Computer Science
Medical Business Operations Mr Hopkins Challenges Case Study

Question Description

I’m trying to learn for my Health & Medical class and I’m stuck. Can you help?

The students will complete a Case study projects that contribute the opportunity to create and relate the thoughts learned in this and previous coursework to examine a real-world scenario. This scenario will illustrate through example the practical importance and implications of various roles and functions of a Health Care Administrator. The exploratory exercises will advance students’ understanding and ability to anticipate judgmentally about the public relations process, and their problem-solving skills. As a result of this assignment, students will be better able to comprehend, scrutinize and assess respectable superiority and performance by all institutional employees.

ASSIGNMENT GUIDELINES (10%):

Students will critically measure the readings from Chapter 5 in your textbook. This assignment is planned to help you examination, evaluation, and apply the readings and strategies to your Health Care Facility and the importance of actualization.
You need to read the article (in the additional weekly reading resources localize in the Syllabus and also in the Lectures link) assigned for week 4 and develop a 3-4 page paper reproducing your understanding and capability to apply the readings to your Health Care organization. Each paper must be typewritten with 12-point font and double-spaced with standard margins. Follow APA format when referring to the selected articles and include a reference page.

EACH PAPER SHOULD INCLUDE THE FOLLOWING:

1. Introduction (25%) Provide a brief synopsis of the meaning (not a description) of each Chapter and articles you read, in your own words that will apply to the case study presented.

2. Your Critique (50%): Case Study

Medical Business Operations: Actualization

Recently, The Superior Care Health Group (SCHG) has been experiencing a large percentage of billing rejections from various third-party payers. Although there are many reasons for the claim rejection, the main problem is Inaccurate billing codes, specifically those as ICD-10 codes.

The office manager, Mr. James Hopkins MHSA, who is new to SCHG, suspect that the problem is with the group’s old billing software. When an office associate is given medical chart information to code, the software only provides a list of potential ICD-10 codes when the physician’s diagnosis is keyed and entered into the system. It is up to the office associate to make the determination between diagnosis that are very similar and difficult to differentiate.Mr. Hopkins knows that newer software can make the code differentiation more automatic and accurate.

CASE STUDY CHALLENGE

  • How and where Mr. Hopkin can start with this project?
  • How can Mr. Hopkins address these issues?
  • Where should he start his research?
  • Once all change are done, which ones will be future results? Describe and explain all of them in detail.

3. Conclusion (15%)

Briefly summarize your thoughts & conclusion to your critique of the case study and provide a possible outcome for the Health Care Center.How did these articles and Chapters influence your opinions about Health Care Computer Application?

Evaluation will be based on how clearly you respond to the above, in particular:

a) The clarity with which you critique the case study;

b) The depth, scope, and organization of your paper; and,

c) Your conclusions, including a description of the impact of these Case study on any Health Care Setting, Law and Legislation.

