...#1…Public health IN THE United States, primary care remains a medical model. This is in contrast to much of the world, where the 1978 Declaration of Alma-At a which recognized that attaining health for all also requires interaction from social and economic sectors - is considered standard. Today, there is much buzz about patient-centered medical homes, a concept that promises to transform the practice of American medicine. There is much to praise about this most recent iteration of the medical home. But the missing ingrethent in all these definitions and models remains public health. A population focus that addresses the social determinants of health is an essential component of primary health care. In the United States, such a comprehensive approach has been labeled community-oriented primary care. This model is built firmly on the Alma-Ata principles and incorporates a public health approach to health services. Community-oriented primary care organizes the delivery of health services, around a population, not simply a collection of individuals. It identifies a population - most frequently a geographically defined community - and uses epidemiology and interventions to improve community and individual health and well-being. In this model, both individual patients and the community are the foci of the delivery of health services. Primary health care stands at the intersection of personal and population health services. It requires integrating medical models of primary care...
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...MARKETING PLAN FOR ABIGAIL’S MEDICAL BILLING AND CODING Abigail’s Medical Billing and Coding Services, LLC is an accurate, timely and affordabl Here are the major elements of a marketing plan: Executive Summary: The Executive Summary should be a brief summary of the entire marketing plan and include the highlights of each section to be included in your marketing plan. It should also include your Business's Mission (or Vision) Statement. Start with your Mission Statement and use this as a foundation for the rest of marketing plan. Next, work on the rest of the plan, skipping the remainder of this section until the rest of the marketing plan is complete. Your Mission Statement should be a simple paragraph describing your company's values as well as what your company does and who it is. After the rest of the marketing plan is complete, come back and finish the Executive Summary. Product Description: The product description is the detailed description of the products and/or services that you intend to market. Anywhere in length from a few paragraphs to a few pages, use this as an opportunity to communicate your ideas regarding exactly what your product is and how your customers will use it. Market Analysis: The Market Analysis is drawn from in-house or third party Marketing Research and includes: * A description of the target market * Distribution channels with any applicable laws or regulations * The unique positioning of the company and its products...
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...From the scenario, determine one (1) key factor driving the reduction in revenue. Recommend a revenue strategy for the organization in the scenario to improve its revenue cycle management. Provide support for your recommendation. Patient Revenue Management solutions must efficiently manage the business of transforming patient care into positive financial outcomes. Clinical records must be linked with billing data to ensure proper reimbursements. Rules and embedded certifiable HIPAA 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...
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...Running head: Evaluating Compliance Strategies Assignment: Evaluating Compliance Strategies Name Axia College of University of Phoenix HCR 220 Date “Guidelines established by the healthcare staff and laws established by HIPAA are what make up the compliance process. These laws and guidelines were established to protect the patients, physicians, and staff members” (U.S. Dept. of Health and Human Services, n.d.). Errors in the office can be avoided by having a compliance process in effect. Using updated billing and coding software will help reduce errors made in the billing process. I agree with having a guide consisting of codes to aid in the billing process. I do regard this as cheating rather, to be used as a guide. Many offices currently have sheets that are located on the front of the patients’ file with the diagnosis and the code next to the diagnosis which the physician fills out. This eliminates an unnecessary step in the billing process and is a quicker, easier, and more accurate way to avoid errors. “In order to avoid rejection of the claim, it is important that the diagnoses and procedures are correctly linked” (AAFP, 1999). This also ensures that the claim is paid for the correct procedure performed by the physician. If an incorrect procedure was billed this could result in a loss of money by the physician for the type of procedure that was performed. The claim will have to be adjusted and resubmitted...
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...In the health care field the compliance process is designed to ensure the maximum benefit for health care claims. The compliance process is made up of guidelines set forth by the Health Insurance Portability Accountability Act and by the healthcare staff. These guidelines are setup to protect the physicians, patients, and medical staff. Medical offices can help to reduce errors by making sure that the staff is properly trained and that the office has updated coding and billing software. I think that each office should have a guide that consists of codes which would aid the employees in the billing process. Some offices currently use sheets that are in the front the patients file that contain diagnosis and the codes, which is filled out by the physician. This helps reduce errors in the billing process when the physician completes the code themselves. The Medicare National Correct Coding Initiative is responsible for controlling improper coding and invalid payments for Medicare claims. It is extremely important to correctly link the procedures and diagnoses so that the claim will not be rejected. When claims are rejected due to incorrect linking of the procedures and diagnoses this could result in a loss of money by the physician or the medical facility. When this error occurs claims have to adjusted and then resubmitted, which results in outstanding patient balances due to errors in the medical office. The main implication that occurs form incorrect medical coding...
