...Compliance and Coding Management Task 2 Western Governor’s University Compliance and Coding Management Task 2 A. Outline a HIM compliance plan that emphasizes the coding function by doing the following: 1. The necessary components of a compliance plan include Code of conduct, policies and procedures, education and training, communication, auditing, corrective action and reporting. The code of conduct is a statement or oath that establishes the intent to perform duties lawfully and ethically. The second component of a plan would include policies and procedures. The policies and procedures for coding would cover items such as how and when to query a physician, acceptable documentation sources, how to rebill a claim, usage of coding guidelines, payer specific issues, and any additional gray areas that may arise in the coding function. Education and training processes must also be outlined in a HIM compliance plan. This would need to identify the number of mandatory CEU’s for each employee, new hire training guidance and requirements, as well as physician and clinical staff educational guidelines and processes. The HIM/Coding compliance plan should also include policies and procedures that address communication, the auditing/monitoring process, any necessary corrective action steps and finally the process for reporting the coding compliance steps that have been followed and any areas identified as risks or any findings of noncompliance. 2. The HIM director...
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...#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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...Correct Medical Billing and Coding in the Healthcare Industry Medical billing and coding is one of today's topics. When services are billed for patients, they must be coded based on the documentation the physician has dictated in the patients chart to receive payment from the insurance company. As the physicians office and/or hospitals practice correct medical billing and coding, this will prevent audits being brought forth in their practice and/or hospital. Kenny, Christopher,Correct Coding for Dialysis Billing Providers must ensure proper coding to avoid returned claim, 2012. This article is geared for those in the medical field who do coding and billing in hospitals for dialysis. The author is educating the coders and billers how to correctly code for dialysis billing. He mentions that The Centers for Medicare and Medicaid, issued a transmittal that has revised the Medicare claims processing manual as it pertains to hospitals billing for dialysis procedures that are non covered under the ESRD benefit for emergency dialysis. In addition, the author discusses how the hospitals should utilize Healthcare Common Procedure Coding System billing code G0275 and code 90935 for hemodialysis. Only to bill G0275, if the hospital is a ESRD facility, emergency services, and when dialysis is performed with related procedures, such as a vascular access procedures or when performed following treatment for an unrelated medical emergency. The author also continues to...
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...Samantha Smith Need for Teams Background Goals and Objectives: The objectives for the first years of operation include are to include creating a medical call center that will be improved and have better customer service as well as exceeding the patients' expectations. Our agents will provide high-quality healthcare advice, products or assistance to residents of the area. We will serve our community’s needs. Forming a health care facility that fully capable to survive on its own cash flow within 10 months or less. To increase the number of call volume by 50% per year through improved customer service. To establish a creative website that includes online booking capability, as well complete information about the practice, hours, demographic information, health information and much more Mission The mission of the call center is to create the health and wellness of the local people by providing them with access to high-quality medical care for people young and old. The center is committed to providing these services exceed the expectations of each our patients, resulting in a successful and respectable business. Keys to Success Patients are the key to making the healthcare function. The call center main focus is on patient care. Educating the patients on the importance of preventative care helps prevent other diseases from taking over their bodies. Giving the patient their yearly checkup allows the doctor to discover if they educate patients. Figure out ways to inform your patients...
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...Group 1 Team Assignment CSEC 630- 9026 Jeff Daniels Written by: Kevin Alton, Nadia Iqbal, and Alex Polevoy July 2015 Table of Contents Introduction.…………………………………………………………………..………….3 Section I: iTrust Threats & Vulnerabilities and Countermeasures.……………..…………..3 Section II: Recommended Changes to Security Management Policies………...……………..7 Section III: Adaption of Requirements to Reduce Security Risk……….……………....…......11 Conclusion. …………………………………….…………………………………….…21 References ……………………………………………………………...………………23 Introduction There are multiple benefits of electronic health records (EHR), which include improved care, quicker access to patient files, and increased physician oversight of care. However, with the benefit of convenience of using EHRs, comes the responsibility of protecting electronic protected health information (ePHI) and safeguarding sensitive patient data. The Health Insurance Portability and Accountability Act (HIPAA) focuses on protecting ePHI with guidelines to ensure organizations have implemented “reasonable and appropriate” security measures to adhere to HIPAA rules and maintain patient confidentiality. HIPAA requires covered entities to conduct risk assessments to verify compliance and attempt to uncover areas where ePHI is at risk of...
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...Implementation Guide for the Use of Bar Code Technology in Healthcare Sponsored by Implementation Guide for the Use of Bar Code Technology in Healthcare © 2003 HIMSS 230 E. Ohio St., Suite 500 Chicago, IL 60611 All rights reserved. No part of this publication may be reproduced, adapted, translated, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. HIBCC ® and HIN® System are trademarks of the Health Industry Business Communications Council. ISBN: 0-9725371-2-0 Table of Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .vii Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xi Chapter 1: The Basics What is a bar code? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 How can you benefit from bar coding? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ...
