Capstone Project - Research Paper Example

Capstone project paper Capstone project paper Several hospitals have started to incorporate risk management in their operations. The major role of the department is to make sure that the organization does not make unnecessary loss due to Potentially Compensable Events (PCE) (Felgen et al, 2004). These are occurrences that can result due to litigation against the providers in health care. Furthermore, health care providers are also forced to compensate the injured in such cases. Thus, most hospitals have occurrence report system which allows the risk managers to track down the PCE and later identify the risk areas in the organization which can be improved. Therefore, there has to be procedures and policies that should be enforced to identify common errors that which have to be reported. Error reporting should be impartial as some hospitals have started to embrace an electronic system. This allows the risk managers to receive, analyze and then review the reports online. The provision of the high-quality documentation to all the patients’ services is an important component of the risk managers program. The providers of vital health care program should clearly interpreted information can be used to judge the appropriateness of the provided information. Thus, for a good document, it should be legible and complete. The record entries must describe the outstanding situation explicitly and meet the regulations of the content and its authenticity. In this document, the signing, proper time and giving the proper date is very important (Londrigan & Lewenson, 2010). The risk managers have difficulty in handling the hospital outpatient service. The managers find it difficult to conduct duties in cases about inpatient and outpatient services. Furthermore, there is limited time between the patients and the caregivers. Thus, to control this, the managers should enforce documentation of phone numbers. Furthermore, proper documentation ensures that the patients get a better follow up service and confirm the instructions given during treatment. The phone management should be complied by HIPAA (Londrigan & Lewenson, 2010). In giving phone results proper time and proper mechanism of notification should be enforced. The hospital is faced with risk at the emergency department. The family members and the patients in this area are faced with intense stress. Furthermore, the emergency staff lack also has difficulty in understanding the stress level of their patients. The emergency department should equip the staff with customer care service in addition to the clinical assessment training. The emergency should embrace the emergence medical treatment and the active labor act (EMTALA). These laws impose a legal duty upon hospitals to stabilize and screen patients. The main aim of EMTALA is to prevent dumping of the patients who cannot pay for emergency services (Felgen et al, 2004). Thereafter, if the patient has emergency medical conditions, the hospital should stabilize this patient before transferring the patient elsewhere. The health information department is concerned by both the inpatient and the outpatient services. Thus, the leaders should ensure that training and proper documentation has been carried out. The coding specialists are responsible in controlling these services. The coders can specialize coding some specific cases, for instance outpatient coding. This is because HCPCS/CPT codes may not apply to the inpatient bills (Felgen et al, 2004). Thus, the heal information will assign the coders to help in coding outpatient coding services. Therefore this process leads to specialization which improves accuracy in the outpatient coding service. In addition, the coder in the inpatient may specialize in different service line like cardiovascular coding. However, hospitals which deal with paper records may employ supervisory level positions which handle issues that may rise from challenges of retrieving and filing a large number of records which may be required after a short period of time. Despite the rising implementation of electronics, there is less concern given to retrieval and storage functions. However, the records are very important for completeness, legal acceptability and accuracy (VHA, n.d). The health information department also deals with analysis of information and its release. In business, revenue cycle refers to activities that are practiced from pricing, selling and collection of the owners’ property. Revenue cycle is complex in hospital due to involvement of a third party. Revenue cycle in hospitals begins before rendering any service. This is acquired during patient registration and insurance identification document. Charges are captured after the patients start receiving services and at the same time clinician documentation is outlined. Lastly, record information is abstracted and later coded to produce the bill. There are some corrections made before presenting the bill to the payer. The payers receive their bills electronically. Thereafter, the receivable accounts are maintained and investigation on the third party scrutinized to initiate the payment process until the hospital confirms that it has received all the payments. This is because revenue matters are very sensitive as the managers have the expertise to alter some important details (Fox, 1997). The clinical documentation improving programs are very important in the revenue cycle and the HIM professionals have the ability to code it accurately. The patient’s bill in the ambulance service is generated automatically to the service chargemaster. A health officer can also work with the patient financial service to and supervise the movement of the chargemaster. This ensures that the HCPCS codes are actually added then changed or at time deleted appropriately (Fox, 1997). Another factor considered is that accurate procedures are adhered. Among other duties is working in liaison with other departmental heads to ensure proper pricing is acquired. The health information manager may work with the patient financial service to help investigate the rejected claims. Financial area is also responsible for charge capture analysis. It is aimed at reviewing the outpatient charges in ensuring that accurate and complete charges are provided. Furthermore, there are other roles which health information managers may play in a hospital setting. For instance, the performance improvement where health professionals can collect, analyze and report data. Some hospitals the health information management professional acts like the director to the performance improvement. They may also utilize the management, the medical staff and other vital areas in the hospital (Felgen et al, 2004). Therefore, hospitals should merge with other healthcare facilities. It should also incorporate ambulatory services and increase the complexity of the hospital care. More hospitals should embrace internet usage in their operation. In addition, there has to be an increased scrutiny given to payment issues and coding through auditing initiatives (Fox, 1997). Generally hospitals offer varied services like the ambulance, surgery services, emergency services and partial hospitalization. In addition, several health care officers help in the provision of patient care. Thus, hospitals have their regulatory body which controls their operations. References Felgen, J et al. (2004). Relationship-based care: a model for transforming practice. Boston: Creative health care management. Fox, D. (1997). Home-base care for a new century. New York: Wiley-Blackwell. Londrigan, M & Lewenson, S. (2010). Public health nursing: practicing population-based care. New York: Jones & Bartlet publishers. VHA. (n.d). It’s time for a hard work at your revenue cycle. Retrieved from https://www.vha.com/AboutVHA/Offices/WestCoast/documents/WC_RCM_Brochure.p df Read More