FOUR COST-EFFECTIVE SOLUTIONS TO

OFFSET REVENUE LOSS IN YOUR HEALTHCARE

ORGANIZATION By: Cynthia Brown, MBA, RHIT, CCS

Owner

CyntCoding Health Information Services

SOLUTION 1 Form an in-house

Ethics Committee with key personnel as members.

There should be an ethics officer in place who has an open door policy and who is a member of the committee.

RATIONALE The role of an ethics committee was solidified

in 1992 when the JCAHO mandated healthcare organizations to develop ways to address ethical issues in their facilities (AMA, 2008). Therefore, if for no other reason than it will be an essential requirement of JCAHO accreditation, your organization would benefit greatly from the development, implementation, and monitoring of an in-house ethics committee. An effective ethics committee can oversee matters involving the false filing of claims, misleading coding, and other financial issues of reimbursement to the facility.

SOLUTION 2 Employee

Relations is essential to maintain a positive and productive work environment.

An Employee Relations Manager should be included as one of the positions in the HR department.

ROLE OF AN EMPLOYEE RELATIONS MANAGER

An Employee Relations Manager (ERM) would ensure that there is regular feedback between staff and management; which would include performance evaluations and rate of pay evaluations.

A period salary comparison should be made by the ERM to ensure job rates meet the industry standards.

An ERM working along with a HR director, management, employees, and other key personnel can help to foresee, advise, and resolve employee conflicts with management.

RATIONALE “Employee Relations involve the body of work

concerned with maintaining employer-employee relationships which contribute to satisfactory productivity, motivation, and morale (NASA, 2009).” Essentially, Employee Relations is concerned with preventing and solving problems involving individuals which arise out of or affect work situations (NASA, 2009). Along with providing a means of evaluating employee performances, employee relations can be a mechanism for solving employees issues, such as pay increases and other grievances before they arise.

SOLUTION 3 Medical Necessity

Guidelines should be developed and implemented with a plan in place that ensures checks and balances for “best practices” and “medical necessity” for each inpatient and outpatient stay or visit to the facility.

MEDICAL NECESSITY Medical necessity is

“healthcare services that a Physician, exercising prudent clinical judgment, would provide to a patient for the purpose of evaluating, diagnosing or treating an illness, injury, disease or its symptoms (CIGNA, 2011).”

RATIONALE The seriousness of fines, loss of reputation,

and loss of revenue through accrediting agencies should be enough justification to develop, implement, and monitor Medical Necessity Guidelines. Medical Necessity Guidelines can help to eliminate unnecessary medical care whether intentional or unintentional. It helps the facility meet its “best practices” doctrine, because it makes the provider look at the type of care they provide. Of course, what is deemed necessary must meet other standards set forth by third party payors and legislation.

SOLUTION 4 The Company

should not just have a “Code of Ethics” in place it should ensure that each employee no matter their position knows what it entails and how to respond when it is not being adhered to.

CODE OF ETHICS IN ACTION

The facility should instigate community involvement demonstrating the company’s intentions to regain trust and move forward with a sincere desire to operate ethically.

CODE OF ETHICS IN ACTION

The violators of any of the legal issues adopted by the facility should be prosecuted and the community and investors alike should be made aware that unethical behavior at the facility has a zero tolerance.

CODE OF ETHICS IN ACTION The Company

should also demonstrate its strategic plans to improve in the services provided through quality assurance, performance evaluations, and peer review.

CODE OF ETHICS IN ACTION

Lastly, a Public Relations expert should be consulted.

RATIONALE When a company is publicly traded it has a

responsibility to its shareholders to operate in a manner that does not put the dollars invested at risk. Unethical behavior is definitely a threat to shareholders’ investment. There are also other major stakeholders who stand to lose when a company is no longer soluble (i.e., employees, suppliers, patients, and the community as a whole). The loss in employment and the revenue dollars generated by the business is irreplaceable. The opportunity for education for the physician and healthcare providers is invaluable. The void as a result of a facility’s demise can be potentially crippling to communities and the economy of the nation.

CYNTCODING HEALTH INFORMATION SERVICES

Cynthia Brown, MBA, RHIT, CCS AHIMA approved ICD-10 CM/PCS

Trainer CyntCoding Health Information

Services Phone: 404-992-8984/E-Fax: 678-

805-4919 P.O. Box 3019 Decatur, GA 30031 cyntcoder@gmail.com or cyntcoder@aol.com www.cyntcodinghealthinformationservices.co

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REFERENCESO’Reilly, K. (2008). Willing, but waiting: Hospitals

ethics committee. Retrieved December 13, 2013 from http:/www.ama-assn.org/amednews/2008/01/28/prsa0128.htm.

NASA. (2009). Employee relations: What is employee relations? Retrieved December 13, 2013 from http:/ohcm.gsfc.nasa.gov/employee_relations/whatis.htm.

CIGNA. (2011). CIGNA Healthcare definition of medical necessity for physicians. Retrieved December 13, 2013 from http:/www.cigna.com/health/provider/medical/procedural/medical_necessity.html.