Finance management & reimbursement methodologies
Part A: Evaluating the importance of government initiatives pertaining to the coding functions
Medicare and Medicaid patient and Program Protection Act of 1987
This initiative enhances comprehensive effort to expand access to healthcare coverage. The access of this health is also ensured at the affordable care act. The act also offers voluntary nature of the medical program and hence government states can remain free or decline federal funding to such programs. The patient protection also ensures that health records of patients are well protected against access by illegal individuals unless authorized by the patient in question. The act promotes protection against rising factors associated with medication and medical patient through legislation that helps to governs patient’s healthcare (Outterson et al., 2012).
Operations restore trust
This government initiative considers a number of issues that brings about poor design of healthcare simulation models. It also mirrors the possibility of failure occurrence of academic healthcare simulation modelers with an aim of building model that mirrors the actual healthcare harms as recognized by stakeholders of healthcare system.. In this case, healthcare planners are used as change agents to enhance the acceptance of simulation in the health sector. The design approach or methodology used determined the effectiveness of the system simulation model for healthcare. On the other hand, , the efficiency, effectiveness and reliability of automated healthcare system is determined by error-free coding that also depends on the model design (Virtue, Chaussalet & Kelly, 2013).
The automated health system that is error-free restores maximum trust to stakeholders who need quality and dependable information from the health care system. Therefore, the operations of restore trust tries to minimize or eliminate poor adoption of simulation modeling in healthcare. As a result, this initiative has the importance of improving the efficiency of healthcare system operations by reviewing differences to other sectors, reviewing size complexity as well as stakeholder issues, present and prospect challenges. In addition, the initiative can help in the review of healthcare planning which also contributes to the improvement of operational efficiency. This also implies that healthcare planning can play a significant role in the use of healthcare simulation modeling to get enhancement in the efficiency of operations (Virtue, Chaussalet & Kelly, 2013).
Medicare integrity program
The Medicare integrity program initiative is also geared towards improving the effectiveness of medical healthcare programs. The program thus ensures that healthcare information of patients is true, reliable and not corrupted in any way. The coding functions used for the automation of healthcare system thus reduce the possibility of illegal alteration or modification of patient’s information. This is possible given that coding functions can be used effectively in order to reduce risk of errors in the clinical coding process hence improving the quality of healthcare services in health organization, hospitals, and other health centers. The initiative for that matter ensures that the information that comes from the healthcare medical system is of the expected content and standard (Slutsky et al., 2013)
Medicare Prescription Drug Improvement and modernization Act of 2003: Recovery demonstration project
The legislation in this act ensures that patients get the right treatment in terms of the type and dosage of drugs or medicine used for the respective disease diagnosis. The initiative also ensures that medical staff in various health centers and organizations employs the use of the modern method of disease diagnosis and treatment for purposes of accuracy and reliability. The use of modern methods is also important in ensuring that clinicians and medical practitioners follow the right process in diagnosing and treating of patients. The coding functions of clinical processes by informatics professionals ensure the use of automated modern methods for implementation of this act.
Prescription drugs have the vast potential of improving health and longevity with past notable innovations in the pharmaceutical field. This past innovation is also characterized by therapies that raised significant safety anxieties. This initiative thus have the importance of responding to challenges that pose threats to the safety of drug prescription through regulation agencies, pharmaceutical firms, and academic institutions in order to check and assess pharmaceutical risks and benefits. The medicine prescription drug, improvement and modernization act 2003 also has the importance of authorizing agency for healthcare research and quality in order to fund research concerning the effectiveness and suitability of health services in addition to the prescription of drugs (Jingwen Caleb & Jobi 2013).
Part B: The role of quality improvement organization
The role of quality improvement organizations contracting under centers for Medicare and Medicaid services as applies to coding process involves facilitating extensive quality improvement activities for the implementation of evidence-based enhancements in care transitions through community organizing, technical assistance and participation monitoring including implementation adverse effects and effectiveness. By so doing, the quality improvement organizations reduces errors experienced by medical beneficiaries at the time of transitions among care settings thus reducing harms that include unnecessary re-hospitalizations (Brock et al., 2013).
Part C: Diagram for the activities of revenue cycle
The following shows the diagram of activities of each step of revenue cycle in their order of occurrence.
The health information management (HIM) staff members will have various roles during each step of the revenue cycle where they are likely to be involved. First, the HIM staff will be responsible for updating financial information of patient regarding the amount paid by the respective patient to the healthcare provider through the service process. The information update for patient by HIM staff is also done to premium payment to managed care organization or the insurer. HIM staff also has the responsibility of processing the third party transactions which involve premium payment by the employer to the insurer on behalf of the patient. In addition, they also process patient benefit plans that are paid by premiums at the insurance company level. In addition, they also back up information processes at each stage of processing, producing payment receipts as well as enforcing protection measures for health information which includes financial information.
Part D: Addressing the automated billing report errors:
Date of service error
The case where the date of service on one portion of the bill for a same-day surgery is not in agreement with the date on other portions of the bill can be solved or corrected by referring from the hard copy source document where the bill transaction was first recorded prior to entering information in the computer system. This correction is subject to the assumption that the automated system has no design or implementation error, otherwise, system redesign and implementation can be considered.
Inaccuracy of diagnosis and procedural codes
The errors associated with diagnosis and procedural codes can be solved or corrected by re-designing and implementing the automated system in accordance with the required procedures of diagnosis.
A billed procedure to the wrong patient
The case where a procedure is billed to the wrong patient can be corrected by reversing the transaction where possible. The automated system can also be investigated for design errors where system redesign can be considered, followed by implementation of the corrected design.
Outterson, K., Hermer, L. D., Huberfeld, N., Leonard, E. W., Rosenbaum, S., & Watson, S. D. (2012). Brief of Amici Curiae Health Law & Policy Scholars and Prescriptions Policy Choices in Support of Respondents on the Constitutional Validity of the Medicaid Expansion in State of Florida v. Department of Health and Human Services. Boston Univ. School of Law, Public Law Research Paper, (12-27), 12-27.
Virtue, A., Chaussalet, T., & Kelly, J. (2013). Healthcare planning and its potential role increasing operational efficiency in the health sector: A viewpoint. Journal of Enterprise Information Management, 26(1/2), 8-20.
Slutsky, J., Atkins, D., Chang, S., & Sharp, B. A. C. (2013). Foreword. Comparing Medical Interventions: AHRQ and the Effective Health Care Program. Methods Guide for Effectiveness and Comparative Effectiveness Reviews, 1.
Brock, J., Mitchell, J., Irby, K., Stevens, B., Archibald, T., Goroski, A., & Lynn, J. (2013). Association between quality improvement for care transitions in communities and rehospitalizations among Medicare beneficiaries. Jama, 309(4), 381-391.
Jingwen Tan, G. Caleb Alexander & Jobi B.Segal. (2013). Academic centers play a vital role in the study of Drug Safety and Effectiveness.PMCID: NIHMS572328.
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