Unformatted Attachment Preview

Introduction to Healthcare Information Technology Chapter Five Medical Business Operations Objectives • Define frequently used healthcare terms • Identify and describe the functions of certain healthcare departments • Describe the uses for clinical software • List and describe the steps in the clinical process or environment • Identify and describe the functions of various medical devices Introduction to Healthcare Information Technology 2 Healthcare IT: Challenges and Opportunities • Health care is one of the largest industries in the US – 14.2 million workers • Bureau of Labor Statistics forecast: – Over 3 million new jobs in healthcare between 2008 and 2018 • Home healthcare services – One of the fastest growing areas until 2018 Introduction to Healthcare Information Technology 3 Medical Terminology • Healthcare – Specialized terminology – Numerous acronyms • Imaging – Often called radiology – Use of technologies to provide visual representation of internal body structures – Can eliminate the need for biopsies or surgery in some cases Introduction to Healthcare Information Technology 4 Medical Terminology (cont’d.) • Major types of imaging technologies – – – – – – X-ray CT scan Fluoroscopy Magnetic resonance imaging (MRI) Ultrasound Nuclear medicine • Newer techniques – Capsule endoscopy Introduction to Healthcare Information Technology 5 Figure 5-1 Modern x-ray machine © Tyler Olson/www.Shutterstock.com Introduction to Healthcare Information Technology 6 Primary Care Physician • Over 20 physician specialties in medicine • Primary care physician specialties – Family or general practice • Broad range of ailments and chronic disorders – Internal medicine • Adult diseases and chronic disorders – Pediatrics • Diagnosis and treatment of children Introduction to Healthcare Information Technology 7 Stat • Term meaning “immediately” • Derived from Latin word statim Introduction to Healthcare Information Technology 8 Acuity • Measure of the degree of patient disease or injury • Can refer to: – – – – Severity Time sensitivity Physical effects Psychological suffering • High-acuity patient less healthy than low-acuity patient, in general Introduction to Healthcare Information Technology 9 Code Blue • • • • Emergency code Indicates patient needs immediate help Can be announced over the public address system Expedites correct staff moving to location where patient needs help Introduction to Healthcare Information Technology 10 Trauma Levels • Trauma – Physical wound or injury to the body – May be caused by accident or violence – Commonly treated at hospital ERs • Trauma center – Centers classified according to their ability to handle different types of trauma Introduction to Healthcare Information Technology 11 Table 5-1 Trauma center levels and resources © Cengage Learning 2013 Introduction to Healthcare Information Technology 12 Controlled Substances • Controlled Substances Act of 1970 – Established government control of certain drugs and chemicals known as controlled substances • Classification scheme with five levels • Schedule 1 substances – High abuse potential – No currently accepted medical use • Schedule 2 substances – Can cause dependence – High abuse potential Introduction to Healthcare Information Technology 13 Controlled Substances (cont’d.) • Schedule 3 substances – Lower abuse potential than schedule 1 and 2 – Example: drugs containing less than 15mg hydrocodone per dosage • Schedule 4 substances – Lower abuse potential than schedule 3 – Examples: diazepam, alprazolam, propoxyphene • Schedule 5 substances – Cough and cold preparations with limited quantities of certain narcotics Introduction to Healthcare Information Technology 14 Controlled Substances (cont’d.) • Healthcare providers that use controlled substances: – Have well-defined policies and procedures for use • Example controlled substance policy components – – – – Locked storage Staff authorization to access Substance abuse protocol Substance audits Introduction to Healthcare Information Technology 15 Electronic Medical Record • Medical record (chart) – Location where provider records aspects of diagnosis and treatment • Electronic medical record – Can be viewed by authorized individuals anywhere in the world – Can be interfaced to other electronic systems • Lab or radiology results can be instantly updated – Controlling access can be more difficult than with paper record Introduction to Healthcare Information Technology 16 Electronic Health Record • Broader than an EMR • Includes demographics, billing, and all historical medical information • Gives providers the widest possible perspective on a patient • Potential for abuse of information exists Introduction to Healthcare Information Technology 17 Medical Departments • Ambulatory/day surgery – Provides surgery on an outpatient basis • Behavioral health – Provides care for mental disorders • Cardiac care units – Treat patients requiring specialized cardiac monitoring Introduction to Healthcare Information Technology 18 Medical Departments (cont’d.) • Cardiovascular – Includes advanced cardiac specialties • Electrophysiology • Heart failure • Heart transplantation • Dermatology – Treats skin diseases: • Usually on an outpatient basis Introduction to Healthcare Information Technology 19 Medical Departments (cont’d.) • Ear, nose, and throat – – – – – – Also called otolaryngology Facial plastic surgery Laryngology (voice) Neuro-otology (middle/inner ear, base of skull) Otology (ear) Rhinology (sinuses) Introduction to Healthcare Information Technology 20 Medical Departments (cont’d.) • Emergency room – Treats patients with life-threatening condition or immediate need – Certified to a specific trauma level • Intensive care unit – Treats patients needing high level of specialized care – Can include intensive monitoring with electronic equipment – Patient may need ventilator, feeding tubes, etc. Introduction to Healthcare Information Technology 21 Figure 5-3 Intensive care monitoring © Edwin Verin/www.Shutterstock.com Medical Departments (cont’d.) • Laboratory – Provides chemical, microbial, microscopic, and other studies to diagnose and treat injury • Medical/surgical – Care for adult patients before and after surgery • Nuclear medicine – Uses radioactive decay of radiopharmaceuticals to diagnose and treat disease Introduction to Healthcare Information