As the new CFO of a community hospital, I am charged with the mandate to identify the root cause of the fall in revenue at the facility over the last three months. Upon meeting the former CFO, it was evident that the primary issue originated from the APC outpatient billing, where errors in coding were realized (Nowicki, 2015). As the CFO, errors in billing and payment are particularly prevalent mistakes that need full focus to ensure the hospital functions in its desired annual profits. Hence, based on the situation at the hospital, the issue was coding, and various mitigation methods can be used.
One of the main areas in dealing with coding areas is training. For a company, either big or small, that desires to attain formidable financial growth, proper and sufficient training must be integrated into the employment criteria (Patel & Ahadi, 2017). Besides, all employees, primarily those who work within the billing and payment department, must meet all these employment criteria. Although the issue may be based on inadequate training, to address the problem, as a CFO, it is vital to ensure that a strict training program is in place and all workers must undertake the training (Patel & Ahadi, 2017). Employees who fail to go through the training process are subject to the disciplinary committee. The other source of the coding issue is due to low electronic and software resources at the facility. The error in Medicare payments must have resulted from the faulty software used within the department (Nowicki, 2015). As the new CFO, it is essential to ensure novel technologies in which billing errors are automatically detected.
Delegate your assignment to our experts and they will do the rest.
In terms of solutions that can be effective include efficient application of the Medicare National Correct Coding Initiative (NCCI tools) ( Schaum, 2016). The primary reason for developing and enacting these tools to enhance accurate national coding techniques and to regulate ineffective coding that leads to inaccurate payments. Moreover, correct medical documentation of all Medicare payment and billing should be carried out to counter any prospective coding error (Writers, 2019). All inaccuracies of coding should serve as a reference point and guide the problem will be solved. The best method to employ to deter coding and medical billing errors is to ensure the facility stays updated on current trends by reviewing publications.
References
Nowicki, M. (2015). Introduction to the financial management of healthcare organizations (6th ed.). Chicago, IL: Health Administration Press.
Patel, H. P., & Ahadi, N. J. (2017). Basics of Billing and Coding: A Primer for the New Hospitalist Attending. Hospital Medicine , 75–83. https://doi.org/10.1007/978-3-319-49092-2_8
Schaum, K. D. (2016). Pieces of the HOPD Payment Puzzle: NCCI Edits, OPPS Payment ... : Advances in Skin & Wound Care . http://journals.lww.com/aswcjournal/Citation/2016/03000/Pieces_of_the_HOPD_Payment_Puzzle__NCCI_Edits,.7.aspx .
Writers, S. (2019, September 6). Common Problems in Medical Coding . https://www.medicalbillingandcoding.org/common-problems-coding/ .
