HIM 660 Final Project Guidelines and Rubric
Prompt
Imagine that you are the health information manager at Community Hospital. In response to a CEO request, you have been tasked with developing a task force
report that will inform an enterprise-wide strategic plan. The CEO has requested that you develop specific recommendations for how the HIM department can
help the hospital increase revenue. Begin by analyzing the HIM department’s key performance indicators (KPIs) and how these indicators impact the hospital’s
overall revenue. Then, use provided data and financial statements to evaluate how well the HIM department is meeting the benchmarks. Use your evaluation to
recommend how the HIM department can meet its KPIs and increase the hospital’s overall revenue.
Specifically, be sure to address the following critical elements:
I. Introduction: In this section, you will discuss the KPIs of the hospital’s HIM department and the relationship of these KPIs to enterprise-wide revenue.
a) Summarize the current environment of the HIM department, using the SWOT analysis you developed in Module Three to support your
response.
b) Briefly explain the connection between the three KPIs of the HIM department and the hospital’s overall revenue.
c) Justify how a cost-benefit analysis could help address the hospital’s reimbursement issues.
II. Claims Management: In this section, you will analyze the aging report to determine issues the hospital is facing related to claims timeliness. You will
then develop recommendations to leverage the EHR and address the timeliness issues.
a) Assess the current issues the hospital is facing related to billing timeliness, and support your assessment with data from the aging report.
b) Determine why the current state of the billing timeliness is a costly issue for the hospital; support your determination using specific examples.
c) Recommend ways the hospital can use the EHR to address billing timeliness; support your recommendations using specific examples.
d) Defend why improving the hospital’s billing timeliness will be most beneficial, as opposed to focusing on other aspects of the claims
management process.
e) Identify the specific resources required to carry out your recommendations, and explain why these resources are critical to improving the
hospital’s claims timeliness
Reimbursement: In this section, you will analyze the payer mix to determine the hospital’s future payer mix and recommend strategies for addressing
the industry-wide shift toward value-based reimbursement.
a) Based on yearly trends in the hospital’s payer mix, determine what the hospital’s payer mix is likely to be in the next year. Support your
determination with data from the payer mix report.
b) Determine the impact of the trends in the hospital’s payer mix on the hospital’s future revenue.
c) Recommend a reimbursement model that the hospital should adopt, and explain how implementing that model will help the hospital address
the current trend of value-based reimbursement.
d) Recommend basic strategies that the hospital should use to improve chronic care management related to its most frequent readmission
diagnoses.
e) Identify the specific resources required to carry out your recommendations, and explain why these resources are critical to successfully shifting
the hospital to value-based reimbursement.
Coding Errors and Fraud: In this section, you will analyze the evaluation and management (E&M) bell curve to determine coding errors occurring at the
hospital. You will then develop procedures for the HIM department to address these coding errors, as well as develop a contingency plan if the proposed
procedures are unsuccessful.
a) Asess the hospital’s current trends related to errors of upcoding and undercoding, and support your assessment with data from the E&M bell
curve.
b) Recommend strategies the hospital should implement to help address the trends identified.
c) Develop a procedure for the HIM department specifying who should monitor the chargemaster and how often the procedure should be
updated; explain how this procedure will help mitigate coding errors and fraud.
d) Develop a procedure for the HIM department specifying who will audit and monitor the accuracy of coding entries. The procedure should
include key components such as present on admission (POA), hospital-acquired conditions and severity of illness, and intensity of resources.
Explain how this procedure will help mitigate coding errors and fraud.
e) Recommend a contingency plan for the HIM department if routine monitoring reveals that recommended procedures are ineffective in
addressing coding errors.
f) Identify the specific resources required to carry out your recommendations and explain why these resources are critical to improving coding
errors and fraud in the organization.
V. Conclusion: In this section, you will discuss how you will measure the success of your recommendations and how those initiatives will affect enterprisewide revenue.
a) Determine the specific benchmarks needed to evaluate the success of your proposed strategic initiatives, and explain how they will be used.
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