Technology 23 Medical Departments (cont’d.) • Obstetrics/gynecology – Provides care for the female reproductive system – Obstetrics provides care surrounding childbirth • OB/GYN related departments – Family birth center – Labor and delivery – Neonatal intensive unit Introduction to Healthcare Information Technology 24 Medical Departments (cont’d.) • Occupational therapy – Care for patients recovering from injury to regain work-related skills – Helping people with disabilities accomplish self-care tasks • Oncology – Care for cancer patients • Operating room – Department where surgical operations are conducted Introduction to Healthcare Information Technology 25 Medical Departments (cont’d.) • Ophthalmology – Diagnose and treat various eye conditions • Pediatrics – Specialized treatment for children – Patients may be medium or high acuity • Physical therapy – Assists patients to regain lost range of motion Introduction to Healthcare Information Technology 26 Medical Departments (cont’d.) • Plastic surgery – Provides reconstruction of the human body • Post-anesthesia care unit – Provides care during recovery from anesthesia • Radiology – Provides imaging equipment using x-ray, ultrasound, or nuclear isotopes to diagnose disease or injury Introduction to Healthcare Information Technology 27 Medical Departments (cont’d.) • Respiratory – Provides breathing treatments for inpatients or outpatients • Bronchodilators • Pulmonary rehabilitation • Mechanical ventilation • Transitional/progressive care unit – Provides transitional care between CCU/ICU and standard care unit Introduction to Healthcare Information Technology 28 Clinical Software • Software – Set of instructions that helps hardware process data into information • Clinical software – Used to manage data and information in a clinical environment Introduction to Healthcare Information Technology 29 Patient Tracking • Patient tracking software benefits – – – – Tracks services provided Manages patient demographics Manages patient visit history Tracks time-specific illnesses like allergies • Many patient tracking systems can interface with scheduling, medical records, and lab software packages Introduction to Healthcare Information Technology 30 Scheduling • Scheduling software manages patient scheduling process • Capabilities – Quickly scan for open appointments – Track patient cancellations, no-shows, and reschedules – Track patient visits by time of check-in and departure Introduction to Healthcare Information Technology 31 Order Entry • Computerized physician order entry (CPOE) – Electronic systems transmit physician’s orders to other healthcare professionals • Advantages of CPOE – Instant availability of patient’s medical history – Current information helps prevent unwanted drug interactions – Statistical reports improve resource management – Linking diagnoses to the order improves billing management Introduction to Healthcare Information Technology 32 Billing/Coding/Auditing • Billing software helps manage billing process – Software decision engines can validate claims – Submits claims to appropriate payer • International Statistical Classification of Diseases and Related Health Problems Codes (ICD-9) – List of over 13,000 codes used in billing • ICD-10 – Complete revision of the diagnosis code set – Includes about 68,000 codes Introduction to Healthcare Information Technology 33 Table 5-2 ICD-9 and ICD-10 code examples © Cengage Learning 2013 Introduction to Healthcare Information Technology 34 Billing/Coding/Auditing (cont’d.) • Audit software – Computer algorithms determine whether correct CPT and ICD codes are used – Can use historical data for trending and analysis to predict and improve performance Introduction to Healthcare Information Technology 35 Practice Management • Practice management software (PMS) functions – – – – – – Patient tracking Scheduling Computerized physician order entry Billing Coding Audit • PMS can be interfaced with EMR systems Introduction to Healthcare Information Technology 36 The Clinical Environment • Clinical process (clinical environment) – Sequence of operations that must occur for the patient to be examined, diagnosed, and treated – May vary by environment • Common features of the clinical environment – Registration, consultation, examination, CPOE, dictation/transcription, referrals Introduction to Healthcare Information Technology 37 Registration • Patient must be registered or admitted: – Prior to being seen by medical staff • Examples of patient data collected during registration – – – – – Contact information Billing information Next of kin Current medications Other pertinent information Introduction to Healthcare Information Technology 38 Consultation • Also known as medical history • Questions about pain levels, location, and intensity • Brief history of activity: – To determine if behavior or actions contributed to the illness Introduction to Healthcare Information Technology 39 Examination • Checking the patient’s physical status • Vital signs – – – – Body temperature Blood pressure Pulse rate Respiratory rate • Initial examination normally performed by nurse or other medical professional – Patient examined in more detail by a physician Introduction to Healthcare Information Technology 40 Physician Order Entry • Process of storing and transmitting orders to other healthcare providers • Types of order entry – Handwritten or typed paper orders – Verbal orders – CPOE • Digital signatures – Encrypted messages similar to handwritten signatures – Allow for electronic transmission and storage Introduction to Healthcare Information Technology 41 Dictation/Transcription • Used with verbal orders • Centralized voice-recording system shared among physicians • Transcriptionist transcribes orders to electronic, paper, or film format Introduction to Healthcare Information Technology 42 Referrals/Consults • Physician may refer (send) patient to another professional for further diagnosis • Consult – Communication between physicians or specialists regarding a patient’s diagnosis or treatment Introduction to Healthcare Information Technology 43 Medical Devices • FDA regulates the manufacture and distribution of medical devices in the US • Definition of medical device – Recognized in the official National Formulary or the United States Pharmacopoeia – Intended for use in the diagnosis or prevention of disease – Intended