[Solved] HIM 600-5-1 Discussion: Compliance—Barriers and Penalties
Potential
Barriers to Compliance
According to Snell (2016), external data
security threats, employee training, and evolving technology are the main
barriers to compliance in healthcare. Based on this perspective, several potential
barriers to compliance can be observed in the Healthy
Health Center case study. Notably, the case study provides that there seems to
be a gap in coder and physician training that needs to be addressed to enhance
coder productivity, accuracy rates, and compliance. Besides, the case study
further posits that its coders are experiencing insufficient physician
documentation inhibiting the ability to select a diagnosis code at the highest
level of specificity. Based on these challenges, significant potential barriers
to Healthy Health Center’s compliance include insufficient physician
documentation and lack of sufficient staff training. Furthermore, the Healthy
Health Center case study provides that the facility averagely incurs $4.5
million in discharged not final billed (DNFB) due to ineffective coding,
clinical documentation policies, and query procedures for compliance. In
comparison to national benchmarks and peer-to-peer comparison, the facility s
coders performance is below average, as indicated in the case study. These
issues (ineffective coding, clinical documentation policies, poor query
procedures, and reduced coder performance compared to benchmarks) are other
potential barriers to the facility’s compliance.
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