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Introduction to Health Services Administration - E-Book

BOOK

Introduction to Health Services Administration - E-Book

(2017)

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Book Details

ISBN
978-0-323-46222-8
Edition
Language
English
Pages
440
Subjects
Medical administration & management
Medical study & revision guides & reference material

Abstract

Learn how to effectively manage both people and a practice as a health care administrator with Elsevier’s Introduction to Health Services Administration. This comprehensive and easy-to-understand text includes an overview of health care delivery in the United States along with an exploration of each role and function of a health services administrator in an ambulatory care facility. From scheduling patients to managing the revenue cycle, you will learn about every aspect of workflow in addition to relevant issues that heavily influence health care practices today, like HIPPA, regulatory compliance, civil and criminal law, and more. This text also provides a wonderful overview of necessary skills such as how to use an electronic health record system and practice management software, how to budget for staff and equipment, how to manage inventory, how to manage risk, how to improve quality and performance in the practice, and how to best market the practice. If you’re looking to become a successful health services administrator, this text is the critical first step.

  • UNIQUE! Comprehensive approach covers the role and functions of a health services administrator and applies them to an array of ambulatory care settings — from a traditional physician’s office to a retail care clinic.
  • UNIQUE! Coverage of key PAHCOM and AAPC competencies help you prepare for the competencies on the CMM and CPPM credentialing exams.
  • UNIQUE! Case study scenarios are constructed around many different settings to provide a snapshot of professional life.
  • UNIQUE! Takeaway boxes highlight key points and important concepts.
  • Current Trends in Health Care boxes discuss methods, ideas, and newsworthy issues.
  • Take Learning to the Next Level boxes clarify the subjects being discussed with supplemental information.
  • Learning Checkpoints appear in each section to help you gauge your own learning successes at that point in the reading.
  • Review questions are tied to each learning objective.
  • More than 200 images illustrate difficult concepts and bring health services administration to life.
  • Key terms with definitions in the margins make it easy to identify and learn new vocabulary.
  • Answers to exercises in the text and review questions in the back of the book equip you for self-study.