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...Jenny Windler Student ID: 000329547 Accreditation Audit (AFT2) Task 1 A. Compliance Status Nightingale Community Hospital is a complete and leading healthcare facility that believes in providing the best quality care to all of their patients. As part of Nightingale’s mission to put the patient first, the hospital must meet medication management standards set forth by the hospital and the Joint Commission. Medication management often involves the efforts of multiple services and disciplines. It is part of Nightingale’s policy that a patient’s information is accessible to a physician, pharmacist or nurse in the management of a patient’s medication. Nightingale Hospital has all the policies in place that the Joint Commission looks for to keep the hospital accredited. A1. Plan for Compliance In reviewing the safety of using medication associated with Anticoagulation Therapy, Nightingale Hospital needs some improvement. There was only one month out of the year that patients did not experience any adverse effects related to Anticoagulation Therapy. Numbers were high at the beginning of the year and tapered off by the end of the year, but Nightingale Hospital should be experiencing more months where there are no adverse events. In combination to the Joint Commission’s finding 2 years ago regarding the lack of documented evidence that the patient’s ability/readiness to learn, learning preference, or educational needs were assessed and documented in the file, we have much...
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... Widespread use of health IT within the health care industry will improve the quality of health care, prevent medical errors, reduce health care costs, increase administrative efficiencies, decrease paperwork, and expand access to affordable health care. It is imperative that the privacy and security of electronic health information be ensured as this information is maintained and transmitted electronically. (US Department of Health and Human Services, n.d.) As a health information technician career opportunities exist in: doctor offices, medical facilities, hospitals, insurance offices, pharmaceutical companies and labs. (Associate of Applied Science in Health Information Technology, n.d.) Health information technicians have multiple duties/task that are done. The following are some of the duties that I’ve learn that health information technicians have to do: * Review patient records for timeliness, completeness, accuracy, and appropriateness of data. * Organize and maintain data for clinical databases and registries, * Track patient outcomes for quality assessment, * Use classification software to assign clinical codes for reimbursement and data analysis, * Electronically record data for collection, storage, analysis, retrieval, and reporting, and * Protect patients’ health information for confidentiality, authorized access for treatment, and data...
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...------------------------------------------------- Task 1: Organization and Leadership Analysis Table of Contents Organization Overview 3 Organization Description 3 Leadership Practices 4 Relationship Between Leadership and Organizational Culture 5 SWOT Analysis 7 Organizational Strengths 7 Organizational Weaknesses 7 Organizational Opportunities 8 Organizational Threats 8 Leadership Evaluation 9 Leadership Strengths 9 Leadership Weaknesses 10 Recommendations for Leadership Development 11 References 13 Organization Overview CHRISTUS Santa Rosa is a well-known hospital system located in San Antonio, TX. Their key mission is about taking care, in all senses of the phrase, of people. I have selected Claudia Trevino, manager of the Revenue Integrity department, to analyze for the purposes of this document. I chose this leader because she constantly demonstrates strong leadership skills as well as compassion, a very important value to our hospital. I hope, by the end of this, that I will be able to understand, on a deeper level, what it means to truly serve the community, to be a great leader, and how to successfully maintain the work-life balance. Organization Description Since its early beginnings in 1869, founded by the Sisters of Charity of the Incarnate Word, CHRISTUS Santa Rosa has made it their mission "to extend the healing ministry of Jesus Christ," and do so by offering their medical services to communities all over the city. The...
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...Health Care Delivery Systems Ja*** Sta***** 04/12/2011 Health Care Delivery Systems Exam Paper The challenges faced in our most extreme healthcare facilities The Dialysis, Correctional, Mental Health, and Substance Abuse health care facilities are four very diverse settings in many ways. Yet in others they are similar. They represent many of the aspects of society that are orphaned, discarded, or swept under the rug, challenging both the caregiver and patient alike. Each represents an environment of extremes. Professionals must exercise the highest degree of vigilance in order to successfully provide patients with the care they need under the unique circumstances that each environment presents. In many ways each one of these facilities has a captive cliental with little or no choice but to be compliant or face dire consequences. In the dialysis setting compliance is enforced by the simple fact treatment is necessary to maintain their life. The correctional setting is harsh and restrictive with many imposed limitations, presenting the potential for serious health risk to inmate and care provider alike. The mental health facility is challenged by the lack of stability within the mind of the patient who is viewed as having “disordered thinking” presenting healthcare providers with the challenge of helping someone who is unable to follow orders or unwilling to even be treated. Substance abuse facilities have a patient base of substance dependent clients who present many...
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...Healthcare Fraud and Abuse Under HIPPA, “fraud is defined as knowingly, and willfully executes or attempts to execute a scheme… to defraud any healthcare benefit program or to obtain by means of false or fraudulent pretenses, representations, or promises any of the money or property owned by…any healthcare benefit.” Unlike Fraud, abuse is, “means that are improper, inappropriate, outside of acceptable standards of professional conduct or medically unnecessary.” Health care fraud arises from an individual or group of individuals filing of a dishonest health care claim in order to turn it into a profit. Abuse; however, is harder for the investigator to identify and establish if the act was committed knowingly, willfully, and intentionally. Healthcare industry is one of the fastest growing sectors of the US economy; almost 10% of the US’s national GDP is consumed by the health care industry. According to Forbes’s report, the US National Healthcare expenditure of 2012 was nearly $3 Trillion. According to the National Healthcare Anti-Fraud Association, nearly $60 Billion is lost to healthcare fraud each year. The healthcare industry is an enormous market; therefore, making it easier for healthcare providers to take advantage of the American population. This paper will focus on why fraud and abuse occurs, different types of fraud, example cases of fraud and abuse, impact to present day healthcare industry, and potential solutions to fixing and preventing fraud and abuse from occurring...
