Question

Fraud and abuse focus

Although you are new to your role as revenue cycle manager, you are nonetheless surprised to learn that there is no formal process in place for isolating potential areas of compliance concern. You recognize that this would be generated from a focused approach for internal or external auditing, leading to identification of coding compliance concerns and opportunities for coder education. Recommend to the coding supervisor a minimum of four best practices to determine focus areas for auditing and monitoring of coding compliance.

Answer 1

To effectively isolate potential compliance concerns in the coding processes, I suggest implementing regular audits, ongoing education and training, conducting risk assessments, and establishing a secure feedback mechanism for reporting.

Step-by-step explanation:

To establish a formal process for isolating potential areas of compliance concern within the coding aspect of the revenue cycle, I would recommend the following four best practices to the coding supervisor

• Regular Auditing: Instituting frequent and routine audits of the coding process to ensure accuracy and compliance with regulations.
• Education and Training: Providing ongoing education and training for coders to keep them updated on the latest coding standards and compliance issues.
• Risk Assessment: Conducting a risk assessment to identify high-risk areas that could potentially lead to compliance issues or fraudulent activities.
• Feedback Mechanism: Establishing a secure and anonymous reporting system that encourages employees to report suspicious activities without fear of retaliation.

By implementing these practices, organizations can proactively minimize the risk of fraud and abuse while promoting a culture of compliance and integrity.