Healthcare Statistics Assignment Discussion

Your quality improvement organization (QIO) has alerted your hospital that you are under a focused review for overutilization of healthcare services for your Medicare population.

· Explain what steps should you take to assess your situation?

· Define what structures and processes within the organization should be examined?

· If a problem is confirmed, outline what steps would you take to correct the situation?

· Distinguish how would you ensure that the situation is corrected on an ongoing basis? Healthcare Statistics Assignment Discussion

1 page, approx 200 word

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Running head: HIT REVENUE CYCLE MANAGEMENT HIT Revenue Cycle Management Institution Affiliation Date 1 HIT REVENUE CYCLE MANAGEMENT 2 Introduction In the regulatory business environment of today, it is important that all U.S businesses adopt a corporate ethics and compliance program that would be effective. When developing a compliance program, businesses need to adhere to the seven elements that exist in a compliance program. These seven elements are mostly vital for organizations especially those that are in the health industry because the elements are vital for the HIPAA compliance program as it will ensure that health information and data of patients are protected. Therefore, when creating a compliance program, it is important for each and every organization to make sure that they have utilized all the seven elements of the program. The seven elements of a good and complete compliance program A compliance program could be termed as the set of protocols that a business develops to deter and prevent any unlawful conduct from taking place and also encouraging a lifestyle of compliance within the organization (Chandran and Lobo, 2016)Healthcare Statistics Assignment Discussion.

The importance of a compliance program is that it enables businesses to identify the legal actions which might be taken against them if they engage in some activities. The two initiatives that will be deliberated when creating a compliance program are potential for progressive impact and top management challenges. Hence, when creating a compliance program, it is important that the seven elements are utilized. Establishment of Standards. Controls and Procedures When creating a compliance program, the first important thing is for the business to establish procedures and standards that will help in deterring and preventing any criminal or unethical conduct from taking place. The management of the business also needs to ensure that it has communicated to the employees about the rules and procedures that have been set. There HIT REVENUE CYCLE MANAGEMENT 3 should be a program where each and every time the employees are reminded of the standards and procedures. Since the company is a healthcare company, it is important that standards and procedures about health information of patients are set. Exercise ethics oversight and effective compliance To guarantee that the compliance program is effective, the healthcare organization must ensure that it has involved all the different layers of management in the ethics and compliance process (Stucke, 2013)Healthcare Statistics Assignment Discussion.

This will help ensure that all management of the company will understand the procedures and standards that are relevant to the business and also ensure that employees understand and follow all these policies and procedures. It is important that every individual that is in charge of a department has complete knowledge of the program. The personnel that will be involved in the oversight of the program in the healthcare organization should be the board of directors and senior management. Exercising due diligence The healthcare organization should avoid or deter from delegating any authority to people who have been determined to have been engaging in activities that are illegal or engaging in behaviors that are inconsistent with the ethics and compliance program. This means that when the healthcare organization is engaged in the hiring process, they should ensure that they have considered the level to which the party’s record of misconduct is in relation to the person’s anticipated responsibilities. Hence, the management of the healthcare organization should be alert of the type of individuals that they are hiring. Effective training and communication HIT REVENUE CYCLE MANAGEMENT 4 The compliance program of the healthcare institution should not only be put in the paper form, but the management should also ensure that the program has been effectively implemented through training and education (Weber and Wasieleski, 2013)Healthcare Statistics Assignment Discussion.

This is because training and education is a practical manner that enables the management to communicate to the employees about the standards and procedures of the program. The training and education should involve all the layers of management including both the senior management and the board of directors of the medical institution. The topics the education program should focus on are proper accounting, confidential information among others. Auditing, monitoring, and disclosure It is important for the medical institution to make sure that the workers follow the ethics and compliance programs. This means that the management of the healthcare organization needs to audit the compliance program so that it may ensure that the implementation of the elements is taking place to determine the effectiveness of the program. The healthcare organization should provide the employees with a mechanism where they will confidentially report any misconduct or inappropriate behavior. The management should also provide employees with guidance on different compliance issues. Discipline and Incentives The healthcare facility should make sure that it constantly promotes the importance and values of the compliance program. This can be done through the management rewarding the individuals that have engaged in actions that have demonstrated adherence while punishing those individuals that have violated or not adhered to the ethical standards of the organization. For the medical institution to make sure that the credibility of the compliance has been maintained, the HIT REVENUE CYCLE MANAGEMENT 5 management should encourage employees that have adhered to ethical standards through giving them incentives. Undertaking corrective action and detecting offenses The medical institution should guarantee that they have taken investigative actions when responding to suspected ethical and compliance violations. The management should also confirm that the confidentiality of these investigations is protected. The healthcare facility should also safeguard that it has developed steps and procedures that will ensure that any misconducts and violations are prevented and do not take place in future (Williford and Small, 2013)Healthcare Statistics Assignment Discussion.

Hence, the management should adopt measures that will enable them to detect offenses to the compliance program. Initiatives relating to health information The two initiatives that relate to health information are potential for progressive impact and top management challenges. These two initiatives largely impact the HIM department of the healthcare institution in terms of staffing and workload because of the compliance program. This is because, for the management to have a progressive impact, they would need to ensure that it has adequate employees who will help the organization to adopt a good compliance program. On the other hand, the challenges that the management has is also another initiative. This is because the company would need employees to help it solve any challenges it faces during the application of the compliance program and hence affecting the HIM department.

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Conclusion It is significant for organizations to adopt a compliance and ethics program to help them perform their functions effectively. A compliance program is important especially for healthcare HIT REVENUE CYCLE MANAGEMENT 6 organizations as it helps them avoid facing any legal actions. When developing a compliance and ethics program, it is vital for organizations to think through all the seven elements that are present in developing a compliance program. Through considering the elements, organizations will have an operational obedience and ethics program. HIT REVENUE CYCLE MANAGEMENT 7 Reference Chandran, S., & Lobo, A. (2016, May). Ethics and compliance in corporations: values based approach. In Ethics in Engineering, Science and Technology (ETHICS), 2016 IEEE International Symposium on (pp. 1-4). IEEE. Stucke, M. E. (2013). In search of effective ethics & compliance programs. J. Corp. L., 39, 769. Weber, J., & Wasieleski, D. M. (2013). Corporate ethics and compliance programs: A report, analysis and critique. Journal of business ethics, 112(4), 609-626. Williford, K., & Small, D. (2013). Establishing an Effective Compliance Program: An Overview to Protecting your Organization Healthcare Statistics Assignment Discussion