COMPETENCIES737.4.4 Coding and FinanceThe graduate evaluates the financial and legal impact of accurate billing and coding for pharmaceutical services in a healthcare system.INTRODUCTIONProper documentation is an important issue and area of concern to the health information management (HIM) professional. Quality of care, patient safety, and regulatory compliance are major focal points for all healthcare organizations. Health information management professionals serve as subject matter experts to ensure that clinical practices meet the requirements of external regulatory agencies as well as internal stakeholders. Health information management professionals can share their expertise by collecting and analyzing financial and clinical data that relate to the pharmacy department. The goal is for health information management professionals to be familiar with how pharmaceuticals impact reimbursement and with related standards surrounding pharmacy best practices.SCENARIOYou 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.REQUIREMENTSA. 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:1. Discuss the application of the National Drug Code (NDC) to the coding function.2. Explain the steps an HIM professional should take to report suspected fraud and abuse in collected data.3. Explain the importance of a pharmacy revenue cycle internal audit based on the scenario.4. Discuss three important points that should be considered when conducting a pharmacy revenue cycle internal audit.a. Justify why these points are important to consider. C. Acknowledge sources, using APA-formatted in-text citations and references, for content that is quoted, paraphrased, or summarized. D. Demonstrate professional communication in the content and presentation of your submission.

Competency Analyze communicable diseases and their potential impact on public health. Scenario Your supervisor has asked each public health nurse to research a different communicable disease and prepare a communication document about the disease. These communication documents will be used to support your department in better understanding the public health issues, the potential consequences to the population, and the actions that public health nurses can take to educate and provide services for the population. As the senior public health nurse in your department, your supervisor has requested that you select your communicable disease to research first and then they will assign your coworkers their communicable disease topic. Instructions Part One - Select one communicable disease from the list below, and research the communicable disease: Vaccination rates of children and any outbreaks Rates of influenza among those over 65 Rising rates of new HIV rates of infection. High immigrant community and concern about Ebola, Zika, or SARS New cases of acute flaccid myelitisRising rates of sexually transmitted diseases Salmonella outbreak Rising rates of hepatitisPart Two - Prepare a communication document that: Explains the selected communicable disease's impact or potential impact on public health. Analyzes data using correct epidemiologic terminology on the communicable disease (from the surveillance sources' websites provided below). Explains the potential impact on the population if this communicable disease is not addressed, with a focus on the social impact and the emotional distress to the community. Examines nursing interventions that have been proven effective in similar communities. Details the action steps that can be taken by public health nurses to prevent and control the communicable disease, including education strategies. Provides stated ideas with professional language and attribution for credible sources with correct APA citation, spelling, and grammar in the communication document.

Consider the new healthcare business or service line that you described in the Discussion Board assignment this week. Use any or all concepts over the course of this class to assist with developing the financial analysis of your new business or service line.Use any or all concepts over the course of this class to assist with developing the financial analysis of your new business or service line.Create a PowerPoint presentation that includes the following:Description of the new health care business or service lineDefinitions of the four areas of the SWOT analysisProvide examples of the type of information in each section of the SWOT analysis.A comprehensive SWOT analysis on the internal and external environment for the service line or new business you plan to openYour presentation should be professional and follow CTU guidelines for PowerPoint presentations.