Table of Contents

Section Title Page Action Price
Front Cover cover
Half title page i
Short TOC ii
Introduction to Health Services Administration iii
Copyright Page iv
Contributors v
Preface vi
Key Features vii
Organization of the Text vii
For the Instructor vii
Table Of Contents ix
Unit I Introduction to Health Services Administration 1
Unit 1_text 1
1 The Health Services Administrator 3
Chapter Outline 3
Chapter Objectives 3
Vocabulary 3
What Is Health Services Administration? 4
A Routine Visit 4
The Role of the Health Services Administrator 6
Duties 8
A Career in Health Services Administration 9
Settings 9
Education 9
Internships and Externships 10
Certification and Credentialing 10
Continuing Education 11
Employment Outlook 11
Review Questions 13
2 Health Care Professionals and Settings 14
Chapter Outline 14
Chapter Objectives 14
Vocabulary 14
Introduction 15
Health Care Professionals 15
Credentialing 15
Licensing 16
Physicians 17
Nurses 18
Physician Assistants (PAs) 20
Medical Assistants 20
Medical Billers and Coders 21
Other Health Professionals 22
Ambulatory Care Settings 24
Physician’s Office 25
Organization 26
Ownership 27
Clinic 28
Diagnostic Facility 28
Ambulatory Surgery Center (ASC) 28
Urgent Care Clinic 29
Retail Health Clinic 29
Acute Care Settings 30
Hospital 30
Other Settings 32
Long-Term Care and Skilled Nursing Facilities 32
Home Health Care 33
Hospice Care 33
Review Questions 33
3 Health Care Delivery1The editors wish to acknowledge the work of Nadinia Davis, whose writing on reimbursement in Foundations of Health Information Management provides the basis for much of the content of this chapter. 35
Chapter Outline 35
Chapter Objectives 36
Vocabulary 35
Introduction 36
History of Health Care in the United States 36
Health Care Providers 36
Health Insurance 39
Federal Government Involvement 40
The HMO Act of 1973 41
Employee Retirement Income and Security Act (ERISA) of 1974 42
Tax Equity and Fiscal Responsibility Act (TEFRA) of 1982 42
Consolidated Omnibus Reconciliation Act (COBRA) 43
Health Insurance Portability and Accountability Act (HIPAA) 43
Balanced Budget Act (BBA) of 1997 43
Affordable Care Act (ACA) 44
Legal and Regulatory Oversight 46
Federal 46
State 47
Local 47
Accreditation 47
Professional Standards 49
Paying for Health Care4The editors wish to acknowledge Nadinia Davis and Melissa LaCour, whose writing in Fundamentals of Health Information Management provides the basis for this section of the chapter. 52
Insurance 52
Assumption of Risk 52
Types of Health Insurance 55
Indemnity 55
Managed Care 56
Health Maintenance Organizations (HMOs) 57
Preferred Provider Organizations (PPOs) 58
Point of Service (POS) 58
High-Deductible Health Plans (HDHPs) 58
The Affordable Care Act (ACA) 59
Medicare 60
Medicaid 62
Characteristics and Challenges 64
Integrated and Fragmented Care 64
Rising Costs 67
Uninsured and Underinsured Populations 68
Review Questions 71
Unit II Administrative Management 73
Unit 2_text 73
4 Health Care Processes and Workflow 75
Chapter Outline 75
Chapter Objectives 75
Vocabulary 75
Introduction 76
Workflow 76
Scheduling 77
Triage 80
Scheduling Methods 81
Check-In 82
Clinical Assessment 83
Checkout 84
Revenue Cycle 84
The Facility 86
Housekeeping 86
Facility Layout 86
Review Questions 89
5 Documentation 90
Chapter Outline 90
Chapter Objectives 90
Vocabulary 90
Introduction 91
The Medical Record 91
Types of Health Data 92
Demographic Data 92
Legal Data 94
Financial Data 94
Clinical Data 96
Signatures 97
Imaging and Laboratory Documentation 98
Operative Reports 98
Discharge Summary 98
Ownership 98
Retention 99
Other Types of Documentation 106
Uses of Documentation 107
Patient Care 107
Support of Litigation 107
Reimbursement 108
Licensure, Accreditation, and Certification 108
Administrative Functions 108
Research 108
Coding 109
