HCM621-0804A-01 Ethics, Policy, and Law in Health Care Management - Phase 3 Discussion Board 2 - Essay Example

HCM621-0804A-01 Ethics, Policy, and Law in Health Care Management – Phase 3 Discussion Board 2 As the Assistant Director of Quality Improvement and Risk Management for Rosewood Children’s Medical Center, a health care facility specializing in inpatient and outpatient health care services for children and adolescents, I will help the organization to provide a list of rights and responsibility of healthcare provider. Enumerated below are the rights and responsibility of the healthcare provider base on legal standards and professional standards for health care organizations.

It is the right of your healthcare provider to ……Be informed when you needed medical health assistanceAssist you in having a comfortable relationship with your practitioner. Asking questions is the patient right to understand his condition. Know complete information about the patient to provide the appropriate service needed. To collect all the payment for services rendered to you which are not covered by the insurance policy but was paid by your provider. To know your opinions, concerns and complaints regarding their services and policiesBe informed in any changes in family size, address, phone number or membership status.

Know that as a member you understand your Evidence of Coverage/Contract Have a records of your medical history, including diagnosis and treatment information To communicate openly with patients about all diagnostic testing and treatment options.To act as an advocate for your patient in seeking appropriate, medically necessary health services.To appeal claims payment issues within 90 days following a claims determination, and then take matters of $1,000 or more to the Program for Independent Claims Payment Arbitration (PICPA).

To know the reasons why some services are being denied to the patients It is the responsibilities of the healthcare provider to…….Provide medical treatment when a member needs it and should handle it with respect with your privacy and dignityProvide information about the health care plan, including information about services that are covered, services that are not covered and any costs that the member is responsible for paying. Provide list of providers and have access to information about particular providers’ education, training and practice.

Allow the member to select a Primary Care Physician (PCP) for them and each covered family members and change PCP for any reason. Assure the members that their medical records are kept confidential and private. Confidentiality laws and professional rules of behaviour allow the provider to release medical information only when it is required for your care, required by law, or necessary for the administration of your plan or support the providers programs or operations that evaluate quality service.

Let you participate with your health care providers in health decisions and have them give you information about your medical condition and your treatment options, regardless of benefits coverage or cost. Inform the member on the care that you received. Should ask consent for all care, unless there is an emergency and your life and health are in serious danger. Listen to your complaint in handling the process and act on the complaint or concern about the provider and the quality of care that you receive.

Accept recommendations regarding the policies on member rights and responsibilities.Health care provider should fulfill its obligations to its members in order to have a mutual relationship. By doing this the provider can achieved its goal in strengthening consumer confidence. The provider should provide its consumer with effective ways to address their concerns, and encourages them to take an active role in improving and assuring their health. In order to reaffirm the importance of a strong relationship between patients and their health care providers the provider should respect their consumers’ rights.

And vice versa the consumer should be cooperative enough in order for the provider to give the needed and required services. Consumers want to be treated with respect and fairly. To provide and maintain a quality health care system the consumer and the provider should have a mutual respect. Cases wherein there is discrimination on the services provided should be given focused. One important factor that a consumer is very particular of is the assurance that their identity should be treated with confidentiality.

The provider can disseminate information about the consumer only if needed and required by law. On the other hand the consumer should also give respect to the provider. The consumer should be cooperative enough in order to help the provider to give services that they needed. The consumer should also do its part in order to have a better result. Reference: Rights and Responsibilities of a Health Care Consumerhttp://carefirst.staywellsolutionsonline.com/library/Wellness/1,3015CIGNA HealthCare Member Rights and Responsibilities http://www.cigna.com/customer_care/member/rights_responsibilities/index.html