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...Introduction: There are a lot of abbreviations used in the United States health care delivery systems. A list of some of these abbreviations that are used by physician’s offices, hospitals, nursing homes, and other ambulatory care services are listed in this paper. 1. AMR - The definition of an Automated Medical Record, otherwise known as an electronic medical record, has been set forth by the 2003 IOM Patient Safety Report as the: • "collection of electronic health information for and about persons" • "provision of knowledge and decision-support systems [for] support for efficient processes for health care delivery" • "electronic access to person-and population-level information by authorized users" ("Definition Of Automated Medical Record", 2012). 2. CMR – According to "Mortality Frequency Measures" (2012), Crude Mortality Rate. The Crude Mortality Rate is the mortality rate from all causes of death for a population during a specified time period. • Mortality rates measure the frequency of occurrence of death in a defined population during a specified interval. • There are several specific kinds of mortality rates, but we will focus only on the ones that are used most often in infectious disease epidemiology. • To calculate a simple mortality rate, we need to know the number of deaths in a given population during a specified time period, and the size of the population in which the deaths occurred...
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...Information Management Compliance. Felicia Ntow Western Governors University Information Management Compliance The hospital’s plan for information management encompasses the full spectrum of data generated and used by the organization in all various departments from housekeeping, laundry services, imaging, and pharmacy through to nursing. In order to provide cost-effective quality services, information must be accurate and communication of the information should be securely transmitted in a timely manner to the appropriate individuals on a need to know basis. Compliance Status The Nightingale Community Hospital current compliance status is not meeting the standards of the Joint Commission. RC.01.01.01 The hospital has just an admission orders form that does not define the components of a complete medical record. The admission orders form does not contain the unique patient’s identification. It has just the patient name, and two or more people may have the same name. Wrong patient identification may be one of the reasons why there have been errors labeling patient specimens. Although there is a place on the form to identify consults, there is no justification for the consult on the patient’s chief compliant and no admitting diagnoses recorded. The medical record on hand does not contain information needed to justify the patient’s care, treatment and services. For example, there is no reason given for intake/output nor is there route for the intake...
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...MGIS 301- Management Information Systems 2D Matrix Barcodes in Pharmaceutical Industry Group Project Abstract Team members: Begüm Ekinil, Ezgi Tuğçe Demir, Gözde Şener, Lukas Hrban, Nurgül Karataş, Tolga Akgündüz, Zeynep Hazal Özuslu In general; barcodes are used for data transfer in various industries. As the years go by barcode technology developed and it is still improving itself. One of the major and the most beneficial improvements in barcode technology is 2D matrix barcodes. These items contain much more informational characters than the line barcodes do. There are several applications of this improved system. Tax returns, packing list, driver’s licenses and patient record are the major areas in which 2D matrix barcodes are implemented. Since data matrix codes contain details of component such as manufacturer ID, part number, unique serial number and expiration date, in pharmaceutical industry using such barcodes would increase productivity by reducing time spent in pharmacy and prohibiting fake drugs. 2D matrix barcodes are one of the informational technology masterpieces that make the life easy. The wideness of subject and its improvement trend are the two main reasons behind our choice. Also we specified the project for pharmaceutical industry because 2D labeling technology has remarkable benefits for pharmaceutical purposes. First of all 2D labeling provides additional information coded in the label to allow for supply chain control. Second, pharmacy...
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...Accreditation Audit AFT2 Task 1. Herman Big Mawanda Western Governors University Contents COMPLIANCE STATUS. 3 PLANS OF COMPLIANCE 7 JUSTIFICATION 8 BIBLIOGRAPHY 10 Nightingale Community Hospital provides leadership in quality health services. Its core values focus on safety, community, teamwork and accountability with a vision of being a hospital of choice for all and a mission to create a healing environment with a passionate commitment to health care excellence. This executive summary of the accreditation audit is presented to the senior leadership to outline the compliance, plan of compliance and institution of the hospital under the reviewed focus area of Information Management as per the Joint Commission Standards. COMPLIANCE STATUS. The Joint Commission Standard IM 02.02.01 requires that the hospital effectively manages the collection of health information. Nightingale Community Hospital is in compliance with this standard under its patient care policy which specifies prohibited abbreviations. Its policy states that the use of abbreviations and symbols in the medical record is discouraged to prevent errors; as these can be associated with misinterpretation resulting in medical errors, and patient harm. In case the intended meaning of the abbreviation or symbol in the context of a specific order is not clear, the ordering practitioner must be contacted for clarification. This procedure demands that the elements of performance under IM 02.02.01 of the...
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