International Classification of Disease, 10th Revision, Clinical Modification 109
Healthcare Common Procedure Coding System (HCPCS) 109
CPT’s Evaluation and Management Codes 110
Review Questions 112
6 Technology 113
Chapter Outline 113
Chapter Objectives 113
Vocabulary 113
Introduction 114
Electronic Health Records 114
Benefits of EHR Technology 115
Health Information Exchanges 121
Challenges to Implementation 122
Incentives for Use 124
Practice Management Software 125
Telehealth 132
Review Questions 134
7 Managing Supplies and Inventory 135
Chapter Outline 135
Chapter Objectives 135
Vocabulary 135
Introduction 136
Managing Inventory 136
Duties and Responsibilities 137
Inventory Loss 138
Employee Theft 140
Ordering 141
Preparing a Purchase Order 143
Receiving 144
Best Practices 145
Review Questions 146
8 Basic Finance and Health Care Accounting 147
Chapter Outline 147
Chapter Objectives 147
Vocabulary 147
Introduction 148
Financial Statements 149
Balance Sheets 149
Current Assets 150
Fixed Assets 150
Liabilities 151
Net Worth 151
Income Statements 151
Budgeting 154
Capital Budget 154
Operational Budget 156
Variance 157
Review Questions 159
9 Revenue Cycle 160
Chapter Outline 160
Chapter Objectives 160
Vocabulary 160
Introduction 161
Health Insurance Basics 161
Cost Sharing 161
Reimbursement Methodologies 164
Fee-for-Service 165
Episode-of-Care Reimbursement 165
Medicare Prospective Payment System 166
Resource-Based Relative Value Scale 166
Hospital Outpatient Prospective Payment System 168
Ambulance Fee Schedule 168
Home Health Prospective Payment System 168
Managed Care 169
Revenue Cycle Management 170
Front-End Processes 170
Scheduling and Registration 170
Insurance Verification 171
Preauthorization 171
Medical Necessity Coverage 172
Advanced Beneficiary Notice 172
Preparing for and Processing Claims 172
Charge Capture 173
Chargemaster 173
Claims 173
Claims Scrubber Software 173
Coding 173
International Classification of Disease, Tenth Revision, Clinical Modification 174
Healthcare Common Procedure Coding System 175
Current Procedural Terminology 175
Clinical Documentation 175
Billing/Claims Processing 176
Postbilling Processes 176
Payment Posting 176
Denial Management 178
Revenue Cycle Monitoring 179
Accounts Receivable (A/R) Days 179
Unbilled Accounts 180
Clean Claims Rate 180
Denials 180
Review Questions 181
10 Quality, Performance Improvement, and Risk Management 182
Chapter Outline 182
Chapter Objectives 182
Vocabulary 182
Introduction 183
Quality 183
Measuring Quality 184
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) 184
Healthcare Effectiveness Data and Information Set 185
Auditing 186
Internal Audits 187
External Audits 187
Billing Audit 188
Compliance Auditing 189
Performance Improvement2The editors wish to acknowledge Nadinia Davis and Melissa LaCour, whose writing in Fundamentals of Health Information Management provides the basis for this section of the chapter. 190
Meetings 190
Performance Improvement Methods 191
Plan, Do, Check, and Act Method 191
Lean Method 191
Six Sigma Method 192
Benchmarking Method 192
Performance Improvement Tools 193
Data-Gathering Tools 193
Data Presentation Tools 195
Bar Graphs, Line Graphs, and Pie Charts 196
Decision Matrix 198
Flowchart 198
Risk Management 200
Disaster Management 202
Planning 202
Review Questions 205
Unit III Ethical and Legal Concerns 207
Unit 3_text 207
11 Legal Issues and Fraud in Health Care 209
Chapter Outline 209
Chapter Objectives 209
Vocabulary 209
Introduction 210
Overview of the Law 210
Criminal Law 210
Infractions 211
Misdemeanor 211
Felony 211
Civil Law 212
Tort Law 212
Contract Law 213
Administrative Law 214
Consent for Treatment 215
Details Regarding Consent 216
Medical Liability and Malpractice 218
Negligence 218
Types of Damages 219
Liability in a Health Care Facility 220
Liability, Malpractice, and Personal Injury Insurances 220
