Risk Reporting And Adjustment Paper

Content type

User Generated

Subject

Health & Medical

School

University of Phoenix

Course

HCS 456

Type

Homework

Uploaded By

creary0999

Pages

Patient and medication safety is the number one priority for any health care organization.

This is why formal and informal methods exist to report events that cause harm to the patient as a

byproduct of medical care and differ significantly. Formal methods are used for reporting

adverse events, incident reports, occurrence reporting, screening. In contrast, informal methods

are those that follow policies and procedures. Formal methods involve the communication of

information to a larger group of people and the transmission of information having a clarity of

purpose. Examples of informal methods include paper writing, reporting findings, and official

letters to pass information. Formal methods are based on the precise structure of the organization

using things such as an organizational chart. Adverse events are reported using incident reports

that are forms based to record information about events, claims, or loss notification (Phillips et

al., 2019).

There are several ways to identify adverse events with document reviews, reporting

systems, patient progress monitoring, and automated surveillance of clinical data. These concepts

are eventually integrated and require a wide range of data details enclosing demographic

information, medications, diagnoses, signs and symptoms, therapies, test results, and outcomes.

Although all available resources are paired, and each has its own merits and demerits, automated

surveillance is expected to become an essential source of adverse event data (Drago et al., 2020).

To detect the same adverse events as identified by patient record reviews, health care

organizations can't rely on the current systems (Coffin et al., 2019). Informal reports involve

sharing the type of information between a particular organization's staff members through

mailing, verbal communication, or informing. They are majorly used to report a synopsis of

lengthy information, present sudden information, report short kinds of reporting, and make

planning reporting.

The development of a risk adjustment program is vital to every health care organization.

It refers to the method to negate the cost involved in providing health insurance for the

differences in patient populations' underlying risk. Patient demographics data and diagnoses are

used to create risk adjustment models to figure out their risk score. According to Rosen, Reid,

Broemeling, & Rakovski, "We believe that ranking schema for risk adjustment should be

contextualized to each quality measure and should consider broader methodology issues rather

than simply the coverage of risk domains" (Rosen et al., 2003). A patient diagnosed with high

blood pressure and diabetes is more prone to having a high-risk score than an individual without

high-blood pressure and diabetes. An insurer who enrolls patients with an extreme level of high-

risk individuals is entitled to receive compensation to recoup the extra costs. Without the risk

adjustment, insurers can deny coverage to high-risk patients; write exclusions in the policies, and

impose unaffordable prices for the insurance premiums for existing individuals with high-risk

medical conditions ("What is Risk Adjustment," n.d.).

In health care organizations, the administrative branch has a critical role. The

administrative level involves many duties such as making daily and long-term decisions,

concentrating on different areas to improve health care organizations' outcomes such as safety,

security, and better health care to patients. It always has perfect risk-managed policies, as

illustrated by the Emergency Medical Treatment and Active Labor Act. This policy is useful

since it enables the patient to be transferred to a hospital at their own risk (Hollaender et al.,

2020). To ensure compliance with managed care organizations (MCOs), the administration of a

health care organization completes various duties such as, managing critical issues in health care,

choosing the best doctors, using all resources efficiently, provide high care to the patients,

serving patients any time by providing special care and managing human and financial resources.

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Patient and medication safety is the number one priority for any health care organization. This is why formal and informal methods exist to report events that cause harm to the patient as a byproduct of medical care and differ significantly. Formal methods are used for reporting adverse events, incident reports, occurrence reporting, screening. In contrast, informal methods are those that follow policies and procedures. Formal methods involve the communication of information to a larger group of people and the transmission of information having a clarity of purpose. Examples of informal methods include paper writing, reporting findings, and official letters to pass information. Formal methods are based on the precise structure of the organization using things such as an organizational chart. Adverse events are reported using incident reports that are forms based to record information about events, claims, or loss notification (Phillips et al., 2019). There are several ways to identify adverse events with document reviews, reporting systems, patient progress monitoring, and automated surveillance of clinical data. These concepts are eventually integrated and require a wide range of ...
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