You are a healthcare executive of a large hospital, serving as director of health information. You have been advised that there are serious concerns regarding the competence of the facility’s billing and coding staff. To address these concerns, you will develop an action plan. The plan will contribute to the examination of information in part or aggregate to identify motives and causes behind the fraud or incompetence found and
provide a system solution to the problem. Please complete your action plan as indicated below in Parts 1-3.
Analyze at least three (3) types of abuse or fraud that may occur during the course of medical coding and billing activities. Determine at least three (3) organizational policies and procedures that monitor such activities and critique the effectiveness of each policy/procedure.
Based upon the trends of abuse or fraud that you identified in Part 1, you examine, collaborate and facilitate the creation of both a new employee orientation program and an ongoing training program for medical billing and coding employees. Design an outline of each training program and construct the learning activities involved. You should also indicate a leadership approach that you would use in the implementation of the programs.
Develop a plan to evaluate the training programs at “time of launch” and again at periodic times over the next two (2) years. Propose the methods used to evaluate the effectiveness of the programs and create performance benchmarks for each training program.
An information asset is a body of information that is defined and managed as a standalone, single unit that can be shared and exploited to the organization’s benefit. It is referred to as an asset because it has financial value to the organization. Enterprise- wide information assets that are common to large health care organizations include billing systems, EHR/EMR, master patient index, clinical automation systems, patient
portals, personal health records, telemedicine, health information exchange (HIE), clinical applications (lab, pharmacy), etc.
The enterprise data warehouse (EDW) is a repository of high value data from different information assets and corporate systems/applications. The data contained in an EDW can be integrated for many strategic uses across the enterprise. Strategic objectives might include activities and initiatives designed to improve quality, safety, cost, productivity, etc.
To complete Part 4, conduct research into the topic of data warehousing in health care organizations and then answer the following:
- List the benefits of an EDW to a health care organization.
- Prepare a strategic objective and explain how it could be facilitated through the use of a data warehouse.
- Select two (2) information assets from the list above. Through a data warehouse, analyze and demonstrate how data from those two assets could be used to accomplish the identified strategic objective.
Minimum Submission Requirements
- This Assessment should be a Microsoft Word (minimum 1000 words) document, in addition to the title and reference pages.
- Respond to the questions in a thorough manner, providing specific examples of concepts, topics, definitions, and other elements asked for in the questions. Your submission should be highly organized, logical, and focused.
- Your submission must be written in Standard English and demonstrate exceptional content, organization, style, and grammar and mechanics.
- Your submission should provide a clearly established and sustained viewpoint and purpose.
- Your writing should be well ordered, logical and unified, as well as original and insightful.
- A separate page at the end of your submission should contain a list of references, in APA format. Use your textbook, the Library, and the internet for research.
- Be sure to cite both in-text and reference list citations where appropriate and reference all sources. Your sources and content should follow proper APA citation style. Review the writing resources for APA formatting and citation found in Academic Tools. Additional writing resources can be found within the Academic Success Center.
- Your submission should:
- include a cover sheet;
- be double-spaced;
- be typed in Times New Roman, 12 -point font;
- include correct citations
- be written in Standard English with no spelling or punctuation errors; and
- include correct references at the bottom of the last page.
- quoting should be less than 10% of the entire paper. Paraphrasing is necessary.
- cite and reference at least four credible sources from the university library.