Question

Which high-risk area associated with fraudulent billing practices do you think is the most problematic?

Describe the role of the HIM professional in supporting an effective compliance program. How does the AHIMA Code of Ethics (covered in chapter 2) guide a HIM professional in this role?

Why do you think that healthcare fraud and abuse is such a significant problem?

What mechanisms would you implement to ensure that staff members are encouraged to report suspected or actual compliance violations?

What impact does the student anticipate that RAC programs have on corporate compliance programs?

Answer 1

•Which high-risk area associated with fraudulent billing practices do you think is themost problematic?

- The most high-risk area associated with fraudulent billing practices is the duplicate billingbecause is more Thant one claim service submitted. The duplicate billing occurs whenthere more than one claim for an item or service submitted to a payer.

•Describe the role of the HIM professional in supporting an effective compliance program. How does the AHIMA Code of Ethics (covered in chapter

- The role HIM professional will have in supporting an effective compliance program is ensuring that thecompliance program stay abrupt in highly complex and related nature of the healthcare industry, andas the federal government’s enforcement efforts and penalties evolve, staying abreast of compliancerequirements continues to be a challenge for healthcare organizations, particularly the personnelresponsible for management and integrity of health information. AHIMA’s Code of Ethics, the AMIAguidelines focus on directing informatics professionals in serving as an expert in their organizationswhile meeting the needs and honoring the right of patients by this oath it will play a major role in thecompliance program.