to affect the structure or function of the body without chemical action Introduction to Healthcare Information Technology 44 Computerized Axial Tomography Scanner • Tomography – Imaging technique in which sections are created by a penetrating wave • Computerized axial tomography (CAT or CT) – X-ray system in which the tomography is created by computer processing • Advantages of CAT scans – High contrast resolution – Tissues that differ in density may be distinguished Introduction to Healthcare Information Technology 45 Electrocardiogram Machine • Electrocardiogram (EKG or ECG) – Two-dimensional representation of electrical heart activity – Read by trained professionals to detect heart disease or abnormality • EKG machines – Commonly transported by hand or small cart Introduction to Healthcare Information Technology 46 Electroencephalograph Machine • Measures ionic current flows within the brain’s neurons • Usually portable and transported by utility cart • Trained professionals can read EEG: – To determine disorders such as coma, epilepsy, and brain death Introduction to Healthcare Information Technology 47 Glucose Monitor • Portable electronic device that directly reads level of glucose in the blood • Results available in seconds • Used in diagnosis of diabetes mellitus Introduction to Healthcare Information Technology 48 Magnetic Resonance Imaging • Uses very strong magnetic fields to create image of internal body structures • Certain viewpoints more easily obtained than with other imaging techniques • Greater detail of internal body structures compared with traditional techniques • MRI machines – Large (room-size) – Complex Introduction to Healthcare Information Technology 49 Figure 5-6 Human brain scan from an MRI © Donna Beeler/www.Shutterstock.com Portable X-Ray Machine • X-ray machine – Uses x-rays to cast static shadows of internal body structures on film or image sensor – Large devices (typically room-size) • Portable x-ray machine – Can be transported to the patient: • In cases where patient cannot be easily transported to a traditional x-ray machine – Machines are portable yet heavy Introduction to Healthcare Information Technology 51 Positron Emission Tomography • Positronic emission tomography (PET) scans – Certain radiopharmaceuticals behave in different ways in different body organs – Radiopharmaceutical administered to a patient emits gamma rays – PET scanner creates 3D image of tracer concentration • Scanners are large and complex Introduction to Healthcare Information Technology 52 Ultrasound • Uses high-frequency sound waves to image soft tissue structures • Image quality less detailed than x-ray or other technologies • Ultrasound uses – Evaluating fetal health during pregnancy – Evaluating blood flow to the brain – Diagnosis of heart abnormalities Introduction to Healthcare Information Technology 53 Vascular/Nuclear Stress Test • Cardiac stress test – Used to determine the heart’s response to physical stress • Vascular or nuclear stress test – Uses radiopharmaceuticals that emit gamma rays – Gamma camera captures detailed images of blood flow in the heart Introduction to Healthcare Information Technology 54 Vitals Cuff • Standard baseline measurements – – – – Body temperature Blood pressure Pulse rate Respiratory rate • Vitals cuff – Device that integrates the entire vital sign measurement process Introduction to Healthcare Information Technology 55 Medical Interfaces • Standards for exchange of health information – – – – – Health Level Seven e-prescribing Continuity of Care Document (CCD) Continuity of Care Record (CCR) International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD10) – Current Procedural Terminology (CPT) Introduction to Healthcare Information Technology 56 Medical Interfaces (cont’d.) • Standards for exchange of health information (cont’d.) – Systematized Nomenclature of Medicine (Snomed) – National Drug Code ID (NDCID) – Picture archiving and communication system (PACS) – Evaluation and Management Coding (E/M codes) Introduction to Healthcare Information Technology 57 Summary • Health care has specialized terminology and numerous acronyms • Hospitals have different medical departments that provide different types of patient care • Clinical software is used to manage and manipulate data and information in the clinical environment • The healthcare environment workflow may include registration, consultation, examination, physician order entry, dictation/transcription, and referrals or consults Introduction to Healthcare Information Technology 58 Summary (cont’d.) • Medical devices are used to diagnose and treat patients and are regulated by the FDA • There are many interfaces and standards that support information sharing between devices and systems Introduction to Healthcare Information Technology 59 ...
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Final Answer

Attached.

1

Medical Business Operations
Name
Institutional Affiliation
Course
Instructor
Date

2
Medical Business Operations
It is widely agreeable that the medical sector is among the largest and the most critical
industries in society. First, it employs the most labor force, including the doctors, nurses, and
other health practitioners. Secondly, it deals with the most critical aspects of life since people can
only go about their day-to-day business if they are of sound health. For these reasons, health
experts and other stakeholders in the medical sector, including the government, have been trying
every way of always improving the sector. Fortunately, technology has also come in handy in
solving some of the problems that were initially being faced in the health sector. For instance,
chapter 5 of class readings has discussed how billing software has helped in validating and
submitting patients’ claims (Slide 33). Coding has also increased the amount of data that the
facilities can handle at a go (Slide 33). While addressing the same issue of technology and
software in the health sector, Miller and Gardener (1997) also affirm that hospitals can now
improve their operations with the new discoveries. These insights help to answer the challenges
that Mr. Hopkins has been facing, as described in case study. This paper, therefore, applies the
insights from the reading (chapter 5) and the article (M...

Carnegie Mellon University

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