SCENARIO: The external auditors have just completed a coding quality audit of your 14 coders' work. The results indicated an 85% error rate, based on the records method of counting and analyzing coding errors. In other words, 85% of the records had one or more coding errors. Based on the code method, the error rate was 12%.
1. How might you go about reconciling the dramatic difference in these results?
2. After reconciliation of the two error rates, it was noted that 42% of the errors were attributable to two of the coders. What further action might you take to determine the source of these errors?
3. Give at least two examples of corrective action that you might design to remedy these errors.
Ethical Coding
Review the AHIMA Standards of Ethical Coding and answer the following questions. http://library.ahima.org/CodingStandards#.Wh7yx62ZNE4
1. What is the definition of coding professional?
2. Give one specific example of an ethical coding action.
3. Give one specific example of an unethical coding action.
Fraud and Abuse
1. Compare and contrast healthcare fraud and abuse. Provide at least one example of each.
2. Describe legitimate coding optimization. Give an example of a legitimate optimization coding action.
3. List and describe the components of a HIM coding compliance plan.
4. What are the benefits of a Coding Compliance Plan?