Case Management

Healthcare Case Management: What Provisions are Missing from Your Healthcare Future?

Posted on by Dominick Flarey

What Provisions are Missing from Your Healthcare Future?

There will be several changes in the medical industry coming soon. The Affordable Care Act is impacting doctors, nurses, and patients with it’s new laws and rules. Many nurses are working fewer hours as a result, and providing quality medical care is becoming a challenge for some. Fortunately, hospitals and clinics will always need nurses and there are many improvements coming along with these changes. Patients should be concerned about their health care plans and what is included in them. A quality health care plan will have the following provisions.

Home Health Care Worker

Many people receive health care services outside of a medical setting, especially as they get older. Home health care workers provide services to people who are temporarily and permanently disabled. A home health care nurse can assist patients with their daily tasks and can also give the patient’s family detailed care instructions. It is always a good idea to include provisions for a home nurse or assistant. Check out programs like United Energy Workers Healthcare for more information on what you may qualify for.

Mental Health Care Services

Some people need mental health care services in their healthcare plan. Before you purchase a health care plan, you should make sure the plan offers coverage for certain mental health care services if this is an issue for you. The plan should offer coverage for inpatient and outpatient treatment centers. Some insurance policies have a separate deductible for mental health care services as well. You should choose a plan that has an affordable deductible for mental health care services.

Chiropractic and Acupuncture Coverage

Some insurance plans do not cover chiropractic and acupuncture services. If you deal with chronic pain, make sure you have services on hand or that are provided for in some way. Some people think that these benefits are not a necessity, but if you ever have a serious injury, you may need chiropractic or acupuncture services and they can be covered.

Pre-existing Conditions Coverage

All medical plans should cover pre-existing conditions. In the past, insurance companies would not insure people who had a pre-existing medical condition. The affordable care act does not allow discrimination based on a person’s current health status. You should make sure that the insurance policy does not permit exclusions based on pre-existing medical conditions.

Preventative Health Care Services

Your plan should offer affordable preventative health care services. Most doctors want to treat a serious medical condition in the early stages of the disease. If your plan has reasonably priced preventative health care services, you can visit your primary care doctor whenever you have a medical problem.

New changes are becoming effective every year, and the changes are impacting individuals and large companies. Your insurance policy is an important purchase. If you have any questions about your policy, you should contact the company for clarification.

 

Please also review our healthcare case management program

Case Management Education: Medical Audits: What You Need To Know To Survive One

Posted on by Dominick Flarey

 

Introduction to medical audits and why they exist

Medical audits can help a medical practice objectively review its employees’ practices of diagnosis, billing, consumption of materials, and time usage. These are all components of quality medical care and profitable operations, and must be balanced for the good of the practice. It is possible to discover weaknesses in a medical practices procedures and care before that weakness is able to be discerned by actual patients or their care through the findings of a diligent medical audit.

Why medical audits are needed

To ensure profitability of a medical practice, the business must find a method of measuring performance of personnel, justifying monetary and time expenditures, and quantifying adherence to accepted standards of care to patients. An efficient way of keeping track of these dissimilar matters is by accurate charting procedures by all staff. That chart record establishes a course of treatment for each patient and forms a traceable medical record of a patient’s treatment history. EHR migration is becoming more popular in the medical field, and requires strict attention to detail. Moving records online makes it easier to store and access data for further treatment or audits. Being able to audit a medical office’s activities can provide a detailed history of the care given to a specific patient and the cost of that care. Those are vital facts for anyone coordinating the operations of a medical office.

 

What is covered; how to prepare, and how to benefit from an audit

Prior to beginning a medical audit, a medical office beginning such an audit should start with a vision of what is to be looked at, looked for, and what the results should represent. It is always important to be able to identify that a practice can migrate properly within the established standard for those records. It is also important to ascertain the level of quality to be achieved and how to reach that level if it is not reached at the time of the audit.

