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Five Steps to Data Quality, Coding and Billing Complianc
Data quality, coding and billing compliance remain on the forefront in both the inpatient and outpatient arenas. Staying abreast of current rules and regulations is a multi-departmental responsibility as is staying on top of the quality of your documentation, coding and billing. Compliance cannot be viewed as a one step process and must be considered an on-going effort. To assist you in this effort, NJHA Information Services offers a comprehensive analysis and consulting program, Five Steps to Data Quality, Coding and Billing Compliance.
This comprehensive program addresses both inpatient and outpatient coding and billing compliance. You can choose to take advantage of the entire 5-Step program or to pick and choose those modalities that are of interest to you and your facility.
| • Step 1: |
DRG Pairs Analysis Report
NJHAIS will prepare a color-coded, easy to read grid that will highlight the potentially targeted DRG pairs and those areas that should be of most concern to your facility. |
| • Step 2: |
Data Quality Medical Record / UB92 Review
NJHAIS will conduct focused inpatient and outpatient medical record coding and billing reviews. Inpatient reviews will be based upon evidence of the DRG Pairs Analysis Report and will address proper assignment and sequencing of ICD-9-CM diagnosis codes with respect to DRG assignment, documentation requirements and conformance to nationally accepted coding practices. Outpatient reviews will focus on the proper assignment of evaluation and management codes as well as all other HCPCS coding. These reviews will also address the proper reporting of modifiers and the appropriate selection of ICD-9-CM diagnosis codes with an emphasis on medical necessity guidelines. The final portion includes a thorough UB92 review to ensure that your bills completely and accurately reflect the outpatient services rendered. |
| • Step 3: |
Coding Compliance Education
NJHAIS will conduct customized coding education for your staff that will include an overview of the OIG's Workplan and the HIM department's role and responsibilities relating to compliance. |
| • Step 4: |
Development of Coding Guidelines
NJHAIS will assist you in the development of internal coding guidelines. |
| • Step 5: |
Design of Superbills
NJHAIS will design hospital specific superbills in a format conducive to your outpatient registration, coding and billing processes. |
For more detailed information to request a proposal, please contact Maureen Barrie (609) 275-4108, mbarrie@njha.com, or Tim Keough, MPA, RHIA, Assistant Vice President at (609) 936-2222 or by e-mail tkeough@njha.com.
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