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Improving health insurance claims process
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A NEW POSITION IN CLAINS DEPARTMENT NEW POSITION IN CLAIMS DEPARTMENT ANNETTE SMITH RASMUSSEN COLLEGE 07052016 FROM: human resource department: Annette Smith human resource Manager. To: CEO of Epic Health Solutions The Claims Department has been having a lot of Volume in the amount of work has is need to be done. I as your Human Resource Manager am concerned about our clients we protect though our Health Insurance are not getting the Professional assistance that they have come to expect of our Company. I would like to get the Claims Department Organized and working smoother than it is. I have come to you with this Problem with a solution to this problem.
The Claims and Patient Business Services departments have made remarkable strides on getting back on track due to these changes, which has provided much needed relief to the MSD. However, MSD is still struggling, on the other hand, with a few issues such as high absenteeism and low morale which makes it difficult to balance available staff with incoming call load. There are also a few factions that are often found socializing in other people’s cubicles or going to the lobby to take personal phone calls. Lastly, there has also been difficulty within the management team as a result of both past and future management styles within the department.
Case 1 -- You work in a busy multi-specialty clinic with a high patient volume. The physicians enter the type of code that will yield the greatest reimbursement. You suspect the codes are not accurate.
WellStar Health Systems is currently the preeminent and largest health care provider in Metro Atlanta. WellStar Health Systems is a not-for-profit institution that is composed of 5 hospitals and an abundance of physician groups. Physician specialty groups included within WellStar are: ENT, Psychiatry, Endocrinology, Pulmonary Medicine, Infectious Disease, General Surgery, Rehabilitation, Pathology, and Rheumatology. WellStar’s organizational design is composed of internal and external factors that define the organization’s size, organizational structure, and processes. Internal and external factors are the basis for influencing managerial conclusions in decision-making. These factors vary from organization to organization and are the rationale for understanding WellStar’s strengths, weaknesses, opportunities, and threats. Understanding these variables is a necessity for the sake of WellStar’s survival
Health Care workers are constantly faced with legal and ethical issues every day during the course of their work. It is important that the health care workers have a clear understanding of these legal and ethical issues that they will face (1). In the case study analysed key legal and ethical issues arise during the initial decision-making of the incident, when the second ambulance crew arrived, throughout the treatment and during the transfer of patient to the hospital. The ethical issues in this case can be described as what the paramedic believes is the right thing to do for the patient and the legal issues control what the law describes that the paramedic should do in this situation (2, 3). It is therefore important that paramedics also
This paper’s brief intent is to identify the policies and procedures currently being developed at Midwest Hospital. It identifies how the company’s Management Committee was formed and how they problem solved and delegated responsibilities. This paper recognizes the hospital’s greatest attributes and their weakest link. Midwest Hospital hired Dr. Herb Davis to help facilitate the development and implementation of resolutions for each issue.
...ta on the most capable strategy to address the HR issues, make additional recommendations, if any, to address the distinguished and prioritized HR issues.
The concept of Case management has was first introduced in the 1970’s by insurance companies as a way to monitor and control costly health insurance claims, commonly created by a catastrophic accident or illness (Jacob & Cherry, 2007). Today almost every major health care organization has a case management program managing and directing the use of health care services for their clients. Also, case management by payer organizations is recognized as external case management.
Intermountain Healthcare was established in 1975 when The Church of Jesus Christ of Latter-day Saints donated its then 15-hospital system to the communities they served. It was formed as a secular not-for-profit organization to administer those hospitals. Now Intermountain Healthcare continues to be a not-for-profit health system based in Salt Lake City, Utah, with 22 hospitals, a broad range of clinics and services, about 1,400 employed primary care and secondary care physicians at more than 185 clinics in the Intermountain Medical Group, and health insurance plans from SelectHealth (McLaughlin, Johnson & Sollecito, 2012). IHC's reputation for clinical excellence is based on a strong foundation of evidence-based medicine and clinical process
In addition, due to the patients showing up late for their appointments and on the wrong dates, there will be a new department implemented into the organization. This department will be the scheduling of patients, sending out reminder cards, and completing a courteous call to the patients about their appointment date, time, and
The Integrated health care is an approach of interdisciplinary of collaboration and communication among health professionals. The characteristic is unique because of the sharing information which in the team members and related to patient care to establishment of treatment whether biological, psychological, and social needs. The interdisciplinary health care team includes a diverse and variety group of members (e.g., specialist, nurses, psychologists, social workers, and physical therapists), depending on the needs of the patient for the best treatment to the patient care.
Banner health is non- profit organization dedicated to provide quality care to the patients. It provides a quality care to the patients in various specialized ares of health care such as cancer care, heart care, rehabilitation care, post surgical care, pediatric care and others (Bannerhealthcare, 2015). 29 hospitals and other medical centers are operated by banner health care and “it provides a more than $153 million in charity care”(Bannerhealthcare, 2015). The goal of banner health care is to optimize the excellence in clinical care, innovation, research technologies and others (Bannerhealthcare, 2015). This paper explains the readiness of the banner health care in addressing
Moreover, I will endeavor to promote safe and better working environment by identification of obstacles and challenges. I will achieve this by identifying these challenges by foreseeing and developing a contingency plan. This is essential as it aids in improving the working environment for all patients and healthcare
Chris had just been promoted as an Executive Assistant for Pat the CEO, Chief Executive Officer, of Faith Community Hospital. Pat had given Chris her very first assignment on her first day of work as an executive assistant and that was to gather information so that Pat can present the issues to the board of directors. Faith Hospital is faced with issues that needed attention and the board of directors must be notified of the issues so that a solution can be remedy to help the hospital stay in business.
Ferris Healthcare, Inc recognizes that their growth as organization was depending on their rapid implementation of project management. Their line managers have been performing as project managers, which most of the times resulted on delayed and over budget projects. All employees agree that a project management methodology is necessary in the organization.
As a CFO of an Ethics and Risk Management Committee, my concerns may differ depending in the type of institution that we are categorized as; are we a for-profit hospital? A non-profit? Community Hospital? Federal or government hospital? Is it a large, medium or small size facility? Is it rural or urban?