...Healthcare 10-11-2013 Current and historical trends relative to professional health care groups Over the course for the 30–35 years, the healthcare professional health groups witnessed profound development in the provision of heath care services. From the late 1960s up to the present, the industry has seen a gradual movement dissimilar from the health care feudalism (Rashford, 2007). During this time, the decision-making and economic power was mostly in the hands of independent facilities and individual physicians, to the health care mercantilism having provider networks, market collectives, governmental regulations and greater dispersal of power across various political and market forces. The economic shifts witnessed, along with dramatic advances in technology, have caused a tension between cost containment and cost expansion forces, with patients and providers caught in the middle. The door has since been opened for speech-language pathologists and audiologists to expand and congeal a more independent environment within the professional healthcare groups. We have greatly witnessed expanded scope and accessibility of skilled services for the communication disorders that have put pressure on the nation’s academic programs for the skilled entry-level professionals and clinical research and specialized training. Because of these, the economies of professional healthcare groups have benefited, from the changes within the health care sector...
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...EDI transaction sets must drive workflow. Medical billers are incredibly important in every healthcare facility— these providers can't stay in business without good billers. Traditionally, billers have either been trained on the job or have been medical coders who do both the coding and billing. However, the shortage of coders and the growing demand for skilled medical billing specialists has employers looking for professionals who know billing basics. Training with Career Step prepares you for a medical billing-specific career in much less time than it would take if you were gaining coding skills as well. As a medical billing specialist, you will take the data provided by the medical coders and use it to compile and submit claims to insurance companies and then subsequently bill patients. Day-to-day responsibilities vary from location to location, but often include: Using coded data to produce and submit claims to insurance companies Working directly with the insurance company, healthcare provider, and patient to get a claim processed and paid Reviewing and appealing unpaid and denied claims Verifying patients’ insurance coverage Answering patients’ billing questions Handling collections on unpaid accounts Managing the facility’s Accounts Receivable reports Medical billing specialists work in almost every type of healthcare facility, including hospitals, doctors' offices, skilled...
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...EXECUTIVE SUMMARY The Marcus Island healthcare system is characterized as socialized medicine where all residents have access to primary care, pharmaceuticals and diagnostic testing. While residents have access to care, they are responsible for a small portion of the payment at the time of service, and in some cases, those who are willing to pay a premium are afforded better access to services. While patients themselves believe their healthcare is either adequate or good, there are several aspects of the Marcus Island healthcare system that suggest care could be better. Specially, Marcus Island’s health care system has been running increasing budget deficits for the past five years. The health care system lacks access to comprehensive services including preventive care and screenings, mental health, dental service, and specialty care. Long wait times for appointments are an issue, as well as continuity of care between providers. Furthermore, there is no system in place to track quality of care indicators. An overhaul of the health care system is needed, including improvements in budgeting and increasing access to the full range of comprehensive health services. In addition, implementation of an electronic health records system would allow for greater continuity of care, improved efficiencies in services, and tracking of quality indicators. DEMOGRAPHICS Demographics: Marcus Island has thirty million residents; the population is growing. Family size is generally...
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...Maxim Healthcare Services Name Institutional Affiliation Maxim Healthcare Services Maxim Healthcare Services has extensive experience in the provision of medical staffing, wellness services, and home health in communities within the nation. The company, with its 25 years in healthcare services provision, dedicates itself to providing patients with affordable, accessible, and quality health care. In addition, the healthcare company puts emphasis on staffing skilled, devoted, and experienced healthcare professionals in various conditions and environments while focusing on compliance. The company’s experience can be attributed to its commitment to quality care and the provision of excellent customer services as well as staffing, homecare and wellness services as mentioned herein. Maxim commits itself to the recruitment, hiring and nurturing (training) experienced, knowledgeable healthcare professionals (Maxim Staffing Solutions, 2015). Maxim’s brands include the Maxim Healthcare Services, which engages in the provision of skilled therapy services and in-home nursing care, and the Maxim staffing solutions, which is classified into three subcategories: Nurse staffing, Allied Health, and Administrative Staffing that oversees the recruitment and allocation of reliable clerical personnel and administrative staffs in various specialties within the nation (Maxim Staffing Solutions, 2015). On the other hand, Allied Health is in charge of staffing experienced medical practitioners...
