WK4 DISCUSSION1 HP-214

Clinical Documentation Improvement (CDI) programs facilitate accurate, thorough documentation in the medical record.  This program also identifies discrepancies that may exist in the provider documentation when the codes are being selected. The successful request for clarification via the physician query process is enhanced when the coding specialist has a strong foundation knowledge base. This points to the importance of coder qualifications. Also, in 2018, Medicare was found to have a billing error rate of 8.1% which equated to a loss of $31.6 Billion. Programs were developed to detect and correct past improper payments. A portion of the focus on these programs is to identify areas of provider confusion within Medicare billing and to develop compliance programs. The Office of the Inspector General, OIG, Compliance Program Guidance states, “Because incorrect procedure coding may lead to overpayments and subject a hospital to liability for the submission of false claims, hospitals need to pay close attention to coder training and qualifications.”

Explore ways facilities ensure that coders are properly trained and are qualified

Include the following aspects in the discussion:

· Research Internal compliance programs and/or external compliance programs

· Discuss the effects of including Clinical Documentation Improvement (CDI) on coder’s accuracy rates

· Discuss which measures health care facilities can take to ensure that coders are properly trained and are qualified

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