INTRODUCTION Proper documentation is an important issue and area of concern to t

INTRODUCTION
Proper documentation is an important issue and area of concern to the health information management (HIM) professional. Quality of care,
patient safety, and regulatory compliance are major focal points for all healthcare organizations. HIM professionals serve as subject matter
experts to ensure that clinical practices meet the requirements of external regulatory agencies as well as internal stakeholders. HIM can share their expertise by collecting and analyzing financial and clinical data that relate to the pharmacy department. The goal is for HIM professionals to be familiar with how pharmaceuticals affect reimbursement and with related standards surrounding pharmacy best practices.
SCENARIO
You are a clinical documentation improvement coordinator. You are reviewing the record for a discharged patient that you received for review
due to a rejected claim. You notice there is documentation of medications administered to the patient in the progress note indicating
blinatumomab infusion. However, the medication reconciliation section in the EHR states blood transfusion. As you continue to look through
the patient record, you confirm that blinatumomab is the correct infusion and note that the correct infusion is billable for $6,900 more than the blood transfusion. You look through your database and find that this same error happened six other times this year. Since there is a pattern for blood transfusion being coded and billed for blinatumomab infusion, you pull up the medication reconciliation section of the EHR and discover
that there is a drop-down box and the choices are alphabetized. Blinatumomab infusion comes right before blood transfusion. You have
brought this issue to the attention of your supervisor. Your supervisor has asked you to provide a report for senior management regarding the error, recommend a corrective action plan, and discuss further legal issues and responsibilities for HIM professionals.
REQUIREMENTS
A. Analyze the scenario, and write a report for senior management discussing the financial, quality-of-care, and legal issues related to
incorrect medication entry and incorrect billing by doing the following:
1. Discuss the financial impact on the hospital when errors like the one described in the scenario occur.
2. Discuss the quality-of-care and legal issues related to the data-entry error described in the scenario.
3. Recommend a corrective action plan to ensure the error described in the scenario does not recur.
B. Explain the legal requirements for pharmaceutical reimbursement by doing the following:
1. Discuss the application of the National Drug Code (NDC) to the coding and billing function in the scenario.
2. Explain the steps an HIM professional should take to report suspected fraud and abuse in collected data.
3. Explain the importance of a pharmacy revenue cycle internal audit based on the scenario.
4. Discuss three important points that should be considered when conducting a pharmacy revenue cycle internal audit.
a. Justify why these points are important to consider.
C. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized.
D. Demonstrate professional communication in the content and presentation of your submission.
RUBRIC
The report includes an accurate discussion of the financial impact on the hospital when errors like the one described in the scenario occur.
The report logically discusses the quality-of-care and legal issues related to the data-entry error described in the scenario.
The corrective action plan to ensure that the error described in the scenario does not recur is logical and includes all of the elements of a
corrective action plan.
The discussion provides a logical description of the application of the National Drug Code (NDC) to the coding and billing function in the
scenario.
The explanation logically addresses the necessary steps that an HIM professional should take to report suspected fraud and abuse in collected data.
The explanation logically addresses the importance of a pharmacy revenue cycle internal audit. The explanation is well supported by the
information provided in the scenario.
The discussion includes 3 important and logical points to consider when conducting a pharmacy revenue cycle internal audit.
The discussion logically justifies why the 3 points to consider in part B4 are important and relevant to conducting a pharmacy revenue cycle
internal audit.
The submission includes in-text citations and references for content that is quoted, paraphrased, or summarized and demonstrates a
consistent application of APA style.
Content reflects attention to detail, is organized, and focuses on the main ideas as prescribed in the task or chosen by the learner. Terminology is pertinent, is used correctly, and effectively conveys the intended meaning. Mechanics, usage, and grammar promote accurate interpretation and understanding.