If a facility fails to comply with the compliance plan they could face lawsuits from patient’s or fines from government agencies. Different facilities maintain different compliance plans, but the each are in place to ensure the facility maintains patient privacy in accordance with various laws and regulations. Each individual step in the medical billing process plays a major role in the facility following their compliance plan. The medical billing steps that relate to compliance plans are steps five through seven. These individual steps are reviewing coding compliance, check billing compliance, and prepare and transmit claims.
This paper will address the foundational frameworks of QI, the various stakeholders’ definition of quality, the various roles of clinicians and patients in QI. This paper will also address why quality management is needed in health care industry, accrediting and regulatory organizations involved in QI. The Foundational Frameworks of QI The foundational framework of QI is a continuous process that focuses on multiple relationships such as implementing improvements and improvements in processes. Some areas that organizations may concentrate their improvement efforts on are the reduction of medication errors, reduction of emergency room wait times or clinical measures such as breast cancer screenings or HIV testing. Walter Shewhart developed the Plan, Do, Study Act cycle used as the basis for planning and direction performance improvement efforts (Ransom, Joshi, Nash, & Ransom, 2008).
The purposes of electronic medical records are for assisting professionals in the healthcare to store and share patient information across disciplines as well as across facilities. Electronic Medical Records are used by “professionals including different levels of providers because they can be assessed from different locations simultaneously, diagnostic images can be viewed from various locations allowing for continuous of care use electronic Medical Records in the health care systems. Electronically stored client records provide quick access to clinical data for a large number of clients and it has prompts to ensure that key information is noted as well as reminders of when labs and vaccines are needed.” (Hebda & Czar, 2013, p. 28). Electronic Medical Records “enable nurses in their varying roles across the continuum of care to create a single narrative for each patient, tracking progress from admission through discharge and within ongoing care in the ambulatory environment.” (Deese & Stein, 2004, p.337) Deese, D., & Stein, M.
Perhaps the research could be actively going out and speaking to someone receiving care, whether it is in a care home or a hospital they need to find out what the patients really want from the health carers. Highlight
The Patient Safety Indicators (PSIs)- The PSIs are a set of quality measures that use hospital inpatient discharge data to provide a perspective on patient safety. Specifically, the PSIs identify problems that patients experience through contact with the health care system and that are likely amenable to prevention by implementing system level changes. The problems identified are referred to as complications
("Health Information Privacy," n.d.) When a patient enters a healthcare facility they have the right to be notified of the privacy practices within the healthcare facility. A patient can request that the healthcare provider take extra steps to ensure the
It provides statistics on volume as well as financial costs of such errors. It investigates the possible contributing factors that lead to medical errors. The report attempts to simplify steps that can be done in order to reduce errors and improve quality in healthcare. It concludes by providing information on approaches all ready being considered in order to fulfill the goal or reducing medical errors. The Institute of Medicine functions under a congressional organization through the National Academy of Sciences.
The privacy rule covers protected medical information. Protected health information is personally identifiable health information that is held or communicated by a covered entity in any form such as paper, orally or electronically (HIPAA frequently asked questions, n.d.). This identifiable information includes some identifiers such as name, data of birth, address, social security number and other information that can be used to identify a person (HIPAA frequently asked questions, n.d.). The privacy rule applies to a laboratory because any protected health information received by the laboratory is safeguarded. Any information created by the laboratory is also protected.
Medical Billing and Coding Each time a patient receives medical care, the physician or other health professional must document the services that are provided. Since each of these encounters is unique, the medical coder assigns alpha-numeric codes that are specific to the patient’s symptoms and diagnosis and identify each procedure and other service performed. This series of codes provides the insurance carrier with a detailed account of the encounter and ensures that providers are correctly compensated for their services. These codes are also important for making critical clinical decisions and for statistical research and health planning analysis. There are several different career opportunities available to choose from and these
Some portals are modules that are added onto an electronic health record system, while others are used as stand-alone websites, and others are integrated into the existing website of a healthcare organization. These applications, modules, or websites are used by the patients of healthcare organizations to gain access to their personal health information. In order to access their personal health information, the individual has to set up a username and password. After they have set up their username and