Compliance plans relate to medical records in making sure that all patient Information is recorded correctly. They, also, relate to medical records by ensuring the correct diagnosis and patient care is outlined in the medical record as described in step four of the billing process. A medical record is a legal document which records a patient’s health information. It must be kept current and accurate by the physician and staff to prevent any lawsuit and to provide the
Vitals, symptoms, diagnosis, prescription, and post care are all significant information that must be noted to ensure that the patient’s insurance company know what they are paying the doctor for. This information is documented in a form of codes that are transported to the insurance company for payment. It is important to make sure that the proper code are recorded to avoid confusion on both ends. Inaccurately coding can lead to false claims which can eventually result in non-payment from the insurance companies. To ensure there are no errors, remaining organized and up to date on coding information is expected.
This is an important aspect for physicians to understand because medical misconduct may prove to be detrimental to their career. Identifying the civil complaint process for patients or consumers used in the event of suspected professional misconduct or incompetence provides a clear understanding of how the consumer files a complaint of a physician. Explaining the role of the respective regulatory agency in investigation of allegations, determining, and applying any appropriate disciplinary action present an explanation of how misconducts are held accountable in the health care industry. Identification of potential criminal liabilities for physicians related to abuses perpetrated in practices involving these issues as well as misconduct emphasize why physicians must treat patients adequately in the proper manner. The appropriate risk management strategies and quality assurance programs that offer in reducing the risk of liability and negligence are of value to many organizations.
It is the responsibility of all health care employees’ to take care of patients. Management and leadership have to be careful with confidentiality, this one of the important ethical issues in the medical field. Confidentiality is protecting patient’s information which is private and personal, and the conversation between doctor and patient. Management need to make sure patient health information is secure and the conversation between patient and doctor is safeguarded. For most hospitals manage, leaders, doctors, nurses are concerned about communicable diseases from patients, especially if the medical staff cannot obtain medical records.
When the patient is a member of a MCO and the physician has signed a contract with the MCO that has a clause that says, “For quality care purposes, the MCO has a right to access the medical records of their patients, and for utilization management purposes” The MCO has a right to audit those patients’ financial records. b. Communicable diseases that are highly contagious or infectious state health agencies require providers to report them. c. When a medical device breaks or malfunctions the FDA requires to notified d. When a patient is a suspect in criminal investigation to assist locating a missing person, material witness, or suspect police can request certain information. e. When records are subpoenaed are there is a search warrant, courts can order the release of patient information. f. When the patient is suing someone and wants to protect themselves.
Evaluating Compliance Strategies; Week 7 The process of compliance in the medical field is set up by an established set of guidelines produced by HIPAA. These guidelines are put into effect in order to protect all employees, physicians, patients, and other professionals in the health care industry. Having a process for compliance assists in making sure as few errors as possible occur during the process of billing. Personally, I see these compliance codes as an excellent method of performing accurate work. In many physicians’ offices now days, it is common to find compliance codes on the physical form that is filled out by the physician.
Ideally, a good care system for patients includes medical professionals as well as friends and family to compliment each other in providing for patient needs. Because patients require care from medical professions in hospitals, there are provisions that the hospital must follow. “Compliance means conforming to a rule, such as a specification, policy, standard or law. Regulatory compliance describes the goal that corporations or public agencies aspire to in their efforts to ensure that personnel are aware of and take steps to comply with relevant laws and regulations (Compliance and Regulatory Compliance, 2013)”. For this reason there are terms of compliance that hospitals must adhere to.
Any medical changes must be documented on a record sheet, marked on the meds chart, and passed over by hand in the communication book. This is especially important so no errors are made with any meds. 2. Good communication in the work place is essential both between the staff team and the service users. If the staff team are not communicating properly mistakes can happen and this can lead to arguments between the staff members, the team and external health providers, ie doctors, chiropodist.
If a client is not feeling well it is essential that they are able to convey this to you. Co-workers - Communicating with other staff members ensures effective team working and continuity of care. It also ensures any health and safety issues are recognized and reported. This can be done face to face or in the client’s daily recording file. Doctors – If we take a client to the doctors it is essential that we are able to inform the doctor of any relevant information required otherwise this may result in a misdiagnosis.
This would ensure that the account has a clean A/R at the time of the medical billing process. They would in addition, study claims rejected by carriers, low fees from the carriers, and clearing house rejections. Calling and compilation are other services which we incorporate into our AR collections solutions. If the patient is responsible for any payment including deductibles, we will make the necessary calls to the patient to collect the amount following