Introduction:

Read the attached “Healthcare Compliance and Coding Management Effectiveness Scenario,” which describes several problems you might face as a newly hired health information management (HIM) department manager. This task will help you to think through the process of determining which types of coding functions are necessary for the HIM department. It will also help you in evaluating staff qualifications for hiring or downsizing purposes. The scenario also encourages you to consider the HIM workflow along with departmental quality and productivity concerns, which may influence decision making.

Task:  


A.  Discuss how you would systematically proceed with the challenges presented in the scenario.

1.  Analyze the various job functions of the current staff.

2.  Analyze the various concepts and processes behind each of the following:

a.  Code look-up software

b.  Encoder software

c.  Charge description master table

3.  Explain how you would determine job functions needed at both the hospital and the new clinic.

4.  Discuss how you would structure a plan for recruiting, hiring, and retaining staff in both departments.

a.  Identify others in the organization who may be helpful to your planning.

b.  Describe how challenges you may encounter during this planning process could be addressed.



B.  Discuss concerns related to productivity and quality standards as presented in the scenario.

1.  Explain how you would identify these concerns.

2.  Explain how you would address the concerns you identified.

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C.  When you use sources, include all in-text citations and references in APA format.

You have recently taken a position as supervisor for a health information management (HIM) department at a rural hospital. Your staff consists of three coders who all perform inpatient coding services. One of these coders also performs coding services for a physician who treats patients in a small outpatient center attached to the hospital.

You also manage a front office employee whose job duties are answering phones, assisting walk-ins with release of information and other requests, filing, and retrieving health records from hospital departments. The hospital implemented an electronic health record about six months ago, but there are still many providers using paper documentation during this transition period.

The chief financial officer (CFO) informed you yesterday that the hospital is purchasing an existing outpatient clinic located in a small town about 50 miles from the hospital. Currently, this clinic has one provider who sees 20–30 patients daily. There is a local lumberyard and small farm equipment manufacturing plant in town, both of which contract with the clinic for medical services for injured workers.

The CFO anticipates the clinic may be more convenient for some patients, and there may be a decrease in patients seen at the hospital’s outpatient center. The CFO’s preliminary projections for patient numbers indicate that you will need to eliminate one of your coding positions within the next six months. The CFO informed you that the clinic has several long-term employees comprised of nursing staff and a front office staff member who performs coding and billing functions while also attending a local community college to become a registered health information technician (RHIT).

Today when you came into work, you overheard your staff expressing concern to each other about the rumor they heard about one of them being fired. They quickly quieted when you arrived and went to their own desks to begin working. Later, one of them came to you as spokesperson for the group and explained their concerns, asking you for the truth. You explained that you needed to gather more information from your superiors and promised a staff meeting before the end of the week to discuss the issue. The spokesperson left your office looking stressed.

You worked most of the morning on several rejected Medicare claims left from the previous HIM director. You had hoped to begin reviewing the policy manual to determine HIM department quality standards and department processes because the nature of some of these claims troubled you. When you asked about some of these long-standing claims, the CFO just shrugged and told you to handle it.

Your thoughts were interrupted by a phone call from the hospital charge master coordinator who was calling for information about the position at the clinic. The coordinator lives about 10 minutes from the clinic and would enjoy eliminating the long drive to the hospital each day. As a 15-year employee with the hospital, the coordinator feels the job offer would be well deserved. You politely express thanks for the call and explain that any interest should be directed to the human resource office. After the call, you sit at your desk wondering why you did not just keep your position as coding coordinator back in your hometown. Maybe this cross-country move was not such a good idea after all.

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