Coding Accuracy CaseStudy

To prepare for this Assignment:

• Review this week’s Learning Resources.
• Read the document, “Case 9: Coding Accuracy,” located in this week’s Learning Resources.
• Reflect on how DRG upcoding was detected through electronic claims data.

The Assignment (2- to 3-page paper):

After reading the case study thoroughly, write a paper in which you respond to the following:

• Propose an action plan outlining what the Healthcare Financing Administration (HCFA) should do to monitor DRG upcoding.
• Recommend key elements to be included in a payment error prevention program.
• Explain the implications of fraud and abuse for this case. Then, discuss the broader implications of fraud and abuse. What are the consequences, and who is impacted?

Provide specific examples in your paper. Support your post with the Learning Resources and at least one current, outside scholarly article (less than 5 years old).