Analyze at least three (3) types of abuse or fraud that may occur during the course of medical coding and billing activities.

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. complete your action plan as indicated below in Parts 1-3.

Part 1

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.

Part 2

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.

Part 3

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.

Part 4

Background

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.

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