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...Medicare program has had an enormous impact on modern healthcare. The program brings healthcare to those 65 and older, but as a result of regulations and federal monitoring, the process for obtaining coverage, keeping coverage, reimbursement for services and the impact on accreditation make some health care organizations struggle to make ends meet. The program impacts not only standards for licensure, certification and accreditation, but also effects quality of care, how providers are paid, and access to healthcare. Medicare stipulates how providers are paid for services. An example would be the Prospective Payment System (PPS). The PPS determines fixed Medicare payment amounts based on the classification of the service provided (CMS.gov, n.d.). Medicare reimbursements are also influenced by many quality programs in place. As stated above, the Hospital Readmission Reduction Program threatens reductions in payment for performance, thus impacting reimbursement as well. Since signed into law in 1965, the Medicare program has played a large role in standards for healthcare providers, clinical quality for its patients, reimbursement to its participating providers, and has provided access to necessary medical care for the elderly. This program also has a very large influence on the health informatics professional’s role in modern healthcare and its emerging technological programs contribute to the growing need of a skilled health informatics workforce. References Boccuti...
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...CIS500 Information Systems for Decision-Making Term Paper - Information Technology Strategic Plan April 12, 2015 1. Write an introductory statement of the company including but not limited to the type of the company, the location, the industry in which it competes, and the organizational vision and mission that encompasses the nature of the company. Being the largest not-for-profit Catholic healthcare system serving the Delaware Valley, Mercy Health System is part of Trinity Health and sponsored by Catholic Health Ministries. Their mission is to serve in the spirit of the Gospel, which means serving the entire community with compassion and healing presence while addressing the diverse factors that impact the health needs of the whole person. Even though they treat people from all walks of life, they have a special concern for the poor and disadvantaged. The goal of Mercy Health System is to be recognized as the leader in improving the health of the community and everyone they serve. Currently, they employ approximately 6,500 caring, highly skilled personnel who are focused on creating positive patient-care. Mercy Health System is a diverse, integrated system that embodies: Four Hospitals acute care hospitals: | Mercy Fitzgerald Hospital | A 213-bed teaching hospital in Delaware County and Southwest Philadelphia | | Mercy Philadelphia Hospital | A 268-bed community teaching hospital serving the needs of West and Southwest Philadelphia communities | |...
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...Management Summary Our management team is comprised of people with many years of experience in the long-term care provider and software development industries. Our philosophy is laser-like focus on the customer’s needs. We have a Chief Financial Officer and four directors reporting to the President and CEO. Part-time positions staffing the customer support desk will be filled as needed and reporting to the Director of Operations. Seven regional sales managers will be contracted as commissioned resellers and reporting to the Director of Business Development. Four have already been identified. Management Team The OBRA e-z management team consists of the President and CEO, the CFO, and four directors: Ken Smitzhe, President and Chief Executive Officer Ken Smitzhe has been working with Information technology tools in the geriatric health are industry for over ten years. His expertise is in the Internet, Intranet and development of strategic business partnerships. Previously, Mr. Smitzhe was National Manager with NCS HealthCare, Inc., a world class provider of integrated healthcare solutions, providing real-time communications between long-term care institutions, including skilled nursing facilities and assisted living facilities. The technology provided by NCS has led to better patient care and a more efficient work environment. At NCS, Mr. Smitzhe was instrumental in the development of the companies’ web based formulas that increased productivity and customer...
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...or providing good care? A14 year old girl Andrea came to trust the nurse that was caring for her and after being told that the information would be confidential, disclosed that she had been sexually active. When it became apparent that she had cervical cancer and needed treatment which required parental consent; Nurse Carol Hathaway faced a dilemma of remaining true to her promise and allow Andrea to possibly go untreated or break confidentiality and inform the parents. The purpose of confidentiality between patient and medical care provider is to gain trust and provide the patient with privacy regarding their medical care and allow the patient assurance that personal matters will remain confidential. When private information is disclosed without the patient consent this is regarded as a breach of confidentiality and is morally, ethically and legally wrong. The implications are a lack of trust between the patient and the healthcare provider and the patient may not disclose vital information regarding their condition thereby may not receive adequate care.(Nathanson, 2000). There are exceptions which “require physicians to report certain infectious diseases to public health authorities to protect the health of the community” (Nathanson). When approaching ethical decisions the nurse must be an advocate for the patient. Advocacy is an important function of nursing and is viewed as an essential component of nursing (Hanks, 2008, p. 469). Nurse Hathaway felt that in order for...
