IMPORTANCE OF COMMUNICATION Flashcards
it includes self-expression and active listening to develop an understanding of what people are saying…
Success Interpersonal Communication
these forms of communications are critically important in healthcare…
Verbal & nonverbal
this is where communication starts…
Registration & Scheduling
What are the necessary details that must be collected and communicated in registration & scheduling?
- pt’s insurance & benefits
- pt’s financial responsibility
this is something billing & coding specialists should avoid…
slang terminology
communicating w stakeholders is critical component of…
Revenue-generating activities
What are the primary stakeholders in a health care org?
- Policymakers
- Patients (consumers)
- Providers
- Third-party payers
they are the organizations that
- cover medical expenses of the policyholder & dependents and
- responsible for maintaining financial stability of hc policies & programs …
Third-party payers
they analyze the
- premium rates
- covered benefits
- reimbursement for services rendered and - determine if changes need to be made to coverage plans for the following year…
Administrative Processes
it is
- composed of policymakers that
- determines who is eligible to receive care & what services are provided, how, where, & by whom
- define how services are paid
Regulatory Agencies
these are all closely regulated…
- Data retention
- Maintenance
- Transmission
- Usage
it is the critical components to maintain data…
Backup & Recovery
- it determines how many pts are being seen in a certain health care setting &
- includes population health management, quality improvement, & cost vs. reimbursement analysis
Administrative Uses of Data
it is a collective source of administrative data w/in an org…
Practice Management System
- it is used by various public entities, medical registries, and providers to maintain the health and well-being of the population
- determine the cost-effectiveness of treatment, procedures, and therapies
Clinical Uses of Data
refers to the records, files, & documents that are physically or digitally stored for future reference & use
Data Storage
it is used for third-party payers to provide pt info like eligibility and patient responsibility amounts
Electronic data interchange (EDI)
the process of collecting pertinent facts abt pt care & outcomes to perform security or other analyses…
Reporting Data
they are the state & federal regulations/org that are responsible for ensuring health care organizations comply with regulations that safeguard patient information, billing, and health records
HIPAA & OIG
it is the division pf Department of Health & Human Services (HHS) and responsible for investigating fraud & abuse related to Medicare, Medicaid, and other federally funded programs…
OIG
- it is a federal regulation that was designed to provide protection of confidentiality and security for patients
- it’s the 1st rule that standardized how a patient’s information must remain confidential…
HIPAA
- a program developed by the OIG for health
care providers to self-disclose instances of
potential fraud - done voluntarily
- OIG view as a cooperative effort toward compliance…
Provider Self-Disclosure Protocol (SDP)
