Concepts in Healthcare Organizations

Step 1: Put the following steps in the order of a routine patient care flow, from the beginning through to the end of the patient encounter flow. 

• New patient paperwork is signed and returned to front desk with insurance information for verification of benefits
• Patient pays standard co-pay if applicable
• Hard copy record is pulled, or made if new patient
• Patient called to back office
• Height, weight, and blood pressure taken by CNA or CMA
• CMS 1500 form is coded and sent to insurance for reimbursement
• Signs in at reception desk
• Patient released from exam room
• Call in to schedule appointment
• Doctor, NP, or Physician’s Assistant examines patient
• Shown to patient care room
• Reason for visit reviewed with patient by CNA, CMA, or NP
• Any refunds due to patient or insurance sent out
• Collections efforts initiated if patient's charges not paid, and any insurance appeals are processed
• Patient checks out and pays any deductible verified
• Explanation of benefits returns with breakdown of payments
• Height, weight, and blood pressure taken by CNA or CMA
• Practice manager applies payments, writes off amounts required by contract with insurance companies, adjusts patient’s account records, and initiates billing to patient that indicates insurance has processed charges

Step 2: Write an essay of 1–2 pages explaining how a new office would be set up or organized. Some of the elements included could be: 

• The physical appearance of the office
• The types of personnel that would be needed
• The types of activities, policies, or procedures that would be put into place to mentor employees and promote teamwork
• Create and describe the demographics of the patients that would receive care at this facility. 
  • Remember that demographics include any and all of the following: type of population (rural, suburban, urban); male or female; adult or child; type of insurance, public assistance, or no insurance; emergency care needed or preventative care; and many others.
• Describe the specialized training that you, the office manager, need to help this particular facility accomplish its mission of efficient integrated medical care to its patient population.