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This assignment involves a 3-step process. Keeping in mind what you have learned in Chapter 10 (Value-based Purchasing), submit one document in which you mention how you would address each of the points. You are a health information management professional at Happy Hospital. Since the hospital is moving toward adopting more value-based initiatives, you are tasked with the following: Nurse X and Nurse Y are confused about the sections and requirements needed in clinical documentation. They have come to you with the sections listed below. How would you educate and inform them as to what needs to be added or changed regarding what they have done thus far? What the nurses have done thus far is gather the points listed below. The document to be designed is the clinical document itself. All relevant sections should be included in this document. - Medications - Physical exams - Laboratory results - Diagnoses - Current immunization record 2. Happy Hospital is in need of someone proficient in data analytics. What sources of data would you work with? What skills would you use to perform this job? Recommend at least one software tool that would help in performing this task. 3. Only recently has Happy Hospital introduced the Physician Quality Reporting System (PQRS) to its clinicians. Which clinicians would be considered "eligible professionals" under PQRS? List the eligible clinicians under PQRS. Also, keeping in mind the most recent PQRS requirements, what measures and sections would you include when reporting? Designing the report mainly involves including the necessary measures and sections that would be included in the report. Be sure to cite your sources. Note: In this assignment, you are helping the nurses gain an understanding of how to align the clinical quality care with the hospital's financial performance goals relative to VBP. To do so, you will complete each step in the assignment. In question #1, you will explain to the nurses in your own words what VBP is and then create a checklist of things to include in a clinical document to be used when reviewing clinical documents for improvement relative to VBP. You may find it helpful to get an understanding of the PQRS and complete question #3 before completing question #1. You do not have to, but it may help (maybe).
Madhur L.
Goodfellow & Perkins gained a new client, Brookwood Pines Hospital (BPH), a private, not-for-profit hospital. The fiscal year-end for Brookwood Pines is June 30. You are performing the audit for the 2023 fiscal year-end, and the audit is currently in the risk assessment phase. The healthcare industry can be very complicated, especially in the area of billing for services provided. BPH contracts with private physician groups who use the hospital facilities, equipment, and nursing staff to treat patients. The physicians in the private group are not employees of the hospital; they are simply using the hospital facilities to treat patients. For example, a group of urologists has their own practice, separate from the hospital, where they treat their patients. If one of their patients needs a surgical procedure that must be done at a hospital, then the attending urologist will approve the paperwork required to admit the patient to BPH. BPH offers inducements to the urologists so they will refer patients to BPH rather than a competing hospital. One of the inducements BPH offers is free office space in the hospital for the doctors to use when they are treating their patients in the hospital. After the doctor and hospital services are provided to the patient, the patient and/or the patient's insurance company is billed. The doctor will bill for the services he or she provided, and the hospital will bill for the use of hospital facilities and staff. Doctors and hospitals bill using a coding system that is standardized across the healthcare industry and consists of three main code sets: ICD, CPT, and HCPCS. Using a coding system is more efficient and data-friendly compared to writing a narrative about the procedures performed. However, the coding system is very complex, with thousands of different codes for medical procedures and diagnoses. To complicate matters even more, for patients who are covered by government-sponsored Medicare or Medicaid, doctors and hospitals must adhere to complicated government regulations surrounding billings to Medicare and Medicaid. As healthcare costs continue to rise each year, BPH administrators struggle to maintain consistent profitability. They look for ways to keep costs low and also to collect from patients and insurance companies as quickly as possible. In addition, BPH must have a strong risk management team to handle unique situations that may occur in hospitals such as malpractice lawsuits and periodic inspections by the state department of health and hospitals. Negative publicity for BPH could lead to decreased revenues if physicians decide to contract with a competing hospital. Evaluating internal control Analysis: Brookwood Pines has a large number of employees, and it is important for the payroll system to have controls to ensure that employees actually worked the hours they are paid for. Answer the following items: a. Determine the key assertion at risk. b. Describe a practical preventive internal control that would directly address the risk. c. Describe a practical detective internal control that would directly address the risk. d. Explain the test of controls you would perform to test the control in your answer to (b), including the evidence that you would obtain. e. Describe the evidence of an exception to the internal control in your answer to (b). f. Explain the test of controls you would perform to test the control in your answer to (c), including the evidence that you would obtain. g. Describe the evidence of an exception to the internal control in your answer to (c).
Sri K.
A small community hospital in the Midwest has used a homegrown information system for years. The system began in the early 1970s with a financial module. Over time, additional modules were added. A limited number of departments selected a commercial system and interfaces were used to integrate these into the overall functionality of the hospital information system. Except for physicians, most in-house clinical or care-related documentation is online. However, about 15% to 20% of this documentation is done by free text and is not effectively searchable. In addition, the screens, including the drop-down and default values, were built using terms selected by the in-house development team in consultation with clinical staff; thus, there is no data dictionary or specific standard language. In the last few years, the hospital has purchased two outpatient clinics (obstetrics and mental health) and a number of local doctor practices. The clinics and doctors' offices are now being converted to the hospital administrative systems. A few of the clinical applications that are tied directly to the administrative systems, such as order entry and results reporting, are also being installed. A major change is being planned. A new chief information officer (CIO) was hired last year, and she has appointed a chief medical information officer (CMIO) and a chief nursing information officer (CNIO). No other significant staff changes were made. With her team in place, one of the CIO's first activities was to complete an inventory of all applications. Rather than continue to build, a decision was made to switch to a commercial vendor, and the hospital selected a commercial system. As a member of the clinical staff with informatics education, the CIO has requested that you develop a training and information presentation for the clinical staff that will: 1. Identify two or more issues with the existing system 2. Provide staff with appropriate "work-around" for using the existing system 3. Provide an overview of two of the standard languages used within the new system, including discipline or specialty, updating frequency, and available cross-maps - One standard language should pertain only to nursing - One standard language should be multidisciplinary. Obtain clinical staff input, using a five-question survey, of specific methods to support the transition to the new system; questions should be open-ended.
Suman K.
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