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...names and different partnerships over the years; the merger of Appleton Medical Center and Theda Clark Medical Center formed Novus Health Group, Novus partnered with United Health of Wisconsin Insurance Company and became United Health Group. Finally in August of 1999 ThedaCare is born from its modest beginning as a merger of two community hospitals. But In 1997, ThedaCare was an organization facing increased competitive pressure; higher costs, lower reimbursements, and a nationwide nursing shortage. The organization encompassed 3 hospitals, physicians' offices, and a health plan. Regrettably, ThedaCare was not connected to the Internet or intranet. All organizational and business communication was conducted by snail mail, phone, and fax. Current State ThedaCare grew through consolidation and acquisition. It became a fragmented organization growing beyond its ability to operate as a cohesive unit. Its infrastructure had a disparate computer system, a disconnected care process and often-conflicting goals. The ThedaCare organization encompassed 3 hospitals, physician's offices and a Health Plan. Each hospital had its own system for registration, scheduling, pharmacy, lab, radiology and billing. Physician's offices had their own system for registration, scheduling and billing. The Health Plan system included registration, coverage and billing. It was functioning as a conglomeration of independent units. Future State ThedaCare realized its challenges and developed a business...
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...Cash Management TEST BANK Define working capital. Working capital is the difference between current assets and current liabilities. What is the purpose of working capital? It is through its working capital that a health care organization collects its funds, pays its employees and creditors and buys supplies. 3. What is the working capital cycle and why must it be managed? Also known as the cash conversion cycle- it represents the time it takes a firm to go from an outlay of cash to purchase the needed factors of production, such as labor and supplies, to the actual collection of cash for the produced product or service. The objectives of cash management is to minimize the collection period and to maximize the payment period. The working capital cycle looks at the four major phases of the inflows and outflows of cash: 1) Obtaining cash, 2) turning cash into resources and paying bills, 3) using the resources to provide services, 4) billing and collecting revenues earned so that the cycle can be continued. It is important to manage the working capital cycle in order to insure that cash is available when needed 4. Describe the two major components of a working capital management strategy? Working capital management strategy has two components: asset mix and financing mix. Asset mix refers to the amount of working capital the organization keeps on hand relative to its potential working capital obligations. Financing mix refers to how the organization chooses...
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...Compliance Strategies Medical Billing and coding compliance is very important to the billing world. Billing management starts at the first patient contact and ends only when the account has been paid in full. . In between, there are a series of important steps, each of which is critical for accurate billing and proper reimbursement. In this essay we are going to discuss the importance of the linkage code, implications of incorrect medical coding, and how physicians and payers fee are related to the billing compliance. We are also going to discuss what steps we can take to meet the compliance standards. When claims are filed correctly they will show the connection between the service being billed and the diagnosis code. The linkage code helps determine which procedure goes with which diagnosis code. If the linkage codes are not correct this will cause the claim to be denied. Linkage codes help the payer to determine the medical necessity for the service provided. Payers will determine the coverage by medical necessity. Services that are considered to be of nonmedical necessity are not covered under an insurance policy. It is important that the billing specialist be aware that different payers will have their own set of medical necessity edits. The implications of incorrect medical coding can cause issues for both the medical provider and the patient. Coding incorrectly can cause denial of claims. Providers would lose their patients trust, causing them to seek health care...
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...was established in the year 1977. United healthcare’s goal is to provide quality healthcare to all its members and better serve all the users (physicians, members, employers) with better functionality (tools, services, health benefit plans etc). Strategy Information Systems plays an important role in United Healthcare, as a implementer of business strategy and source strategic advantage/resource. The striving effort of United HealthCare is to provide public with better tools, services and products by conducting innovative research that improves the quality of healthcare and admits to user needs. United Healthcare mainly focuses on delivering quality of health care to its customers. UHC came up with a new strategy called Bridge2Health; an integrated approach which helps users to gain better health. This approach allows the physicians to know more about the member’s health information which helps them to take better decision and provides appropriate guidance. UHC started a new program which assists users in searching for physicians and hospitals depending on their specialization and rating; this reduces users time and cost. The program was mainly established to support users from not being wrongly diagnosed with poor quality care. It consists of “712,622 health care professional (physicians), 5,594 hospitals and 64,000 pharmacies [1]”. This large network allows members to choose the physicians which results in better treatment (care) with lower cost. Through its innovative approach...
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...and Baker, R.W. (2011). Healthcare Finance: Basic Tools for Nonfinancial Managers, through the four elements of financial management: planning, organizing and directing, controlling, and decision making healthcare organizations can increase revenue, lower expenses, and become leading healthcare providers by achieving their financial goals. Yet, when an organization fails to use ethical financial reporting practices, and the four elements of financial management than it becomes endanger of collapsing. The two articles that I will highlight in this paper will assist in explaining both the effects of successful financial reporting practices, and those of poor reporting practices. In the article, New White Paper Details Impact of Health Reform on Critical Revenue Cycle Issues (2013), the successful use of the financial management elements planning, organizing...
