Pharmacy revenue cycle internal audit

You are a clinical documentation improvement coordinator and a liaison to the HIM department. You are reviewing the record for a discharged patient that you received for review due to a rejected claim. You notice that 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 infusion. 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 infusion. You look through your database and find that this same error happened six other times this year. Since there is a pattern for blood infusion 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 for infusions, and the choices are alphabetized. Blinatumomab infusion comes right before blood infusion. 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

Your submission must be your original work. No more than a combined total of 30% of the submission and no more than a 10% match to any one individual source can be directly quoted or closely paraphrased from sources, even if cited correctly. An originality report is provided when you submit your task that can be used as a guide.

You must use the rubric to direct the creation of your submission because it provides detailed criteria that will be used to evaluate your work. Each requirement below may be evaluated by more than one rubric aspect. The rubric aspect titles may contain hyperlinks to relevant portions of the course.

A. Analyze the above 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 that the error described in the scenario does not recur.
B. Explain the legal requirements for pharmaceutical reimbursement by doing the following: