scholarly journals HEALTH INFORMATION MANAGEMENT (HIM) IN THE CONTROL OF MEDICAL CLAIMS ERRORS

2020 ◽  
Vol 8 (1) ◽  
pp. 327-335
Author(s):  
Kashef K. Alshaban ◽  
Lina Almasri
Keyword(s):  
Health Care Providers ◽  
Performance Indicators ◽  
Electronic System ◽  
Business Strategies ◽  
Care Providers ◽  
Medical Claims ◽  
Crucial Component ◽  
New Business ◽  
Financial Issues ◽  
Hospital Finance

Preparing and submitting medical claims to health care providers is a crucial component in hospital finance. Owing to the complexity of the process, medical claims errors may result in financial issues. Our objective is to examine the process of preparing and submitting medical claims in the distinguished Healthpoint Hospital/Abu Dhabi, also the reasons for rejection of medical claims so as to focus in control hospital’s medical claims errors. The cases of claim rejection between the years 2014-2018 according to the hospital records are as follows: 2018 (January – May) 5%, 2017 4.4%, 2016 8%, 2015 & 2014 24%. Other cases of medical claims regarding Vitiligo (37 cases), obesity (14 cases), and Audiometry (23 cases) are also reviewed. It seems that the most common medical billing errors are related to technical and nontechnical errors. The strategy of controlling medical claims errors is designed in the hospital by applying key performance indicators (KPI) that demonstrate how effectively the hospital is achieving the key business objectives. The result proves that the strongest electronic system and applying the new business strategies led to reducing the rejections of medical claims due to mistakes.

scholarly journals Predicting Consumer Effort in Finding and Paying for Health Care: Expert Interviews and Claims Data Analysis (Preprint)

2017 ◽  
Author(s):  
Sandra Long ◽  
Karen A. Monsen ◽  
David Pieczkiewicz ◽  
Julian Wolfson ◽  
Saif Khairat
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Care Providers ◽  
Health Care Information ◽  
Medical Claims ◽  
Effort Level ◽  
Care Information ◽  
Claims Data Analysis ◽  
To Receive ◽  
Level Of Effort

BACKGROUND For consumers to accept and use a health care information system, it must be easy to use, and the consumer must perceive it as being free from effort. Finding health care providers and paying for care are tasks that must be done to access treatment. These tasks require effort on the part of the consumer and can be frustrating when the goal of the consumer is primarily to receive treatments for better health. OBJECTIVE The aim of this study was to determine the factors that result in consumer effort when finding accessible health care. Having an understanding of these factors will help define requirements when designing health information systems. METHODS A panel of 12 subject matter experts was consulted and the data from 60 million medical claims were used to determine the factors contributing to effort. RESULTS Approximately 60 million claims were processed by the health care insurance organization in a 12-month duration with the population defined. Over 292 million diagnoses from claims were used to validate the panel input. The results of the study showed that the number of people in the consumer’s household, number of visits to providers outside the consumer’s insurance network, number of adjusted and denied medical claims, and number of consumer inquiries are a proxy for the level of effort in finding and paying for care. The effort level, so measured and weighted per expert panel recommendations, differed by diagnosis. CONCLUSIONS This study provides an understanding of how consumers must put forth effort when engaging with a health care system to access care. For higher satisfaction and acceptance results, health care payers ideally will design and develop systems that facilitate an understanding of how to avoid denied claims, educate on the payment of claims to avoid adjustments, and quickly find providers of affordable care.

scholarly journals Patients’ satisfaction regarding facilities and services provided at AYUSH clinics of primary health centres in rural Puducherry

2019 ◽  
Vol 6 (6) ◽  
pp. 2498 ◽  
Author(s):  
Chithra Boovaragasamy ◽  
Seetharaman Narayanan
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health Care Providers ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Cross Sectional ◽  
Crucial Component ◽  
Primary Health Centres ◽  
One Year

Background: Patient satisfaction is a crucial component of the health care system in today’s competitive modern era. There is a limited literature describing the patient satisfaction on AYUSH care and therefore this study was undertaken to assess the satisfaction about facilities, healthcare providers and treatment among the patients attending selected AYUSH-attached PHCs in rural Puducherry.Methods: A facility based cross-sectional study was conducted among the patients who attended AYUSH clinics at 4 selected PHCs of Puducherry over a period of one year. Personal Interviews using semi-structured pretested proforma was conducted for capturing information on socio-demographic variables, satisfaction regarding the facilities and health care providers. Telephonic interviews were conducted two weeks after the centre-based personal interviews, to assess the patients’ treatment satisfaction levels.Results: Out of the 584 patients interviewed, 71.23% rated as very good/excellent their interaction with the healthcare providers, with regards to satisfaction about the infrastructure facilities, the proportion rating very good/excellent ranged from 64.47% to 93.93% across the different AYUSH PHCs.Conclusions: Overall satisfaction about the quality of services and treatment was good among the patients.

scholarly journals Study on Evaluation of Medication Adherence and Drug Related Problems In High Risk Elderly Population

2021 ◽  
Vol 9 (8) ◽  
Keyword(s):  
Medication Adherence ◽  
Health Care Providers ◽  
Prescription Drugs ◽  
Community Pharmacists ◽  
The Elderly ◽  
Care Providers ◽  
Drug Related Problems ◽  
Adherence To Medication ◽  
Patient Interview ◽  
Crucial Component

Medication adherence is a crucial component in the treatment of chronic diseases. In the elderly, clinicians are faced with a unique set of problems associated with adherence that they may not have been adequately trained for. The present study was designed to assess the socio-demographic profile, adherence and drug-related problems among elderly. Methods: An observational study involving 30 patients aged over 60 years using at least five prescription drugs and discharged from hospital. The occurrence of adherence and DRP were assessed by means of an identification tool specifically developed for use by community pharmacists, including a semi structured patient interview and a checklist of common DRP. Results: Out of 30 study subjects, it was observed that majority of the study subjects had drug related problems. High, moderate and low adherence to medication was found. Conclusion: It is evident that there is a great need on the part of health care providers to not only prescribe medications to the patients but also make a conscious effort to address the issue of non-adherence to the prescribed medications and other non-pharmacological measures. Keywords: Morisky, Drug compliance, elderly, habits, medications

scholarly journals Measuring Quality in Emergency Medical Services: A Review of Clinical Performance Indicators

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Mazen J. El Sayed
Keyword(s):  
Health Care ◽  
Emergency Medical Services ◽  
Health Care Providers ◽  
Performance Indicators ◽  
Clinical Performance ◽  
Medical Services ◽  
Care Providers ◽  
Quality Initiatives ◽  
Control Programs ◽  
Emergency Medical

Measuring quality in Emergency Medical Services (EMSs) systems is challenging. This paper reviews the current approaches to measuring quality in health care and EMS with a focus on currently used clinical performance indicators in EMS systems (US and international systems). The different types of performance indicators, the advantages and limitations of each type, and the evidence-based prehospital clinical bundles are discussed. This paper aims at introducing emergency physicians and health care providers to quality initiatives in EMS and serves as a reference for tools that EMS medical directors can use to launch new or modify existing quality control programs in their systems.

Malpractice & Negligence: Cal. Supreme Court Clarifies Negligence Provisions under State’s Elder Abuse Act

1999 ◽  
Vol 27 (2) ◽  
pp. 203-203
Author(s):  
Kendra Carlson
Keyword(s):  
Health Care ◽  
Supreme Court ◽  
Health Care Providers ◽  
Elder Abuse ◽  
Skilled Nursing Facility ◽  
Pressure Sores ◽  
Care Providers ◽  
Nursing Facility ◽  
Skilled Nursing ◽  
The Supreme Court

The Supreme Court of California held, in Delaney v. Baker, 82 Cal. Rptr. 2d 610 (1999), that the heightened remedies available under the Elder Abuse Act (Act), Cal. Welf. & Inst. Code, §§ 15657,15657.2 (West 1998), apply to health care providers who engage in reckless neglect of an elder adult. The court interpreted two sections of the Act: (1) section 15657, which provides for enhanced remedies for reckless neglect; and (2) section 15657.2, which limits recovery for actions based on “professional negligence.” The court held that reckless neglect is distinct from professional negligence and therefore the restrictions on remedies against health care providers for professional negligence are inapplicable.Kay Delaney sued Meadowood, a skilled nursing facility (SNF), after a resident, her mother, died. Evidence at trial indicated that Rose Wallien, the decedent, was left lying in her own urine and feces for extended periods of time and had stage I11 and IV pressure sores on her ankles, feet, and buttocks at the time of her death.

Using Technology to Improve Access to Health Care for Culturally and Linguistically Diverse Populations

2012 ◽  
Vol 19 (3) ◽  
pp. 71-76 ◽  
Author(s):  
Pauline A. Mashima
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Access To Health Care ◽  
Underserved Populations ◽  
Linguistically Diverse ◽  
Care Providers ◽  
Department Of Health ◽  
Use Of Technology ◽  
Access To Health ◽  
Improve Access

Important initiatives in health care include (a) improving access to services for disadvantaged populations, (b) providing equal access for individuals with limited or non-English proficiency, and (c) ensuring cultural competence of health-care providers to facilitate effective services for individuals from diverse racial and ethnic backgrounds (U.S. Department of Health and Human Services, Office of Minority Health, 2001). This article provides a brief overview of the use of technology by speech-language pathologists and audiologists to extend their services to underserved populations who live in remote geographic areas, or when cultural and linguistic differences impact service delivery.

