CODING COMPLIANCE

Blain Hospital

Presented By: Brittany Blain

What is Coding Compliance?

Process of ensuring the coding of patient diagnoses and procedures complies with coding rules and guidelines.

Essentially coding checks and balances

Why do we need it?

Stopping healthcare fraud and abuse Unintentional is still fraud, check before you sign off.

Office of Inspector General (OIG)Compliance programs designed to help protect facilities

Provide structure to policies, finances and procedures

Why do we need it?

Top 5 Target Areas: Complex vs. Simple Pneumonia

Medical Back Problems

Stroke vs. Transient Ischemic Attack

One Day stays for Medical DRGs

Chest Pain One Day Stays

Optimization

The tools you need at your fingertips- Diagnosis Related Groups (DRGs)- Software programs

- Alerts- Prompts - Automated Assistance

Most importantly double check your work or ask a compliance officer

Code of Conduct

- Misuse can lead to disciplinary action

- Utilize hotline for questions without fear of retribution- Understand acknowledgement

before you sign

Thank you!