This is a (2) Part Assignment.

Part 1

You are the chief compliance officer for Tybee Healthcare. You have only been in this position for 6 months. One of the things that you have learned is that there is no system in place to monitor the compliance efforts. You have decided to identify 10 indicators that you will monitor on a routine basis.

1. What are the 10 Indicators?

2. What threshold do you recommend that the organization should strive to meet?

3. Justify your recommendations.

Part 2

As compliance coordinator, you spend a lot of time looking for compliance issues that need correcting. Today, you are looking at various reports and charts. You cannot tell from the information provided to you if there is a compliance problem, but you can identify areas that need further investigation.

Review the potential compliance issues attached to this assignment: Potential Compliance Issue

Potential Compliance Issue

As compliance coordinator, you spend a lot of time looking for compliance issues that need correcting. Today, you are looking at various reports and charts. You cannot tell from the information provided to you if there is a compliance problem, but you can identify areas that need further investigation.

Review the table below for potential compliance issues:

Write a Y if the situation indicates a potential compliance problem; write an N if the situation describes a simple error or insignificant finding.

Justify your responses.

Medicare reviewed 100 heart cath charts. The MS-DRG was changed on 2 of the cases	N. This is a very small number of MS-DRG changes, which therefore does not show a pattern
Principal Diagnosis: Septicemia Secondary Diagnosis: Urinary Tract Infection Procedure: None
National percent of simple pneumonia: 76% Your hospitals is 77%
98% of all physician queries ask questions that would increase reimbursement.
Principal Diagnosis: Contusion, chest Secondary Diagnosis: Fracture, femur Procedure: Open reduction, internal fixation (ORIF), femur
The number of advanced beneficiary notices (ABNs) for the past year is 1.
A review of remittance advice shows 50 denials over the past month, with 42 of those denials for medical necessity.
The annual Report of compliance activities shows the following: Number of discharges: 22, 000 50% of the medical services were audited Only inpatient services were audited 50 charts were audited
A new compliance software package was installed in January. In March, HR evaluated salary ranges for all jobs in the hospital. The admission coordinator positions salary was dropped by 25%. The new hires have a high school education and strong typing skills.
The coding supervisor reviews a random sample of inpatient, outpatient, and ER records for correct coding. The sample is taken from all services, all physicians, and all coders.
An audit performed on rebills showed that 62% were higher weighted MS DRGs, and 38% were for lower.