CHAPTER 33 INFORMATION AND ADMINISTRATION CAREERS Benefit Chart Confidential Customary Deficient Dictation Insurance Reasonable Transcribe Journal question: What personal qualities would make a student a good candidate for a career in information or administration?

Chapter 33 Learning Objectives Identify at least 10 terms relating to health care information and administration. Specify the role of selected information and administrative health care workers, including personal qualities, levels of education, and credentialing requirements.

Information and Administration Careers Critical to the quality of care delivered Cover a broad spectrum of careers Health care facility administrators Health care facility managers Supervisors Medical secretaries Unit coordinators Medical records personnel

Information and Administration Careers

Information and Administration Careers Educational Costs and Earnings

Health Service Administrators Responsibilities Manage the facility budget, programs, and personnel Responsible for relations with other agencies and organizations Coordinate services, hiring, and training of personnel Responsible for establishing the policies and procedures of the facility Adhere to Health Insurance Portability and Accountability Act (HIPAA) guidelines Meet legal regulations

Joint Commission Accredits 88% of U.S. hospitals ORYX initiative New program by the Joint Commission The facility’s performance goals and the standards for staff and equipment are considered. Data include patient outcomes. Use expanded for home care, behavioral health, ambulatory, and laboratory facilities. The Joint Commission was formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). It is recognized nationwide as a symbol of quality that reflects a health care organization’s commitment to meeting certain performance standards. Discuss accreditation for health care facilities and the role of the Joint Commission.

Health Service Administrators Education Individuals with a 4-year bachelor’s degree usually find positions in small institutions. Master’s or doctoral-level preparation is preferred to work in large facilities. Internship is required by many administrative programs. Licensure is usually required for an administrator position in large facilities.

Medical Staff Services Responsibilities Maintaining the credentialing of all physicians and allied health practitioners in a health care facility Maintaining records of licensing, continuing education, and training Responsible for reviewing and implementing federal standards Certification as a certified provider credentialing specialist National Association of Medical Staff Services (NAMSS) is the certifying agency for the certified provider credentialing specialist.

Patient Representative Helps patients understand the health care policies and procedures of the facilities Obtains services for the patient Helps patient make informed decisions about their care Work may vary depending on the needs of the patient May help patient draft a living will or resolve a conflict Patient representatives are also know as patient advocates.

Patient Representative Education Facility may set its own requirements for education and experience. Many patient care representatives have a master’s degree in a health-related field.

Human Resource and Labor Relations Personnel Recruit, screen, and hire qualified personnel Provide training Interview prospective employees Explain benefits Supervise background checks Education Varies with responsibilities or duties Bachelor’s degree for entry-level position Master’s degree in Human Resources Administration Certification is available. The Joint Commission mandated criminal background checks on any person that interacts with patients. Refer students to Box 33-2 and discuss the pre-employment background check list.

Health Care Pre-employment or Student Background Check

Fair Credit Reporting Act (FCRA) Defines guidelines for requesting or requiring background checks

Health Care Risk Manger Supervises programs to reduce the number of accidents and incidents involving patients and staff members Establishes policies and procedures Reviews documents Patient charts Employee incident reports Communicates with legal representatives Certification and licensure are available. Employees complete incident reports when an error or adverse event (reportable variance) occurs. Discuss the term adverse event as related to the health care environment.

The Joint Commission’s Official “Do Not Use” List The Joint Commission’s Do Not Use list and the National Patient Safety Goals were designed to address specific areas of patient safety.

Health Services Clerk or Office Manager Has the duties of receptionist, accountant, and assistant Responsible for the smooth operation of the services

Hospital Registration Staff Record and manage the admission of clients Responsibilities of the admissions clerk Preregistration interviewing Verifying insurance Arranging transportation Assigning beds for hospital stay May also assist with death and birth forms Education On-the-job training Managers may require college degree in a health-related field. Refer students to Skill List 33-1 Assisting the Patient with Insurance Forms.

Preadmission Form FIGURE II-6 The patient may complete the admission form alone or with help from a health care worker.

Sample of Insurance Form The forms must be completed accurately because the code used for reimbursement for services is determined in part by use of the insurance form. Refer students to Skill List 33-1 Assisting the Patient with Insurance Forms.

Medical Secretary Duties of the medical secretary Taking dictation Transcribing and charts Filing records Keeping budget records and fee schedule Assisting with medical reports, articles, and conference proceedings Preparing correspondence Education or training Vocational training or associate degree Knowledge of medical terminology is essential. Refer students to skill list 33-2, “Preparing a Business Letter”.

Business Correspondence Sample FIGURE 33-2 Business correspondence reflects the relationship of the health care worker with the patient.

Sample Record for Charges and Payments FIGURE 33-3 Records for charges and payments are used to provide accurate billing. (From Cooper MG, Cooper DE, Burrows NJ: The medical assistant, ed 6, St. Louis, 1993, Mosby.)

Summary The role of the health information and administration health care team is to manage the budget and maintain patient records. Health information administrators manage personnel by hiring and training workers.

Review The type of payment basis that provides for payment at the time of service is: a. Private pay b. Medicaid c. Fee for service d. Co-payment e. None of the above

Review The type of payment basis that provides for payment at the time of service is: a. Private pay b. Medicaid c. Fee for service d. Co-payment e. None of the above

Review The medical transcriptionist: a. Listens to and types information to provide a permanent record b. Provides access to information c. Analyzes public health data d. Records the work of the photomicrographer e. Types charting done on a discharged patient

Review The medical transcriptionist: a. Listens to and types information to provide a permanent record b. Provides access to information c. Analyzes public health data d. Records the work of the photomicrographer e. Types charting done on a discharged patient