The Need for Nurse Training to Promote Improved Patient-Provider Communication for Patients With Complex Communication Needs

2013 ◽  
Vol 22 (2) ◽  
pp. 112-119 ◽  
Author(s):  
Debora Downey ◽  
Mary Beth Happ
Keyword(s):  
Health Care Providers ◽  
Communication Disorders ◽  
Provider Communication ◽  
Nurse Training ◽  
Care Providers ◽  
Speech Language Pathologists ◽  
Complex Communication Needs ◽  
Team Members ◽  
Patient Provider Communication ◽  
Communication Needs

Abstract Hospitalized patients across the age continuum often present with complex communication needs (CCN) due to motor, sensory, cognitive, and linguistic barriers they may experience during their admission. Although hospitals recognize the need to enhance communication to improve quality and safety for all patients, the emphasis has been primarily on improving ”care coordination” amongst the health care providers the patient encounters across all points of admission. Most hospitals have yet to focus on improving the patient-provider communication experience, especially for patients with CCN. However, this population no longer can be ignored, as new standards mandate efforts to improve communication for patients with CCN. Nurses, as the team members responsible for continuous care during hospital stays, and speech-language pathologists, as communication disorders specialists, are positioned distinctively to facilitate patient communication and prevent miscommunications between patients and care providers. This article highlights the need to enhance the patient-provider communication experience for patients with CCN. We review the state of nurse training for patients with CCN, discuss the role speech-language pathologists can play in developing and implementing nurse training protocols, and outline basic elements nurse training modules should include.

Interdisciplinary Therapy Assessments for the Older Adult

2012 ◽  
Vol 17 (1) ◽  
pp. 11-16
Author(s):  
Lynn Chatfield ◽  
Sandra Christos ◽  
Michael McGregor
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Standardized Testing ◽  
Health Care Providers ◽  
Outcome Measurement ◽  
Care Providers ◽  
Patient Centered ◽  
Screening Process ◽  
Evidenced Based ◽  
Changing Economy

In a changing economy and a changing industry, health care providers need to complete thorough, comprehensive, and efficient assessments that provide both an accurate depiction of the patient's deficits and a blueprint to the path of treatment for older adults. Through standardized testing and observations as well as the goals and evidenced-based treatment plans we have devised, health care providers can maximize outcomes and the functional levels of patients. In this article, we review an interdisciplinary assessment that involves speech-language pathology, occupational therapy, physical therapy, and respiratory therapy to work with older adults in health care settings. Using the approach, we will examine the benefits of collaboration between disciplines, an interdisciplinary screening process, and the importance of sharing information from comprehensive discipline-specific evaluations. We also will discuss the importance of having an understanding of the varied scopes of practice, the utilization of outcome measurement tools, and a patient-centered assessment approach to care.

The Interaction of Pulmonary Physiology and Swallowing: A Juggling Act for the Physician and Speech-Language Pathologist

2009 ◽  
Vol 18 (1) ◽  
pp. 34-40
Author(s):  
Karen J. Dikeman ◽  
Marta S. Kazandjian ◽  
Elbert Tun ◽  
Panina Niyazova ◽  
Tien-Tsai Tsai ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Medical Condition ◽  
Team Approach ◽  
Care Providers ◽  
Geriatric Population ◽  
Pulmonary Physiology ◽  
Speech Language Pathologist ◽  
Ventilator Dependence ◽  
Clinical Case Studies ◽  
Single Disease Entity

Abstract Patients who are dependent upon tracheostomy and/or ventilator use present a particular challenge to health-care providers. The interaction of pulmonary physiology and deglutition is complex, as illustrated in the course of patients who are in the weaning process. Speech language pathologists (SLPs) should work closely with their physician colleagues to understand the influence of multiple medical co-morbidities on intervention. In traditional medicine, the clinician's objective is to connect a patient's many symptoms and complaints to a single disease entity. However, in caring for the ventilator dependent geriatric population, a symptom such as dysphagia typically results from the interplay of various, multi-organ symptoms, and conditions. This article strives to demonstrate the “juggling act” that the physician and SLP must balance between the patient's current medical condition, pulmonary dysfunction, and disordered swallowing. Clinical case studies illustrate the benefit of swallowing intervention on quality of life. While the care of patients with tracheostomy and ventilator dependence requires a team approach, with respiratory therapy and nursing vital members, this article emphasizes the roles of the SLP and physician.

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