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...ealth Health care Provider and Faith Diversity Health Care Provider and Faith Diversity Lakeshia Grimes Grand Canyon University: HLT 302 02/19/12 Dr.Sunshine Weeks Abstract Healthiness source in urban area contain most patients being from different faiths. For example, Baha’i, Sikh, Buddhist patients similar to Christianity use conservative healing to balance a quantity of practices in their faith the same as prayer, faithfulness, and meditation. In the majority case as observes the viewpoint to curing and health care stipulation, Baha’i, Sikh, and Buddhist, now as Christians, contain a position for up to date medicine, and scientific practice as a balancing explanation to spiritual interference in moment of sick wellbeing. In this essay I will establish, patients hardly ever mind while they search for care from providers with unusual religious partiality for as long as those providers put the patient’s attention at the forefront. I also will establish the significant components of healing, what is essential to people of a particular belief, and how do patients examination health care providers. Health care professionalism stress that providers permit patients to illustrate from their personal religious practice and to be responsive toward such necessities of individual patients. The faith system of Baha’i, Sikh, and Buddhism, their religious, their religious insight on curing, health enthusiastic and mechanism of their...
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...BCRC document: China - Healthcare Providers. Business & Company Resource Center ________________________________ Datamonitor Industry Market Research , Feb 13, 2012 pNA China - Healthcare Providers. Full Text: COPYRIGHT 2012 Datamonitor MarketDefinition The healthcare providers sector is valued as total expenditure on healthcare in each country. This includes final consumption spending on healthcare goods and services. Goods and services in this sector include inpatient, outpatient, long-term medical care, medical goods including pharmaceuticals and supplies, and collective services such as administration requirements. Public spending (e.g. by national and local governments, social security schemes) and private spending (e.g. payments made by private-sector health insurers and individual out-of-pocket expenditures) are both included. Any currency conversions used in the creation of this report have been calculated using constant 2010 annual average exchange rates. For the purposes of this report, Asia-Pacific comprises Australia, China, India, Indonesia, Japan, New Zealand, Singapore, South Korea, Taiwan, and Thailand. ResearchHighlights *The Chinese healthcare providers sector is expected to generate total revenue of $303.9 billion in 2011, representing a compound annual growth rate (CAGR) of 15.9% between 2007 and 2011. *The outpatient care segment is expected to be the sectors most lucrative in 2011, with total revenue of $106.4 billion...
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...Changing Landscape of Healthcare HCS 490 The healthcare landscape is always changing as organizations develop new techniques and processes in response to the challenges they face on a daily basis. For example, with the new law that President Obama signed, the Affordable Care Act, also known as Obama Care, made a huge change to health care reforms. This new law gave citizens healthcare regardless of pre-existing conditions or income. The Obama Care does create shifts and challenges in the healthcare landscape. Obama Care does have its benefits. People with pre-existing conditions can now have insurance without being turned down because of condition, this includes children as well. Young adults can now stay on their parents insurance up to the age of 26 and applications cannot be denied like in the past because of errors made on the application. Obama Care also covers services without co-pays, like mammograms and colonoscopies or other preventive test. Individuals and families will pay insurance based on their income, if you don’t have insurance by March of 2015 you will be fined. Even though people will get coverage with pre-existing conditions, this allows insurance companies to raise their rates. The insurance can’t cancel you because you are sick, but citizens do have the right to appeal a health insurance company if the citizen does not agree with a health care plan (Obama 2014). One of the biggest challenges of the new reform will be Integrated Health Care Delivery...
