for DR.SAMUELSON only!!!!!

Week #5-To Do List-CCH

Week 5: Introduction

Introduction To Compliance Documentation & Reporting

Proper documentation is an inherent component of delivery of care, not an add-on. One of the oldest battles in healthcare is that between the hospital Medical Records department and the admitting Physician to complete necessary documentation for the Patient’s Chart. The most common cause of loss of admitting privileges has been from this source. This process has only become more important and necessary with the increasing recognition of the importance of proper documentation for legal and ethical defense purposes.

Documentation also serves a number of financial aspects of patient care delivery, including billing, grant writing for research projects, medical research to discover future tests, procedures, and cures, and funding for government supported agencies and programs.

Objectives

To successfully complete this learning unit, you will be expected to:

Identify the uses for health care documentation.

Learn the essential components of quality documentation.

Categorize the document guidelines under the federal False Claims Act.

Identify the documentation required for compliance under the Federal Stark Law.

List the aspects of documentation compliance with regard to electronic health records.

Identify the important issues regarding ethical coding practices.

Learn the most common illegal practices for HIM reporting.

Identify the key concerns under the federal False Claims Act that relate to reporting.

Determine the impact of the Physician Quality Reporting Initiative (PQRI) on HIM processes in physicians’ offices.

Identify the circumstances in which a health care professional is mandated to report a patient’s diagnosis.

Week 5: Discussion

Answer the following questions:

Review the various uses for health care documentation and discuss how each has an impact on the health care delivery system

Discuss procedures you might enact in your facility to avoid violating the False Claims Act

Discuss why physician offices should participate in PQRI

Week 5: Case Study Assignment

Please read and choose one of the following case studies:

Case study on page 111 of your textbook. (This Case Study is in the section for Securing EHR and starts with "NOTE: In each CMP (Civil Monetary Penalties) case resolved through a settlement agreement, . . . ")

Case study on page 127 of your textbook. (This Case Study is in the section for Phantom Patients and starts with "Two Charged in False Claims to Medicaid."

Case study on page 128 of your textbook. (This Case Study is in the section for Services not Performed and starts with "WASHINGTON—April 14, 2008—A board-certified radiologist, Fred Steinberg, M.D., his imaging centers . . ."

Case study on page 131 of your textbook. (This Case Study is in the section for Upcoding and starts with "July 2007: In Florida, a doctor was sentenced to 78 months in prison and ordered to pay $504,000 . . . "

Case study on page 133 of your textbook. (This Case Study is in the section for DRG Creep and starts with "In a report from the Office of the Inspector General, with recommendations regarding the evidence of upcoding DRGs by hospitals:"

Case study on page 134 of your textbook. (This Case Study is in the section for Misuse of Modifiers 25 and 59 and starts with " Findings: Forty percent of code pairs billed with Modifier 59 in FY 2003 did not meet program requirements, resulting in $59 million in improper payments."

Case study on page 135 of your textbook. (This Case Study is in the section for Qui Tam and starts with "New Jersey Hospital Company Settles Qui Tam Lawsuit Alleging Medicare Fraud for $256 million."

Provide an explanation for the choice you made. Your paper must address the following:

Address problem of the case decision.

A thorough analysis including resources.

Detailed comprehensive realistic recommendation.

Supplements with extensive compelling evidence from legitimate sources.

Sources cited correctly in the body of the case and reference page.

***PLEASECHOOSE ONE OF THE CASE STUDIES FROM ABOVE SO THAT I CAN TYPE OUR FOR YOU FROM THE TEXT***