionary leaders, any organization will face major problems in all sectors governing it. It will be like a structure that is poorly constructed having wrong designs: when one member fails, the rest of the structure should stand still because the stresses will be distributed to the other members, but, in this case, it will fail and collapse.