Monthly Compliance Report

The project is divided into two milestones, which will be submitted at various points throughout the course to scaffold learning and ensure quality final submissions. These milestones will be submitted in Modules Three and Five. The final product will be submitted in Module Seven.

In this assignment, you will demonstrate your mastery of the following course outcomes:

Evaluate the efficiency of coding policies for their implications on employee training
Assess healthcare documentation by utilizing industry standard technology for its relevance in the auditing and health data standard reporting processes
Recommend workflow policy adjustments for improving technology processes
Evaluate electronic health record systems through audits and reporting for information placement and system updates
Analyze ethical violations for maintaining compliance with healthcare rules and regulations
Prompt
As the compliance manager of the SNHU Medical Clinic, it is your responsibility to identify any deficiencies in the coding process for the encounters in the clinic. You will select encounters to be audited to determine the percentage of charts that are documented accurately when comparing the documentation to the selected code(s). This achieved rate will be recorded and reported back to the provider. If this rate is less than the agreed percentage, the provider will receive education from your department on the identified deficiencies. A monthly report will be provided to the appropriate compliance departments or director of the department.

Your monthly compliance report should answer the following prompt: What issues have been identified as needing improvement either in the form of education or technology improvement to meet the goals for the SNHU Medical Clinic? A description of the compliance plan (see Segment of Compliance Plan Example, linked in the Final Project Submission assignment in Module Seven of your course) should be presented in this paper, including any positive, negative, or neutral results that having a compliance plan presents for a facility.

Specifically, you must address the critical elements listed below.

Preface
Compose a preface for the monthly compliance report after completing the separate elements below. Be sure to include the focus of the report and frame it for your intended audience.
Evaluation
What is the overall outcome of the provider chart audits? Are there any providers that need extensive education based on the outcomes? Provide support for your answers.
There are charts in the case study where the documentation did not support the diagnosis and evaluation and management (E/M) coding that was billed for the encounter. What coding guidelines and/or policies should have been followed when establishing the diagnosis and E/M code?
How would you implement or revise the review processes of clinical documentation for prospective, concurrent, and retrospective reviews? Be sure to include the workflow and training opportunities for staff in your response.
Does the EHR system provide the necessary criteria for reporting the quality measures for the patients? Is this an appropriate system for the clinic, or should adjustments be made to improve the user experience and dependability? Support your answer.
Compliance
What is the importance of the compliance program? Are there any specific benefits associated with having a formal compliance program? What consequences are there to not having a compliance program? Be sure to support your answers.
Analyze the formal compliance program currently in place. Is that appropriate for the clinic type, according to OIG classifications?
What are the consequences if the plan is not adhered to, and how should the organization monitor in order to remain compliant? Do any changes need to be addressed to improve the usefulness of the compliance program? Why or why not? Support your answer.
Recommendations
Recommend what may need to be adjusted to improve and enhance the coding process at this enterprise. Where is additional education needed to better understand the coding process? Support your answer.
Recommend improvements in the clinical documentation processes based on evaluation of the workflow processes to accommodate the Systematized Nomenclature of Medicine (SNOMED) process. Be sure to justify why these changes would help.
In reference to quality measures, do the improvements recommended accurately reflect the provider’s patient population regarding SNOMED? Why or why not? Support your answer.
Recommend the training for medical staff necessary to attain the industry standards to meet healthcare data reporting requirements. Consider how industry standards have changed in recent years. Support your answer.
What is fraud and abuse? What should the auditors do/what directions to follow if they suspect fraud or abuse?
With consideration to which technology would need supplementing or replacing, what additional technology would you recommend to improve the functions of the current processes in the clinic?
What additional resources may be needed for implementing your technology recommendation? Consider resources such as budget, staffing, and training in your response.
What intervals are audits scheduled, and are they sporadically scheduled? Who does the organization report issues to if fraud and abuse is detected?
After evaluation, would you recommend modifying the workflow process in the clinic or would an upgrade be sufficient? Why? Be sure to support your choice.
Conclusion
What is the overall status of the coding program of this entity? Support your answer.
Overall, did this entity maintain compliance with healthcare rules and regulations? Support your answer with evidence from the providers’ charts. Consider any major ethical issues that may have been discovered during your analysis.
Were there any significant training issues identified in the audit? What preventions are in place to prevent training deficits from arising?
Does the technology being used in the clinic support the reporting of the healthcare data reporting requirement guidelines? If not, what recommendations can be made to improve the technology?
Milestones
Milestone One: Draft of Evaluation
In Module Three, you will submit a draft of the evaluation section (section II). Complete an audit of the information provided in the case study, identifying educational needs, process, and workflow concerns. After completing the evaluation of the final audit results, compile a list of providers that need additional education. This milestone will be graded with the Milestone One Rubric.

Milestone Two: Draft of Compliance and Recommendations
In Module Five, you will submit a draft of the compliance and recommendations sections (sections III and IV). This portion of the paper will address the purpose for the compliance document and how this relates to the daily operations of the facility, and describe the phases of evaluation by the OIG after a serious deficiency is found in an audit. This milestone will be graded with the Milestone Two Rubric.

Final Submission: Monthly Compliance Report
In Module Seven, you will complete the preface and conclusion sections (sections I and V), and submit your final project. It should be a complete, polished artifact containing all of the critical elements of the final product. It should reflect the incorporation of feedback gained throughout the course. This submission will be graded with the Final Project Rubric.

What to Submit
Your monthly compliance report must be 10- to 12- pages in length (plus a cover page and references) and must be written in APA format. Use double spacing, 12-point Times New Roman font, and one-inch margins. Include at least seven references cited in APA format.