In this assignment, you continue in your roles as the Revenue Cycle Manager. You have been asked by the Coding taskforce to review some coding results for one of the hospital’s clinics. There is a concern that a physician is receiving a significant higher amount of reimbursement from E&M coding, than other physicians are. The physicians provide the same services and treat comparable patients – similar volume and severity of care. Provide possible reasons for the billing discrepancy (example: accuracy, upcoding, quality) and a solution to resolve the issue. Include reimbursement data variances amongst the providers. Include coding compliance strategies. Remember to provide sources to support your conclusions and recommendations. Review the coding data and compile a 1-page summary of your findings. Format as a APA report.

Your summary should:

• Analyze and interpret the physician reimbursement data that has been collected. Summarize the results.
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• Determine if adjustments should be made to the coding staff, based on the data.
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• Make recommendations specifically to address coding quality monitoring and compliance strategies.

Answer rating: 100% (QA)

The practice must establish who are going to be liable for coding or verifying the right codes for the diagnoses services and procedures Those liable ... View the full answer