Medical Professional Lawsuit 221
Interrogatories 221
Depositions 221
Subpoenas 222
Inside the Courtroom 222
Burden of Proof 223
Verdict 223
Statute of Limitations 223
Mediation and Arbitration 224
Laws Affecting the Health Care Facility 225
Patients’ Bill of Rights 225
Americans With Disabilities Act 225
HITECH Act 227
Compliance Reporting 227
Child Abuse Prevention and Treatment Act 227
Elder Abuse 229
Patient Self-Determination Act 229
Occupational Health and Safety Act 231
Hazard Communication 232
Ionizing Radiation 232
Bloodborne Pathogens 232
Clinical Laboratory Improvement Amendments Act 233
Health Care Fraud and Abuse 234
Stark Law 234
False Claims Act 235
Sunshine Act 235
Legal and Ethical Issues 235
Review Questions 237
12 Health Insurance Portability and Accountability Act (HIPAA) 238
Chapter Outline 238
Chapter Objectives 238
Vocabulary 238
Introduction 239
Portability 239
Privacy Rule 240
Security Rule 243
Enforcement 248
Consequences of HIPAA Noncompliance 248
Review Questions 250
13 Compliance 251
Chapter Outline 251
Chapter Objectives 251
Vocabulary 251
Introduction 252
Compliance Program 252
Development 253
The Office of Inspector General 253
Compliance Plan 256
Importance of Documentation 257
Implementation 258
Monitoring for Effectiveness 259
Noncompliance 260
False Claims Act 260
Anti-Kickback Statute 260
Physician Self-Referral Law (Stark Law) 260
OIG Audits and Actions 262
Disclosure 263
Resolution Process 264
Corporate Integrity Agreements 265
Review Questions 267
Unit IV Communication 269
Unit 4_text 269
14 Business Communication and Professionalism 271
Chapter Outline 271
Chapter Objectives 271
Vocabulary 271
Introduction 272
Professionalism 272
Patient Respect 273
Dependability 273
Professional Team Collaboration 273
Effective Communication 274
Communication Barriers 275
Privacy 276
Lack of Time 276
Special Populations 277
Elderly Patients 277
Cultural Sensitivity and Competency 278
Hard-to-Reach Populations 279
Patients in Pain 280
Verbal Communication 280
Phone Etiquette 280
Answering the Call 281
Confirming Appointments 281
Test Results 281
Billing 282
Closing the Call 282
Triage and Call Flow Management 282
Patient Visit 283
Nonverbal Communication 283
Written Communication 284
Email Etiquette 284
Email or Phone Call 285
Replying to Incoming Email 285
Subject Line 285
Message Content 285
Closing and Signature 286
Proofreading 286
Carbon Copy and Blind Carbon Copy 287
Reply to All 287
Forwarding Emails 287
Attachments 287
Professional and Formal Business Letters 287
Business Address 288
Date of Letter 289
Recipient Address 289
Greeting 289
Main Body 289
Closing 289
Signature 289
Form Letters 289
Memorandums 289
Heading 290
Body or Content 291
Formatting 291
Distribution 291
Meetings 292
Agenda 292
Minutes 292
Review Questions 296
15 Marketing* 297
Chapter Outline 297
Chapter Objectives 297
Vocabulary 297
Introduction 298
Marketing Needs of the Health Care Practice 298
Identifying Customers 299
SWOT Analysis 299
Strengths and Weaknesses 300
Opportunities and Threats 300
Marketing Tools 301
Community Involvement 301
Automated Phone Calls 302
Newsletters and Blogs 302
Print Ads in Magazines and Newspapers 302
Internet Reviews 303
Social Media 303
Websites 304
Choosing a Website Name 304
Creating a Site Map 304
Home Page 305
About Us Page 305
Testimonials or Information Page 305
Specials Page 305
Contact Us Page 305
Designing Pages 305
Increasing Website Traffic 306
Public Relations 307
Addressing Bad Press 307
High-Quality Customer Service 308
Patient Loyalty 308
A Helpful Attitude 308
Identifying With Patients 309
What Do Patients Expect? 309
Patient Surveys 309
Problem Patients 310
“Welcome to Our Office” Packet 311
Introduction to the Medical Office 312
Missed Appointments and Cancellation Policy 312
Medical Office’s Financial Policy 312
