A) Categorizing Components of an Audit Plan
A) Categorizing Components of an Audit Plan (Level 2—Understanding) Review the audit scenario provided below. Place the applicable portions of the scenario into the correct audit plan category by following the prompt in the flow chart figure below. Calvin is the Compliance Director at Memorial Hospital. He has been preparing an audit that was required by the chief financial officer (CFO). The audit results will be presented to the hospital executive committee. The focus of the audit is the CC/MCC capture rate. The coding dashboard includes this metric for the top five MS-DRG families. The capture rate has been decreasing over the past six months. The CFO wants to identify the root cause of the decrease and implement solutions as soon as possible. Calvin has contracted with Amazing Auditors to conduct the external review. Amazing Auditors is a local firm and will conduct the audit on-site at Memorial Hospital. The auditors will have access to the EHR medical documents, CDI queries and responses, and the UB-04 billing form for each inpatient admission to validate reported secondary diagnoses and to identify unreported secondary diagnoses. Amazing Auditors will audit 200 records from the past 12 months (February 1, 202X through January 31, 202X). This will provide information for encounters prior to and during the CC/MCC capture rate decrease. Calvin is going to use a stratified random sample to identify the admissions for the audit. He is selecting records from no CC/MCC MS-DRGs and from with CC MS-DRGs. Both categories represent MS-DRGs where a higher level of severity could have been missed by the coding unit. The coding unit has an accuracy rate metric of 92 percent. The compliance rate for the audit will be determined by the code over code method. The audit will take place during the fourth week of March. At the completion of the audit, Amazing Auditors will provide a debrief with representatives from HIM, coding, compliance department, patient financial services, CDI, and the CFO. The written report will be provided within three weeks of the end of the audit. B) Summarizing Medicare Compliance Documents (Level 6—Creating) As a leader and manager, the health information administrator is responsible for communicating compliance requirements and regulations. This responsibility requires the manager to interpret compliance guidance documents, relate requirements to hospital-specific operations, make a plan of action, and execute the plan. Go to the Medicare National Coverage Determinations Manual (Publication #100-03) located at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS014961Links to an external site.. There are four parts to the manual and numerous sections. Review the table of contents and pick an NDC to use for this assignment. It would be wise to choose a topic that is of interest to you or that you know some information about. For example, if you have a family member with diabetes, you may be interested in #100.14, Surgery for Diabetes. You are a data analyst at Memorial Hospital. You have been charged with preparing an educational session about the NCD because your facility has been receiving denials for
******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."
