Finished Draft

Alycia Albers

PHASE 4 BD

CTU

9/15/2014

The healthcare system

This is a not-for-profit health care system which has been committed to provision of the patent care, teaching, research as well as the desired care services to the community locally. The institution has an innovative and quality care services to ensure that it provides the desired service and ensure improved quality as well as efficiency of the services (Nass, 2009). The main aim of its existence is to cover the gap that is available in the community and provide the kind of services that have not yet been provided. It also intends to reach out and give cheaper services to the low income people and even the people with disabilities.

Organization structure

This health system is the organization whereby the medical leaders get actively involves in the ways that it delivers the healthcare to its communities. There is strong physician participation at all the levels. As they partner with the nursing department, it allows for the focus of best practices which are intended to promote the superiors quality and services. The institution physicians usually serve on Board of governors as well as Board of Trustees and thus pretty much engaged in the governance of the health system (Fordney, 2013). In the entire organization, the operations are normally operated through the joint administrative partnerships. In all functional area, there is a manager which reports directly to higher management levels.

The process of checking patients in and out

In the healthcare system, there has been provided with the patient check in-check out module which is meant to reduce the time that should be taken to check the patients in and out. The staff will be informed on all the important details of the patients before they get to see the doctor. It is an electronic system which first involves checking in through updating mini registration (Wu & American Bar Association, 2007). For the new patients, Patient Intake Form and practice management software will auto-fill all the data that the patient has provided. The second step will be to print 5 labels and then enroll the particular patient for the care. Any outstanding bills as well as missing documents will be identified. Then the patient is supposed to report for their appointment. After seeing the doctor, any new information will be updated on their profile. The patient is then checked out after all services are provided.

Scheduling patients

The first thing will require arriving in advance of the time to do everything that needs to be done before the arrival of the patients. The next thing will be to determine the average time that it takes for the doctor to see another patient together with the time it takes to have the follow-up patient. The tests and procedures will also be used to determine the time and that the patients need to leave for home (Blesi & Kelley-Arney, 2012). It should all be simple and also patient-centered.

Community and patient resources

The healthcare institution has been able to offer various resources for the purpose of helping out its patients as well as community and ensure that they are living well. For some of the patient resources, the organization provides a high quality care at a discounted fee particularly for the low-income and the uninsured persons. There are clinics set at many places in the community to ensure cover of the medical appointment, the dental appointments and any urgent care (Fordney, 2013). In addition, the organization frequently organizes health and wellness events and provides the emergency preparedness resources.

Process of interacting with patients

It is recommended that the CMAA staff should begin the communication by greeting the patient. At that stage they are required to make proper introduction of themselves, the job title as well as the duties that will be related to their care. The staff will be required to explain to the patients the whole process that entails their care and enquire whether they are comfortable with the process (Nass, 2009). All the patient queries will then be solved and the staff will be expected to behave confidently as well as professionally for the purpose of making the patients feel at safe hands. Every staff member will be able to get a procedure manual to guide anyone in performing the procedures that they might not be sure about. Before any beginning, it is advisable to check on the resident’s armband to avoid asking the patient for their identity.

Health insurance plans

Along with the healthcare services that the institution has been providing, it has partnered with insurance company to ensure that it presents some insurance plans for patients together with their families. Some of the areas that the organization provides the health insurance plans on ranges from vision, medical, dental insurance to life insurance (Keir & Keir, 2008). With its partnership, the institution strives as hard as possible to ensure that it has provided the most affordable options as well as the personalized support which will ensure healthy and safety of the patients. It is also within the duty of CMAA staff to make proper verification of the patient’s insurance.

Financial procedures related to the policies of the organization

When a patient has arrived, it will be the duty of the CMAA staff to ensure that the patient has completed to form all necessary paperwork and then is supposed to input the newly created financial record. The patient before being allowed to get the physician service then should provide a receipt on payment for the services which then will be updated on their account. The CMAA should be able to specify the payment methodology that has been used by the patient. The organization’s policy is to ensure that every member of staff handling the patient’s payment information has done so effectively. The organization wants to ensure that all proper controls have been put in place as well as utilized (Blesi & Kelley-Arney, 2012). The policy requires the employees to specifically know who will be handling certain monetary responsibilities. Employees need to be familiar with the policies for handling any income, expense, documentation, and payroll as well as the financial reporting and statements.

Clean claims

It is among the many duties of the CMAA worker to ensure that for the claims filled, they are clean claims. At the institution, the main goal is mainly to process all the claims during the initial submission and it should be complete claim for the purpose of submission. The workers therefore are expected to verify, file as well as keep all the transmission reports and make use of the original claims forms only. The workers should always avoid any folding of claims as much as possible. The handwritten claims should never be submitted. Uppercase letters should always be used and the claims are required to be printed darkly (Rimmer, 2010).

Financial procedures

The financial procedures that are related to the institution’s cash flow involve the payments made by the employees. The post patient payments usually get recorded in the patient’s accounts. This then should be followed by the follow-up claims. The person in charge needs to determine any unpaid status of the unpaid or any late payments mostly those from health insurance. After the collection of the payment, the accounts receivable will be debited on the organization’s account (Keir & Keir, 2008). The cash flow is also significant in determining the amount of cash that is needed to run the operations.

Billing policy and procedures

CMAA has the responsibility of ensuring that all the claims have been submitted accordingly. They are required not to bill the member until they have properly received the explanation of benefit. Deposits should not be expected before covering all services. The CMAA should be able to make payment for the purpose of crediting all necessary accounts (Rimmer, 2010).

