[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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