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...than nursing home protocol. Even with changes in regulations, reporting systems, and documentation over the past couple of years, the nursing home industry still has its share of problems. Patient safety is meant to provide patients freedom from healthcare associated preventable harm, meaning when things go right, nothing bad happens. Nursing home organizations have been constantly trying to improve their reputation and the way people view them, but how? Don’t patients make up a nursing home? What about their safety? Shouldn’t we start there? How do we make improvements? Telehealth, a new approach to improving patient safety in nursing homes, will use telecommunication technologies to deliver health related services and information that support patient care, administrative activities, and health education (Dixon, Hook, McGowan, 2008). In this paper I will explore the major benefits of Telehealth and how its implications can improve patient safety in nursing home care. What is Telehealth and why is it important? Telehealth is the means and methods to improving access to care and reducing healthcare associated costs. It is also a system that can be used for education purposes, to keep physicians and medical staff in the know on healthcare changes and updates; in which combined together are the steps to improving patient safety in nursing home facilities. It is an expansion of telemedicine, and unlike telemedicine, (which focuses just on the curative aspect) it focuses more on preventative...
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...Principles of Healthcare Reimbursement Anne B. Casto, RHIA, CCS Elizabeth Layman, PhD, RHIA, CCS, FAHIMA Copyright ©2006 by the American Health Information Management Association. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, photocopying, recording, or otherwise, without the prior written permission of the publisher. ISBN 1-58426-070-X AHIMA Product No. AB202006 Ken Zielske, Director of Publications Susan Hull, MPH, RHIA, CCS, CCS-P, Technical Reviewer Marcia Loellbach, MS, Project Editor Elizabeth Lund, Assistant Editor Melissa Ulbricht, Editorial/Production Coordinator All information contained within this book, including Web sites and regulatory information, was current and valid as of the date of publication. However, Web page addresses and the information on them may change or disappear at any time and for any number of reasons. The user is encouraged to perform his or her own general Web searches to locate any site addresses listed here that are no longer valid. AHIMA strives to recognize the value of people from every racial and ethnic background as well as all genders, age groups, and sexual orientations by building its membership and leadership resources to reflect the rich diversity of the American population. AHIMA encourages the celebration and promotion of human diversity through education, mentoring, recognition, leadership, and other programs. American...
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...Healthcare Utilization and Finance WGU Organizational Systems &Quality Leadership KOT1 Lynnell Fulkerson Healthcare Utilization and Finance Medicare A1. Medicare Part A Medicare Part A covers medically necessary services and supplies including hospitalization and skilled nursing facility (SNF) care. Mrs. Zwick spent five inpatient days in the hospital and 40 days in a SNF. Medicare Part A will cover 100% of the first 60 days of Mrs. Zwick’s hospital stay after she pays the $1,184 deductible. Because Mrs. Zwick spent at least three days as an inpatient in the hospital, and assuming that the skilled nursing facility Mrs. Zwick is admitted to is Medicare certified, Medicare Part A will pay for 100% of her first 20 days in SNF (2013 Medicare Costs, 2012). Medicare Part A also covers days 21- 100 in a SNF with a $148 per day co-pay, however, Mrs. Zwick had a hospital-acquired infection (HAI) of the urinary tract and was unable to participate in rehabilitation for 7 days. Medicare will not cover the costs of those 7 days in the SNF because in 2009 the Centers for Medicare & Medicaid Services (CMS) stopped paying for preventable conditions including hospital-acquired urinary tract infections (Paddock, 2007). The skilled nursing facility will not be reimbursed for the cost of care and services for that time. The additional time in the SNF, 13 days, will be covered by Medicare Part A except for the $148 daily...
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...It is of no surprise that the healthcare environment is rapidly evolving throughout the United States. This includes rising healthcare cost, provider shortages and ongoing changes within the Affordable Care Act. In addition, the American Associate of Nurse Practitioners (AANP) (2013), developed standard of practice guidelines that must be adhered by all nurse practitioners. Acknowledging the standards of practice is key as well as taking initiative in making sure they are being implemented in practice. Quality Assurance and Continued Competence is a standard of care that ensures the nurse practitioner remains compliant in continuing education. AANP (2013) identifies this can be achieved by attending continuing education programs, remaining...
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