1. CHAPTER 33 INFORMATION AND ADMINISTRATION CAREERS

2. 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

3. 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

4. Information and Administration Careers

5. Information and Administration Careers Educational Costs and Earnings

6. 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

7. 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.

8. 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.

9. 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.

10. 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.

11. 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.

12. 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.

13. Health Care Pre-employment or Student Background Check

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

15. 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.

16. 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.

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

18. 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.

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

20. 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.

21. 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”.

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

23. 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.)

24. 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

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

26. 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.

27. 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.

28. 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.

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

30. 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.

31. 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.

32. 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.

33. 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.

34. 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)

35. 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.

36. 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.

37. 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.

38. 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.

39. Inpatient Chart Order

40. 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.

41. Guidelines for Charting

42. 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

43. Types of Health Insurance

44. 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.

45. 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

46. 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

47. 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.

48. 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.

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