RCM unifies the clinical and business side of healthcare using both primary and secondary patient data, insurance, and provider and the revenue cycle is vital in creating compliant and efficient reimbursement processes. The revenue cycle is divided into four which are preclaims activities, claims processing, account receivable and claims reconciliation and collection. The preclaims submission is the first process in the cycle which begins with patient case management and preregistration such as collection insurance information before patient arrives then collecting subsequent patient information to create a medical record number to meet financial, clinical and regulatory requirement and Medicare patient are advised on financial responsibilities if…
1.A professional nurse coordinator has the job of supervising and coordinating care for his assigned unit or patients. 2. A professional coordinator ensures that patient care is up to applicable standards and works to make sure the patients in his care, other staff members and visitors are safe in health care environment. 3. A professional coordinator may assist with developing care plans for patients and make sure they are carried out according to the facility's standards.…
In today’s healthcare, case management ascends to an irreplaceable component in delivering quality care. The interaction of the case managers with multiple departments in a health system allows open communication, resulting in quality metrics demonstrating value in areas such as length of stay, observations, accounts receivable, and appeals or denials of patient care (Miodonski 2011). According to the Case Management Society of America (CMSA) hospital case management exists as a collaboration of assessments, plans, implementations, coordination, monitoring and evaluations of options and services for healthcare consumers. Huntsville Hospital (HH) Case…
There are various subsystems within the Cypress Health Region, the focus of this analysis will be the subsystem in Leader Saskatchewan. According to Hayajneh (2007) “A system is a collection of independent but interrelated elements or components organized in a meaningful way to accomplish an overall goal” (p. 1). According to the Cypress Health Region website, the mission of the health region is delivering “safe, quality services to each person” (n.d.). This is the overriding goal that drives the region’s purpose and decisions in providing care.…
TRICARE health care program offers several different plan options that available to enrollees depending on where they live and their beneficiary category. The main beneficiary categories include: Active duty service members, active duty family members, retired service members and their family members, National Guard and Reserve members, survivors and select former spouses. The TRICARE Prime program offers comprehensive care in areas near military treatment facilities. TRICARE Prime provides all enrollees with a primary care manager where one would receive most routine care from.…
Abstract: Improving Post-Hospitalization follow-up for Veterans who are admitted into Non-VA facilities Objectives: VA policy mandates Non-VA facilities to notify the VA Transfer Center or Fee Basis department about Veterans’ admissions to initiate possible transfers and reviews for reimbursement. Since there is a lack of communication, primary care teams are not aware of the Veterans’ admissions. Consequently, Veterans who are admitted into Non-VA facilities do not receive appropriate and timely post-hospitalization care with their VA primary care teams. The objective of this quality improvement project is to improve post-hospitalization follow-up for Veterans who are admitted into Non-VA facilities by facilitating communications among Transfer…
The University of Michigan Health System is one of the largest health care facilities in the world. The facility is also referred to as the University of Michigan Hospital. It is one of the largest hospitals in the state of Michigan, as well as a premier academic medical center. Michigan Health System has a vision of creating the future of health care through discovery, as well as to become the national leader in care, education, biomedical innovation, and health care reform (Regents, 2015). An important aspect of quality assurance is utilization management.…
I have decided to complete my project in a physician’s office, which is in Louisville, MS. The size would be based on the number of people that receives service at this location which is approximately a hundred people on average daily. The facility is funded by state and local citizens; therefore, the ownership is private. The population that is served will be the public with open doors to all. The services available would be immunization for all ages, and healthy -you are completed at this facility which is an excellent service and convenient for the local community.…
Often, assessments made by the intake worker and the nurse provide the basis for care. In most settings, the psychiatrist or advanced practice nurse evaluates the patient and provides orders within a limited time frame. Medical problems are usually referred to a primary care physician or specialist, who assesses the patient and consults with the unit physicians. To provide standardization in treatment and improve outcomes, inpatient units use clinical…
First of all, it’s not an “unidentified fax”, it clearly has Dr. Who’s name. The procedure for unidentified fax does not apply. 2nd, I followed the instruction regarding all correspondence with Doctor/Psychiatrist/Consultant’s name on it (who does not have a fixed office in CTYS), should be forwarded to the related program manager. This has been the practice for over 16 years.…
Technology Informatics Over the years, hospitals have worked hard to decrease the amount of post-discharge medication errors. According to Allison et al. (2015), electronic medication reconciliation is a system created to help medication inconsistencies. These electronic medication reconciliation handouts are now part of Joint Commission on Accreditation standard requirements.…
Background Information A literature review of patient handoff, and communication gaps of patient information during intrahospital patient transfers. The communication of complete and accurate patient information can be challenged, because of increasingly fast-paced and complex health care environments. Patient Handoff refers to, the process of transferring primary authority and responsibility for providing clinical care to a patient from one departing caregiver to one oncoming caregiver. Caregivers include attending physicians, resident physicians, physician assistants, nurse practitioners, registered nurses, and assistant care providers (Patterson, & Wears, 2010).…
Formulate Patient Care Plan: “When formulating this plan, physical therapist often consult with other specialists and medical personnel including doctors, dentists, nurses, social workers, occupational therapists,…
Doctor’s Hospital is an acute care facility in a small town. Due to a major financial disruption they had to transform their organization’s governing structure. As a result, they did not consider the impact of CIO in IT and they turn CIO’s full-time job into a part-time job. Therefore, Doctor’s Hospital faces many information system challenges. Along with that hospital is undergoing 3 phase construction.…
Ambulance Service Midland Healthcare offers fully-equipped ambulances staffed with trained paramedics, nurses and drivers to manage all the day-to-day fleet operations as well as those midnight emergencies. The ambulances are equipped with required medicines, emergency kits, and patient transport equipment and additionally carry life-saving equipment to take care of all kind of critical emergencies including accidents, heart attacks, and paralysis attacks. Call our toll-free number to 1860-333-333-3 now! EBUS Endobronchial ultrasound (EBUS) is a minimally invasive but highly effective procedure used to diagnose lung cancer, pulmonary infections (including TB), haemoptysis (coughing blood), sarcoid, interstitial lung diseases (ILD) and…