 

It is important to have a quality standard to aspire to when beginning an audit. That way, future goals can be set using the results of your medical audit to improve your operations and elevate your standard of care. By using the audit as record of how the medical practice is performing and serving its patients as well as its own business interests, a medical audit can serve as a quality control study to highlight the state of the practice. Future operations and practice decisions can result from studying the outcome of a medical audit and determining what the medical practice needs.

 

In conclusion, medical audits are something that can help your practice and the medical industry. Audits help you ensure that all physicians are following proper procedures for charting etc. With the digitization of most records, it’s not surprising that the medical industry is also following that trend. This can be good news as far as audits go, and storing medical records securely online can make them easier to organize and access for the future. Before beginning your audit, remember to have a vision of what you want your company to be like. Encourage employees that this is a great learning opportunity to help everyone become better and more efficient.

Emma is a freelance writing currently living in Boston, MA. She writes most often on health and education. To see more from Emma, say hi on Twitter @EmmaSturgis2

 

 

Please also review our Case Management Education program to learn more

 

HEALTHCARE CERTIFICATIONS ARTICLE ON BIG DATA AND HEALTHCARE

Posted on by Dominick Flarey

Good article about big date and healthcare.

The article, “Strong Opportunities for Big Data in Healthcare – Population Health Management, Clinical Decision Support and Real-World Data”, by Frost & Sullivan states,

“The healthcare industry is steadily realizing the value offered by Big Data solutions, particularly in “-omics” research and medical record mining. However, current investments are focused on serving immediate needs of the investing stakeholders, which often makes them siloed and incrementally beneficial, as opposed to a strategic organizational redesign of the data strategy that provides exponential returns on investment.”

To read the entire article, please click here

If you would like to learn more about AIHCP’s healthcare certifications then please review our programs

Certified Case Manager Article and Rising Health Care Prices

Posted on by Dominick Flarey

Healthcare costs are out of control.  This article below looks at why the US cannot control these rising prices.

The article, “The truth about why the U.S. can’t control healthcare costs” by Ryan Gamlin states,

“A graphic making the rounds on social media has people talking—plots health spending per capita against the average life expectancy for two dozen countries. The chart has renewed the important conversation around why the United States’ experience is such an outlier, spending more than any other country by a wide margin, effectively proving the adage that “more is not better.”

To read the entire article, please click here

Please also review our Case Management Program.  If you wish to become a certified Case Manager, then please review

Healthcare Case Management Article on Healthcare Issues

Posted on by Dominick Flarey

We talk so much about health care that we sometimes forget the most important thing, health itself.  This article goes into this issue deeper and explains somethings about healthcare and health.

The article, “The One Important Thing Missing From the Health Care Debate” by Jeffrey Pfeffer states,

“You may have seen the big news on health care: Aetna is going to stop offering individual health insurance policies on the health exchanges in 11 of the 15 states where it operates. Aetna AET -0.31% follows the lead of another large health insurer, United Health UNH -0.47% , which announced in April that it was withdrawing from almost all of the health insurance marketplaces where it operated.”

To read the entire article, please click here

Please also review our healthcare programs.  We offer a comprehensive healthcare case management program for qualified professionals.

Healthcare Certification Education: Get the Most out of Your Healthcare with These 5 Tips

Posted on by Dominick Flarey

Get the Most out of Your Healthcare with These 5 Tips

Health insurance is expensive and many people do not take full advantage of everything their health insurance offers. There are times when health insurance can actually save you money and keep you healthy. Here are five life hacks to help you get the most bang out of your healthcare bucks.

Make Sure Your Insurance Is Right For You
Research your healthcare insurance options thoroughly before you make a final decision. Take inventory of the healthcare needs for you as well as your family and pick a plan that best covers the things you most need from your insurance, such as lower deductibles and lower copays.

Take Full Advantage Of Health Insurance Open Enrollment Periods
If you have already picked a healthcare plan and you don’t think it is right for you, open enrollment is a way to address inadequacies in insurance coverage. During open enrollment, think about your life changes over the last year and also think about the life changes you are able to anticipate for the upcoming year, if possible. If you are planning for an upcoming major life change such as having a baby or major surgery, use the open enrollment period to pick an insurance policy that will best cover you and your family through these life events.

