From Registration to Accounts Receivable – The Whole Can of Worms 2007 UBO/UBU Conference Briefing: Developing and Maintaining Your MTF Coding Compliance Plan Date:21 March 2007 Time:

2007 UBO/UBU Conference From Registration to Accounts Receivable 2 Objectives Know the main elements of a coding compliance plan Understand the tools to ensure compliance with your plan

2007 UBO/UBU Conference From Registration to Accounts Receivable 3 Elements of a Coding Compliance Plan A general statement of your organization’s commitment to compliant coding The source(s) of your facility’s official coding guidelines Appropriate resources – UBU Professional Services Guidelines – ICD-9-CM Coding Clinic – CPT Assistant

2007 UBO/UBU Conference From Registration to Accounts Receivable 4 Elements of a Coding Compliance Plan Ultimately responsible for the code assignment in your facility Procedures for obtaining clarification on documentation issues Different coding rules for different places within the facility Facility specific coding rules

2007 UBO/UBU Conference From Registration to Accounts Receivable 5 Elements of a Coding Compliance Plan Process for correcting coding errors – Internal – External Process for coding of new procedures Method to resolve coding and documentation issues Process for dealing with claim rejections Statement in your plan that you will not modify or assign codes strictly based on maximizing reimbursement (RVU)

2007 UBO/UBU Conference From Registration to Accounts Receivable 6 Understand the Tools Develop coding policies and procedures – High risk – High volume – OIG Workplan Conduct audits per your compliance plan – Trust but verify – Keep a documentation trail

2007 UBO/UBU Conference From Registration to Accounts Receivable 7 Understand the Tools Take action based on audit results – Provide education to coders and providers – Revise policies Review OIG Workplan – Modifier issues – DRG issues

2007 UBO/UBU Conference From Registration to Accounts Receivable 8 Understand the Tools Track the Case-Mix Index Reviewed denied claims

2007 UBO/UBU Conference From Registration to Accounts Receivable 9 Summary Know the main elements of a coding compliance plan Understand the tools to ensure compliance with your plan