In the healthcare industry, there are regulations and recommendations set by both federal and state agencies that mainly pay for services and regulate healthcare. Many patients are now entitled to health insurance with the help of the Affordable Care Act (ACA). A health administrator should be knowledgeable on policies and insurance. Their mandate is to conform to what is required. The main function is to understand the laws that protect the health of the patient. There are various between Medicaid, Medicare and Workers Compensation programs. Also, the administrator should be aware of the private insurance entities such as Blue Shield and Blue Cross. Compliance issues should be applied as well as proficiency when it comes to researching information
…show more content…
The health record can either be in the form of electronic or paper and it highlights the facts related to patient care for justification purposes. Many cases have been reported regarding unauthorized personnel having access to private health information through electronic means (Terry, 2009). Violations of the HIPAA should be reported because fraud in insurance may lead to litigation.
The medical team should also ensure reporting of fraud to the concerned authorities. Qui Tam is provided when a private citizen litigates in place of the federal government in cases of fraud either by government contractors. It is a type of lawsuit filed by an individual who is referred to as a “whistleblower” or a “relator”.
Conclusion
Healthcare administrators can ensure that employees adhere to regulations. First of all, supervising various personnel in order to ensure appropriate medical records, insurance billing and coding is important. Frequent audits are necessary so that the employees comply with the regulations provided by the state and federal agencies. Any identified challenge should be dealt with for example arranging for a training program. Training the staff will help in reporting any misconduct taking
The health record can either be in the form of electronic or paper and it highlights the facts related to patient care for justification purposes. Many cases have been reported regarding unauthorized personnel having access to private health information through electronic means (Terry, 2009). Violations of the HIPAA should be reported because fraud in insurance may lead to litigation.
The medical team should also ensure reporting of fraud to the concerned authorities. Qui Tam is provided when a private citizen litigates in place of the federal government in cases of fraud either by government contractors. It is a type of lawsuit filed by an individual who is referred to as a “whistleblower” or a “relator”.
Conclusion
Healthcare administrators can ensure that employees adhere to regulations. First of all, supervising various personnel in order to ensure appropriate medical records, insurance billing and coding is important. Frequent audits are necessary so that the employees comply with the regulations provided by the state and federal agencies. Any identified challenge should be dealt with for example arranging for a training program. Training the staff will help in reporting any misconduct taking