Pick Your Primary Care Physician
Find a primary care physician with a background in health information management programs you are comfortable with. Work to cultivate a strong, positive relationship with your doctor and his nurses. Pick a physician that you trust, respect and feel comfortable being honest with about your health. Your primary care doctor should be invested in your well-being and proactive about getting you to come in for preventative exams.

Always Take Advantage Of The Free Stuff
Everyone loves freebies. Many insurance plans offer stuff for free and many people do not take advantage of these opportunities. For example, an insurance plan may offer a free flu shot, a free Well Woman exam, free birth control and free antibiotics. Many vision plans actually offer one free pair of glasses or a free annual eye exam for all covered individuals.

Utilize Health Programs, Assessments, And Coaches
A lot of insurance companies offer free or low-cost health programs and health assessments. Always check to see if your insurance company offers for programs that are dedicated to blood pressure, cholesterol, rehabilitation, and weight management. Many health insurance programs actually reward individuals for doing their part to live a healthful, active life of wellness. These health opportunities through insurance programs pay people for exercising, being fit, eating right, meeting goals, and picking nutritious foods.

For some families, healthcare is the primary expense that eats up the budget. It pays (literally) to be more involved in you healthcare so you don’t have to compromise your well-being in the long run. Preparation is key. You will get better quality care and improved health if you take a proactive role in your own health. You deserve it. Being proactive about your health by utilizing all benefits of your healthcare plan is just as important as nutrition and exercise. Your health means everything.

If you would also like to learn more about Healthcare Certification Education options from AIHCP, then please review.

Certificaton In Case Management and Nursing Leadership

Posted on by Dominick Flarey

Career Nurses: How to Become a Successful Leader in Your Hospital or Clinic

A leader can be defined in countless ways, but every definition includes the ability to motivate and educate others to improve themselves and their performance. In a hospital or health clinic, leaders ensure patients are properly cared for and employees are happy and qualified. Here are some tips to help career nurses become leaders.

Interact with Your Coworkers

Nurses serve their patients diligently. While this is certainly a chief job component, becoming a leader also requires getting to know your coworkers. The better you know the people you want to lead, the greater understanding you will have of their areas for improvement. Make sure to befriend your coworkers and learn what motivates them.

Get a Master’s Degree in Nursing Online

The more education you get the more knowledge you have. This will make you better equipped to lead others and increase your nursing acumen. Obtaining a master’s of nursing online will also expose you to facets of nursing you may be less experienced in. Such experience allows you to better relate to nurses and doctors in your hospital or clinic. Now, top universities offer master’s degrees in nursing online, meaning there has never been a more flexible or convenient time to get your master’s degree.

Seek Out Committee Positions

Most hospitals and clinics have some sort of panel, committee, or advisory board. Volunteer for a position on one of them. You will obtain valuable decision making experience and get to hear from your coworkers. You will learn what they are passionate about and what bothers them at the workplace. Once you know the concerns employees have, you can help them turn concerns into improvements. The face time you will get with others is also key to developing trust and communication.

Lead by Example

Leaders must back up their words with actions. When you communicate a message, make sure it comes to fruition. Doing small things to make the workplace better—whether it be cleaning up the breakroom, greeting people in the morning, or any other small gestures of service—show people that you lead by example.

Thank People

Positive affirmation goes a long way. It makes coworkers feel appreciated. It also makes you likeable. Compliment the people in your hospital or clinic when they do a good job. Let them know that you value them and the talents they bring to the workplace.

In Conclusion

Career nurses can be influential leaders. In fact to be truly successful in any hospital or clinic, a nurse must be a leader in some fashion. Nursing is a career where one must take the initiative as someone’s life may depend on it. It is not just about making the workplace a better or happier place for your co-workers, but it could mean life or death for certain patients. If you are thinking of getting into a nursing career, keep the tips above in mind and keep doing your homework to make sure that this is a career that is right for you. In the end, you will need to become a leader and if you are successful, then you will have a truly fulfilling and memorable career.

