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Coding Accuracy Case Study Essay Assignment Term Paper
Assignment: Coding Accuracy Case Study
The importance of accuracy in medical coding cannot be overstated. Proper coding leads to proper payment. Unfortunately, some providers and organizations attempt to manipulate revenue by coding for more services at a higher level of complexity in order to get larger reimbursements from insurance companies. This practice is known as “upcoding.” The Healthcare Financing Administration (HCFA) does monitor for upcoding, but its processes are not adequate, and many uncoded claims for diagnosis-related groups (DRG) are overlooked.
In this Assignment, you consider a case study about the HCFA’s monitoring of upcoding and develop an action plan for improving the monitoring process. You also discuss the elements that should be included in a payment error prevention program and the implications of fraud and abuse in healthcare.
To prepare for this Assignment:
Review this week’s Learning Resources.
Read the document, “Case 9: Coding Accuracy,” located in this week’s Learning Resources.
Reflect on how DRG upcoding was detected through electronic claims data.
The Assignment (2- to 3-page paper):
After reading the case study thoroughly, write a paper in which you respond to the following:
Propose an action plan outlining what the Healthcare Financing Administration (HCFA) should do to monitor DRG upcoding.
Recommend key elements to be included in a payment error prevention program.
Explain the implications of fraud and abuse for this case. Then, discuss the broader implications of fraud and abuse. What are the consequences, and who is impacted?
Provide specific examples in your paper. Support your post with the Learning Resources and at least one current, outside scholarly article (less than 5 years old).
RUBRIC |
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Excellent Quality 95-100%
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Introduction
45-41 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned. |
Literature Support 91-84 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned. |
Methodology 58-53 points Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met. |
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Average Score 50-85% |
40-38 points More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided. |
83-76 points Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration. |
52-49 points Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met. |
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Poor Quality 0-45% |
37-1 points The background and/or significance are missing. No search history information is provided. |
75-1 points Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration. |
48-1 points There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met |
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Coding Accuracy Case Study Essay Assignment Term Paper |