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Learning Goal: I’m working on a business exercise and need guidance to help me learn.


As the coding manager, you arereviewing your monthly budget when your new coder knocks on the door.She explains that she is finishing a final college course and needs tointerview an HIM professional for an assignment. You ask her to comeback to your office tomorrow at 9am and you schedule a 30-minute segmentwith her on your calendar.

When she returns the next day, shebegins by asking you to talk about insurance variations, and she asks ifyou can give a specific example, excluding PHI, of course.

You show her this example.

Thecoder also asks about external audits, and wonders if an audit alwayslooks for coding errors. To exemplify the complexity of external auditsthat are a part of Health Information Management practices, you share arecent Medicare audit.

recent Medicare audit.

Thenew coder draws the conclusion that insurance is the biggestfrustration in coding management. You want her to understand that whileinsurance contracts are a complex issue in your world, externalregulations are a tremendous frustration for HIM, as well. The OIG,Office of the Inspector General, regulates HIM and many other areas ofhealthcare.

Areas of healthcare.


Complete the three linked assignments and submit them in one zipped file.