 

About the Author:

About the Author: Lizzie Weakley is a freelance writer from Columbus, Ohio. She went to college at The Ohio State University where she studied communications. In her free time, she enjoys the outdoors and long walks in the park with her 3-year-old husky Snowball.

 

 

Another excellent way to enhance your nursing career and become a leader is via a certification in Case Management.  Nurses with good organizational skills and leadership qualities should consider becoming certified in Case Management with AIHCP.  A certification in Case Management is an excellent choice for you!

AIHCP

Healthcare Providers Across the U.S. Select Allscripts to Establish Chronic Care Management Programs and Accountable Care Organizations

Posted on by Dominick Flarey

CHICAGO, Oct. 13, 2015 (GLOBE NEWSWIRE) — Several physicians practices and organizations recently selected Allscripts (Nasdaq:MDRX) to create or bolster their population health strategies. These providers want to provide better ongoing management of patients with chronic diseases and form accountable care organizations (ACOs) to facilitate value-based care and reimbursement models.

Sourced through Scoop.it from: globenewswire.com

Good outcomes for chronic care is correlated with good healthcare management of the patient and his or her needs.

This article looks at how healthcare providers can supply better care for better long term results.

If you would like to become a certified healthcare case manager, then please review the program and see if your qualified.

#certifiedhealthcarecasemanager

Case Management Training and Medical Coding

Posted on by Dominick Flarey

Staying Mistake Free: 5 Keys to Halting Medical Code Errors

Medical coders assist physicians in submitting the proper codes and documentations to patients and other payers. The following are five common medical coding errors and suggestions on how to avoid them.

Wrong Interpretation of Operative Reports

Coders are only going to bill for procedures that they see documented by a physician. Even if in the report a doctor gives a description of the procedure, and even if the procedure is listed as being performed, most coders are not going to code it if there is not an operative description present. This problem can be solved by making sure that the provider writes down the operative description for every procedure performed, and the coder should be trained to be able to interpret an operative report and code it appropriately.

The Coder Does Not Know about the Bilateral Procedures/Services

In many cases, a medical coder is going to work in a different location than the physician and their patients. It’s easy for a doctor to forget to write down a bilateral procedure, like an injection, x-ray, or medications. If this happens, there is no way that a coder can bill for them. A physician must take responsibility for their part in the coding process. Bilaterals should be highlighted or circled to guarantee they are properly billed.

Unbundling

This is when an entire procedure is broken down into little parts and charged separately. If there is already a comprehensive code for the entire procedure, unbundling is unethical, illegal, and could lead to an audit. Coders must know comprehensive codes like the back of their hand.

Code Not to its Highest Specificity

Certain codes need four or five digits in order to reach their highest specificity. If the codes are not properly written, the claim may be rejected. This can be fixed by a coder guaranteeing that a diagnosis has been coded to the highest level of specificity. If they are not sure, they can use a code book or look it up on the Internet.

Using Outdated Material and Getting Wrong Codes

Medical billing codes change. For this reason, universities that provide an on campus or online health information degree teach their students the importance of staying up-to-date with the latest codes and the latest coding technology. Additionally, coders should go to seminars or attend web seminars to make sure they are up-to-date on codes.

Medical coding is an important part of the healthcare profession. When done properly, it guarantees that physicians are paid for the services they provide while at the same time guaranteeing that patients are only billed for the services they receive.

 

Case Management Training is key to understanding medical coding as well.  Please review our Case Management Training program and let us know if you have any questions

AIHCP

Population Health Management Starts with Flagging High Costs

Posted on by Dominick Flarey

Population health management programs must start by identifying patients in the top tiers of spending, says the Health Care Transformation Task Force.

Sourced through Scoop.it from: healthitanalytics.com

Population health management deals with unequal distribution of healthcare costs within certain groups.  For instance the top five percent of patients deal with half the total annual expenses.  This makes sense since those dying or elderly or terminally ill require more expensive care while most the healthy population requires less expensive techniques

If you are interested in case management training, then please review.  Also please review our program and see if it matches your academic and professional needs as a healthcare professional

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