The key functions of Health Information Management include:
- Maintaining a manual containing the approved medical policies, abbreviations, and forms that govern all the client records.
- Educating and disseminating necessary information regarding the hospital’s policies and procedures to the members of staff.
- Provision of adequate access to medical records of the discharged patients by the rules, laws, and standards of JCAHO.
- Conducting ongoing reviews on the medical records of the hospital.
- Coding the medical procedures and diagnosis for statistical processes, billing, and client’s information system.
- Ensuring that there is information integrity.
- Processing all the necessary documents showing all medical and demographic information once a patient is discharged.
- Complying with all laws and policies that govern clients’ integrity, security, and confidentiality of medical records.
- Providing Cancer Registry Reports to the Georgia Comprehensive Cancer Registry as required by the law on notifiable diseases.
When Blue Shield and Blue Cross (commonly known as BCBS) was initially established in the 1920s, It was meant to be a prepaid hospital/health service plan. Today, BCBS works towards ensuring that everyone accesses health insurance. It addresses issues relating to the ever-increasing costs of healthcare and ensures that extending insurance coverage to all people becomes nationally prioritized (Cunningham 34).
The lack of effective universal medical care coverage is likely to increase costs in health care. This is mainly due to the accumulating debts that result from patients’ inability to cater for their health costs as a result of the failure to have insurance. When uninsured patients visit the hospitals and cannot afford to pay the bill, the hospital is left with huge debts while at the same time, the payment is made as raised insurance premiums. The cost of treating such patients is covered by providers and by taxpayers who are forced to pay more taxes (Roehr 889).
Documentation of the client’s full medical information, as well as the demographic information, helps in facilitating follow-up programs and ensuring that care for the clients continues even after discharge.
Mary should not assume that she will get the same kind of coverage. This is because the health care insurance offerings vary between different states.
While the doctors offering primary care in the HMO plan are responsible for making referrals to any other providers within the health plan, members in the POS plan are allowed to refer themselves elsewhere outside the plan and still get coverage.
In a situation where there is a difference between the given charges and the DRG Reimbursement the higher charge becomes a contractual write-off for the hospital meaning that the customer will not be charged any amount of the indicated difference. The hospital readily accepts to have DRG reimbursement made as complete payment.
Failure to correct the information on the claim form can result in denied claims or even erroneous payments. The payments made may be different from what is required.
The 1996 National Correct Coding Initiative was implemented to enhance the effective and correct coding of the Part -B claims as well as to ensure that no erroneous payments for the mutually- exclusive coding combinations are made (Kongstvedt 3-10).
Some of the risk areas that can be identified through the auditing process include:
- Frequent services are offered to a specific client.
- Services or additional tests are done and that are not necessarily medically required.
- The various charges, in relation to office visits, are above the actual documented services or time.
- The various services offered and that are not within the specialist’s expertise.
- Charges of medical supervision are given in the absence of a physician.
- DRG upcoding.
Works Cited
Cunningham, Richard and Cunningham, Junior. The Blues: A History of the Blue Cross and Blue Shield System, DeKalb, Ill.: Northern Illinois University Press, 1997.
Kongstvedt, Peter.The Managed Health Care Handbook, USA: Aspen Publishers, Inc., 2001.
Roehr, Bob. “Health care in US ranks lowest among developed countries”. Bio Medical Journal, 337 (211): 889, 2006.