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...fragmented health care system. Cultural bias and social stigmatism have hampered the acceptance of such sweeping changes to the American health care system. Culturally some Americans feel they are handing over their health care choices to government control, socially some Americans believe that the government it reducing free trade, taking control of health care and limiting capitalism in the health care market. This argument is to disprove those stances hoping to provide an outline of what Americans should accept as reasonable ethical, cultural and social changes to a system that was, and is, still fragmented in many ways. There have been many changes to the health care system thus far, but there are many more that need to take place. It is no longer ethically acceptable to just meet the medical needs of Americans, but to pursue greater levels of standards of care practices for those in need. Ethically it is time for Americans to start to question some of the cultural and social “norms” I believe and start to be more socially responsible for themselves and others regarding the health care system as a whole. By following this outline and looking at the examples I think that many Americans would agree that this would be an easy task to accomplish, it may take us as a society out of our comfort zones, but it is time for us to change our way of thinking. Changing the System According to the Institute of Medicine’s report brief, Crossing the Quality Chasm: A New Health System...
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...Training of Health Professionals One of the most important interventions stated in the research in regards to using misoprostol for a medical abortion is comprehensive counseling conducted by a healthcare professional. This is to ensure a positive experience for the woman during her pregnancy termination (Zamberlin et al. 2012). Of key importance is having a clinic where staff are knowledgeable and skilled in misoprostol use for medical abortion, especially in settings where there is stigma surrounding abortion care, where there is minimal access to safe abortion services and where unsafe abortion is common (Billings 2004). However, multiple studies have identified a serious lack of knowledge among health providers...
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...Sunshine State Medical Billing Service Legal Issues in Business BUSI 561-D05 LUO 12/16/2011 This paper explores the legal challenges faced when forming and operating the Sunshine State Medical Billing Service. The legal issues surrounding the business will be analyzed using a business law perspective, as well as a Christian worldview. This legal business plan was prepared by Karri-Marie Baskin, Suzanne Ludikhuize, Renada Manning, Susan Schaeffer, and Dixie Wallace. Executive Summary Sunshine State Medical Billing Service’s physical location is in Tampa, Florida. Because the billing company utilizes the internet, it is able to provide services to many doctor’s offices across the United States. Sunshine State Medical Billing Service selected the Tampa site for several reasons: Low corporate and unemployment taxes, no individual income tax, large hiring base and new business incentive programs. http://www.tampaedc.com/site-selection/business-incentive.aspx; http://money.usnew.com/money/business-economy/small-business/articles/2009/01/06 Sunshine State Medical Billing Service offers the best streamlined billing service via the latest technology in the nation. Our clients are licensed doctors, who choose to use an outside billing company to act as their agent to bill and collect fees due them for services rendered. While there is a growing trend of medical billing services being offered as a home business, our clients can be assured that all of our employees are...
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...Financial Reporting Practices and Ethics in Healthcare Jeanette Jordan 03/07/16 HCS-405 Prof. Adrian Parker Abstract Financial management is a vital part of organizational effectiveness, it is a discipline with a long and respected history. Health care service delivery is a business, and the concept of financial management assists in balancing the inflows and outflows that are a part of the business. The managers within a health care organization will generally have one of three views the financial view, the process view and, the clinical view. Health care managers must of necessity interact with one another. Thus, managers holding different views will be required to work together. So, health care managers who understand health care finance will be able to interpret and negotiate successfully such interactions between and among viewpoints. (Mohamed Refaat, 2016) There are four elements of financial management planning, controlling, organizing and, decision making. In planning the financial manager identifies the steps that must be taken to accomplish the organization's objectives. Thus, the purpose is to identify objectives and then to identify the steps for accomplishing these objectives. In controlling the financial manager makes sure that each area of the organization is following the plans that have been established. In organizing the financial manager decides how to use the resources of the organization to most effectively carry out the plans that have been established...
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...Business Intelligence is becoming more constituent within an organizational structure; however, creating a successful strategy demands data volumes and a exponentially grow in an organization. As an organization demands increase so does the strategy to meet long-term and short-term visions and needs because they are an organizations foundation. Business intelligence is a formal structure that is staffed through internals from the IT and leaders. It helps define an organizations tasks, responsibilities, roles, and procedures. It helps promote an effective business by processing and supporting the organizations strategy. In this paper, I will discuss the Resort and Clinic case. The paper will discuss what was learned from the both cases. I will provide the appropriate citing that will present the reason or reasons as to why I drew my conclusion. In addition, my citing will establish counterarguments that will support my conclusion. Lessons Learned In reference to the Clinic and Resort cases they both had disconnected systems within their organizations; however both organizations can increase their costs of operation by implementing an innovative and a highly recognized business data system. Although popular and highly recognized business data systems are not considered to be the best solutions for businesses by their leadership, they are possible solutions. The inefficiency of services and the lack of continuity in business process were because of the disconnected...
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