Protecting patients' privacy

As a healthcare worker, CMAA should be able to provide necessary measures so that they can protect any patient confidentiality at all times. The patients have the right of authorizing the release of their health information (Nass, 2009). For the purpose of maintaining the confidentiality, they should be able to confirm the identity of the patient at their first encounter. The patient’s case can never be discussed with anyone else without the authorization of the patient. The hard copies of the records should not be left in a place that an unauthorized person might have an access to them.

Accounting and bookkeeping procedures and processes

Just like any other institution, this organization makes use of book keeping for the purpose of tracking its business expenses. The proper documentation clearly shows effective debiting as well as the crediting procedures. The healthcare institution also makes use of balance sheet to determine its financial position. It also makes use of income statement to know the performance of the business and determine what could be done. The organization has an accounting system that should facilitate recording, classification as well as the summary of the financial records (Blesi & Kelley-Arney, 2012). The process should involve review of transaction a period of time, proper entry, any post transactions, confirmation of trial balance, then proper adjustments and the preparation of the balance sheet together with the income statement.

Office procedures for forms of documentation

Documentation should be realized to be the most important procedure in the assigned work. There are five steps that the employees are required to follow to ease on the pressure of documentation. The first step requires assembling the proper tools for the job. The next step is to track all the tasks for a number of days. This is followed by documenting the most important five procedures (Rimmer, 2010).After that it requires identification of what is to be included in the procedure binder. The last step is organizing the procedure binder.

HIPPA rules and regulations

HIPPA has been created with the efforts if protecting individuals that are covered by health insurance and also setting standards for storage as well as privacy of the personal medical data. The HIPPA privacy rule has provided federal protections for the personal health information that is held by physicians and it also gives patients array of rights in respect to the information (Fordney, 2013).

HIPPA forms

There are number of documentation and forms that are HIPPA elated. These forms include first, the patient related form which represents all the information about a certain patient as well as any information that is useful in the organization. It also includes the staff, volunteers as well as observer forms which are meant to contain information that revolve around the organizational staff and outside parties (Fordney, 2013). Lastly, it includes the Data sharing, business as well as the contracting forms.

Advance directives

These as used in the healthcare system are the living will that allows one to document their wishes which concerns their medical treatments come the end of life. The CMAA should help individuals in making the right decisions for their will and also determine whether they are in a good state of mind to make the decisions (Rimmer, 2010).The emergency medical technicians cannot and should not honor the living wills or the powers of the attorney.

Medical record responsibilities

In the organization, it is recognized that every individual is an individual that has unique healthcare needs as well as wishes. Since the employees deal directly, they need to have knowledge of the modern equipment, the ability of maintaining records as well as files, interpersonal skills and even the ability to maintain the patient confidentiality (Wu & American Bar Association, 2007). Further, it is required that the employees respond to all the requests for the medical records which might involve processing letter as well as reports and also keeping the supervisor informed on any problems and issues.

Obtaining patient demographics and their insurance information

The staff needs to be able to fill the patient demographic sheet and ensure that all the basic demographic information has been put into the sheet accurately. Should ensure it has information on the; name, date of birth, doctor information, sex as well as the social security number among others (Keir & Keir, 2008). The patient’s insurance coverage should be verified way before the services have been rendered. For any claim creation, the process has to start with the entry of demographics and then followed by the insurance verification.

Receive, triage and route phone calls

The CMAA should receive, triage as well as route to the appropriate team members in all the incoming calls and place the outgoing going calls. All calls should be answered the soonest time possible and with a smile on the face. For triaging calls, there will be a manual placed near every phone mainly for reference (Nass, 2009). In routing the calls, it is advised that the staff be aware of where the calls should be send.

Reviewing records for medical necessity

In order to address all the complaint claims, the CMAA will be required to review the medical records of patients to establish any additional documentation which could help prove the medical necessity. It should provide an explanation to the medical necessity and thus know the proper course of action (Rimmer, 2010).The CMAA should be sure to make proper reviews for the purpose of avoiding any errors in determining the medical necessity. This will ensure that the payments have been made solely for the services which meet the medical necessity requirements.

Release of information guidelines

Standards have been set by HIPPA that every healthcare institution should follow to safeguard the patient privacy as well as confidentiality. Therefore, information regarding a certain patient will only be released if it has been included in hospital’s directory and when the patient has not made any specifications that no information shall be released (Fordney, 2013). All the inquiries should identify the particular patient by name, together with the information on the patient’s general condition as well as information location of both the inpatient and outpatient and will only be released when there is proof that the inquiry has identified the patient by their name.

References

Blesi, M., Wise, B. A., & Kelley-Arney, C. (2012). Medical assisting: Administrative and clinical competencies. Clifton Park, NY: Delmar, Cengage Learning.

Fordney, M. T. (2013). Insurance handbook for the medical office.

Keir, L., & Keir, L. (2008). Medical assisting: Administrative and clinical competencies. Clifton Park, NY: Thomson Delmar Learning.

Nass, S. J., Levit, L. A., Gostin, L. O., & Institute of Medicine (U.S.). (2009). Beyond the HIPAA privacy rule: Enhancing privacy, improving health through research. Washington, D.C: National Academies Press.

Rimmer, M. M. (2010). Coding basics. Clifton Park, NY: Delmar Pub.

Wu, S. S., & American Bar Association. (2007). Guide to HIPAA security and the law. Chicago: ABA Section of Science & Technology Law.