CHAPTER 33 INFORMATION AND ADMINISTRATION CAREERS

Abbreviations AHIMA: American Health Information Management Association CEBS: certified employee benefits specialist CPCS: certified provider credentialing specialist FCRA: Fair Credit Reporting Act HIM: health information manager JCAHO: Joint Commission on Accreditation of Health Care Organizations NAMSS: National Association of Medical Staff Services NPSG: National Patient Safety Goals RHIT: registered health information technician RRA: registered records administrator

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.)

Health Unit Coordinator or Manager Performs nonclinical activities Assembling and maintaining client charts Transcribing physician's orders Acting as receptionist and secretary on the unit Health unit manager Coordinates the nonclinical activities for several units Establishes polices and procedures Manages personnel Prepares the budget Education Health unit coordinator and manager certification after 2 year-college program

Medical Records Personnel Organize, analyze, and generate data for patients’ records Most employment is in hospitals. One of the fastest growing occupations

Registered Records Administrator (RRA) or Health Information Manger (HIM) Responsible for management of the information system Create policies and procedures for department Responsible for employee evaluation and budget preparation Education or training 2-year college certificate or 4-year college or university degree Supervised experience may be required in some programs. The American Health Information Management Association was formally known as the American Medical Records Association.

Registered Health Information Technician Performs the technical functions of medical records maintenance Organizes, analyzes, and evaluates records Education: 2-year program or through the American Health Information Management Association’s independent study program In a small facility, the technician may have the full responsibility of the medical records department.

Medical Transcriptionist Listens to and types information to provide a permanent record from a variety of audio equipment Most facilities use digital or analog dictating equipment. Training Knowledge of medical terminology and computer skills are needed. Some community colleges and vocational schools offer associate degree programs in transcription. Certification is voluntary. Medical transcriptionist is also called a medical stenographer. The use of the Internet and speech-recognition software provide quicker return of documents.

Health Science Librarian Locates and provides information to practicing professionals, researchers, and students Education Master’s degree Certification is available.

Public Health Educator Responsibilities Teaching new and experienced health personnel May specialize in fields of practice Organizing and directing health education programs for groups and community needs Designing ways to increase use of public health resources Education Bachelor’s or master’s degree Standard teacher certificate may be required Health educations may specialize in fields of practice such as personal, community, consumer, environmental, or public health.

Public Relations Personnel Plan and conduct programs such as press releases and advertising strategies for the agency Education Bachelor’s degree in public relations is preferred.

Biomedical Photographer Documents life-related health events Often specializes in one area such as animal, plant, or surgical photography Education 2 to 4 years of college for training in photography and basic sciences Certification and registration are available. Photomicrography is taking photographs through a microscope.

Medical Illustrator Specialized artist who provides sketches, paintings, drawings, computer images, and three-dimensional models Education Completion of program at one of five accredited schools (program requires a bachelor’s degree for admission) Advanced functions of medical illustrators include production of instructional models of artificial body parts.

Health Information and Communication Careers Medical writer Creates and edits technical material for educational and marketing materials Education Master’s degree preferred Public health statistician Gathers, analyzes, and presents public health data used to uncover trends and the causes of diseases Doctorate in public health (DPH)

Content Instruction Office management Maintaining confidentiality of patient records Appointment procedures Appointments done in pencil so they can be erased Most offices call patients to confirm appointment. Information is kept in written form or stored in a computerized system. Filing may be numerical or alphabetical, or both Cross-referencing of records Scheduling laboratory tests and other procedures Refer students to Skill List 33-4 Scheduling an Appointment.

Appointment Reminder Card FIGURE 33-5 After the necessary information is gathered, some offices provide the patient with a card as a reminder of the next visit.

Records Management The medical record for a patient is a legal record that contains Medical history and physical assessment Test results Surgery reports Notes about patient’s condition and course of treatment Duties include making sure patients understand forms. Confidential information may not be given to anyone other than those authorized by the patient and health care practitioner.

Medical Records FIGURE 33-6 The medical record may be made up of several different forms, and the types of forms may vary according to the care needed.

Inpatient Chart Order

Records Management Records must be accurate, legible, complete, and organized to provide efficient care. Oral record must be transcribed or written in permanent form. Information that a clerk transcribes or copies from one written record to another is checked by authorized personnel.

Guidelines for Charting

Methods of Payment Insurance Payment in advance for services in the event that they are needed Types of insurance Group Private insurance Federal Medicare and Medicaid programs States provide worker’s compensation and disability programs

Types of Health Insurance

Methods of Payment An insurance company may not pay a certain part of the cost of treatment. Deductible Amount paid by patient before insurance company pays Copayment Percentage of each transaction to be paid by the insured Individuals may have coverage from more than one insurance program. Without insurance, patient is responsible for full payment.

Methods of Payment Billing codes Used to designate the type of treatment and to determine whether coverage is allowed Diagnostic-related groups (DRGs) Established by the federal government Determine a usual, reasonable, and customary (URC) fee for services for Medicare recipients

Job Duties and Opportunities Career Title Years of Education Job Duties and Opportunities Credentials Required registered records administrator 2- to 4-year university degree Management of information system in health care facility RRA Health service manager 4-year university degree or more Manage a facility, including the budget, programs, and personnel CEO Health service clerk On-the-job training to MS degree Duties of receptionist, accountant, and assistant; uses telephone None Patient representative MS degree in health- related field Assists the patient to understand health care practices and policies MA or MS health unit coordinator 2-year community college degree Performs nonclinical activities on the nursing unit; assembles and maintains charts HUC

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.

Summary Three personal characteristics of an efficient clerk are the ability to work with various personalities, courtesy, and efficiency. Five forms used for the medical record are the admission report, graphic sheet, nursing record, laboratory report, and physician orders.

Summary Three methods of payment for health care include fee-for-service, individual, and group insurance.