Patient Portal 312
Patient Instruction Sheets 313
List of Community Resources 314
Legal and Ethical Issues 314
Review Questions 315
Unit V People and Organizational Management 317
Unit 5_text 317
16 Hiring, Training, and Evaluating Employees 319
Chapter Outline 319
Chapter Objectives 320
Vocabulary 319
Introduction 320
Strategic Human Resource Management (SHRM) 320
Recruitment Strategy 321
Whom to Hire 322
Advertising Channels 322
Internal Recruitment Methods 322
External Recruitment Methods 323
Hiring 323
Prescreening 324
Interviewing 324
Selection 325
Answer Key 373
Chapter 1 373
Learning Checkpoint 1-1. What Is Health Services Administration? 373
Learning Checkpoint 1-2. A Career in Health Services Administration 373
Review Questions 373
Chapter 2 374
Learning Checkpoint 2-1. Health Care Professionals 374
Learning Checkpoint 2-2. Ambulatory Care Settings 374
Review Questions 374
Chapter 3 375
Learning Checkpoint 3-1. History of Health Care in the United States 375
Learning Checkpoint 3-2. Legal and Regulatory Oversight 376
Learning Checkpoint 3-3. Paying for Health Care 376
Review Questions 376
Chapter 4 377
Learning Checkpoint 4-1. Workflow 377
Learning Checkpoint 4-2. The Facility 378
Review Questions 378
Chapter 5 378
Learning Checkpoint 5-1. The Medical Record 378
Learning Checkpoint 5-2. Uses of Documentation 379
Review Questions 379
Chapter 6 380
Learning Checkpoint 6-1. Electronic Health Records 380
Learning Checkpoint 6-2. Challenges and Incentives 380
Review Questions 381
Chapter 7 381
Learning Checkpoint 7-1. Managing Inventory 381
Learning Checkpoint 7-2. Ordering 381
Review Questions 382
Chapter 8 382
Learning Checkpoint 8-1. Financial Statements 382
Learning Checkpoint 8-2. Budgeting 382
Review Questions 383
Chapter 9 383
Learning Checkpoint 9-1. Health Insurance Basics 383
Learning Checkpoint 9-2. Reimbursement Methodologies 384
Learning Checkpoint 9-3. Revenue Cycle Management 384
Review Questions 385
Chapter 10 385
Learning Checkpoint 10-1. Quality. 385
Learning Checkpoint 10-2. Performance Improvement 386
Learning Checkpoint 10-3. Risk Management and Disaster Management 386
Review Questions 386
Chapter 11 387
Learning Checkpoint 11-1. Overview of the Law 387
Learning Checkpoint 11-2. Consent for Treatment 387
Learning Checkpoint 11-3. Medical Liability or Malpractice 388
Learning Checkpoint 11-4. Medical Professional Lawsuit 388
Learning Checkpoint 11-5. Laws Affecting the Health Care Facility 388
Learning Checkpoint 11-6. Health Care Fraud and Abuse 389
Review Questions 389
Chapter 12 392
Learning Checkpoint 12-1. Privacy Rule 392
Learning Checkpoint 12-2. Security Rule 392
Review Questions 393
Chapter 13 393
Learning Checkpoint 13-1. Compliance Program 393
Learning Checkpoint 13-2. Compliance Program 393
Review Questions 394
Chapter 14 394
Learning Checkpoint 14-1. Professionalism 394
Learning Checkpoint 14-2. Effective Communication 395
Review Questions 395
Chapter 15 397
Learning Checkpoint 15-1. Marketing Needs of the Health Care Facility 397
Learning Checkpoint 15-2. Marketing Tools 397
Review Questions 397
Chapter 16 398
Learning Checkpoint 16-1. Recruitment and Hiring 398
Learning Checkpoint 16-2. Training and Development 398
Learning Checkpoint 16-3. Performance Reviews and Termination and Dismissal 398
Learning Checkpoint 16-4. Employment Laws 399
Review Questions 399
Chapter 17 400
Learning Checkpoint 17-1. Functions of Management 400
Learning Checkpoint 17-2. Conflict Management 401
Review Questions 401
Chapter 18 402
Learning Checkpoint 18-1. Projects 402
Learning Checkpoint 18-2. Project Management Life Cycle 402
Review Questions 402
Glossary 403
Index 417
A 417
B 417
C 418
D 419
E 419
F 420
G 420
H 420
I 421
J 422
L 422
M 422
N 423
O 423
P 423
Q 424
R 424
S 424
T 425
U 425
V 425
W 425
X 426

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