I have chosen two roles that are integral to the Health Care Industry. The first being Health
Educator and the second being Medical Coder. The following discussion will be looking at what a day in
The life of each of these roles may look like.
Health Educator
Health Educator roles are various and diverse depending on what setting they are utilized in.
From the public school system to long term care to public health, health educators are hard at work.
Being that I work in long term care, I have chosen to describe a typical day in the life of a health
Educator in a long term care setting.
Their day begins early and usually with a morning or clinical meeting to discuss the previous
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Some of these settings include acute
Care hospitals, long term care, physician offices and clinics. Medical coders are in integral part of
The Reimbursement process. They code services in the ICD-9 and soon the ICD-10 system. They
Also code services provided in the health care field.
Once again, I will describe what a day in the life of a medical coder in long term care may
Look like. Similar to the Health Educator, the medical coder usually attends a daily clinical meeting to
Discuss the previous day’s events and the plan for the day ahead. Medical coders work closely with
MDS or minimum data set nurses as they are responsible for the assessments that are completed
For the health care center to get reimbursed for the services provided. They also work closely with
Medical billing office employees to ensure that the codes on the UB are correct and match the
Coding of the MDS. They would also review the admitting diagnoses of recent admissions into
The facility and use the discharge summary to put their diagnosis into the system and discerning
The admitting diagnosis and prioritizing them in order or importance for payment
HCPCS level 1 uses CPT codes to identify medical services & procedures level 2 is used to identify the products, supplies, and services that are not in CPT codes ICD-10 used for diagnosis and in patient procedures There 's so many different types of services and procedures within the medical field that different codes are needed to specifically identify them properly. Coding was created to make medical billing simple. Proper coding will ensure accurate and timely reimbursements.
E/M codes tell what was done in the office. Everything that the doctor or physician has done is documented, and coded. If a certain thing was not done then it should not be coded, and charged for that is considered fraud. Also everything that is done in the office must be documented, and coded using the E/M codes. If the E/M coding was done incorrectly the person would get in trouble for fraud, and not only that the office would have a bad reputation, and other insurance companies wouldn 't probably want to go through that office anymore.
Impact of CMS Regulations and Reimbursement Models The Health Care Industry HCM307-1802B-03 Unit 1- Individual Project 1 Michael Green May 22, 2018 Introduction Healing Hands Hospital is preparing financially for the many different reimbursement changes associated with Medicare Advantage Plans. My financial team and I, have been asked to evaluate our current billing and operations workflow processes and incorporate the current trends. We will be discussing how Medicare Advantage affects Healing Hands Hospital, and how we can utilize these trends to maximize patient care. Organizational Budget Reimbursement and financial trends will change go hand and hand.
If an invoice comes in regarding something that is not required for the patient to have a special approach is taken to state, why they will not be covering this bill then they return it to that office. This job requires a lot of organization. Once an invoice comes in they do not automatically pay them, therefore the stack of invoices becomes big toward the end of the month. I also sat with a lady named Nelda, that covers all the financial statements except the bank reconciliation. I was able to see the format that is used to get all of these reports ready for the end of the month.
With the number of codes increasing from 14,000 to 70,000, the demand for coders and billing personnel has increased and exceeds local demand. Many healthcare organizations recently have contracted with coding vendors to provide ICD-9 coding assistance, in part to allow in-house coders to undergo ICD-10 training and participate in dual coding. However, It is still unclear how coding professionals and vendors will be impacted long-term by the implementation. According to Forbes, the ICD-10 switch for providers has been better than expected.
According to Ruud, Johnson, Liesinger, Grafft, and Naessens (2010) a timely follow-up visit to a primary care provider presents a critical opportunity to address the conditions that precipitated the hospitalization, to prepare the patient and family/caregivers for self-care activities, and to prevent unnecessary hospital
This rule adopts standards for eight electronic transactions and for code sets to be used in those transactions. It also contains requirements concerning the use of these standards by health plans, health care clearinghouses, and certain health care providers. The use of these standard transactions and code sets will improve the Medicare and Medicaid programs and other Federal health programs and private health programs, and the effectiveness and efficiency of the health care industry in general, by simplifying the administration of the system and enabling the efficient electronic transmission of certain health information. It implements some of the requirements of the Administrative Simplification subtitle of the Health Insurance.
Coders would be involved in these tasks. Accounts receivable for health care providers differ from accounts receivable
It is important to enter correct codes for patient billing because the insurance needs to know what the patient is being diagnosed with so they can charge the right amount. When incorrect codes are entered by someone, the claim that was submitted can be rejected or denied. A rejected claims means that there is an error within the claim which means that the claim has to be corrected and resubmitted. A denied claim means the claim has been determined by an insurance company to be unpayable. Both types of claims are often denied or rejected because of common billing errors or missing information, but can also be denied based on patient coverage (Medical Billing
To ensure the billing process goes forward in a timely fashion, all medical notations should be entered at the time of the patient appointment. If that doesn 't happen, it should happen as soon as possible afterwards. This ensures that the notations are as complete and accurate as possible. Remember, any delay in medical notations will delay the billing and payment cycle.
During a clinical shift, I would be responsible for providing care to patients with malignant hematological diseases, completing pertinent assessments and teaching skills, such as how to care for the mouth when experiencing mucositis and how to avoid infections. Self-reflection on Professional Practice All nurses registered in the general and extended classes are required to complete their self-Assessment every year. Self-Assessment is a self-directed, two-part process that results in a learning plan (CNO self assessment 2018). Through the process of self-assessment, you identify your areas of strength and learning needs (CNO
Additionally, this experience helped me to develop effective therapeutic communication techniques and enforce skills to provide enhanced care for the resident. An improvement that I would make for next semester is to improve my execution and time management while performing tasks. I intend to perform skills with greater confidence and improve my overall interactions with the patients, families, and health care workers. Improving these interactions will benefit in the overall comfort of the patient and improve the care that I will provide to them. Overall, this Long Term Care experience provided me with the necessary fundamental skills practice and critical thinking development that will be utilized in the following semesters and throughout my nursing
I am very interested and excited in having a career as a Public Health Educator. I was really surprised when I read the requirements for being a Public Health Educator. The requirements for being a field are: a bachelor’s degree and having the CHES certification would put individual at an advantage with potential employers. The core competencies are very important because they are going to determine whether the individual becomes a successful health educator.
During a clinical shift, I would be responsible for providing care to patients with malignant hematological diseases, completing pertinent assessments and teaching skills, such as how to care for the mouth when experiencing mucositis and how to avoid infections. Self-reflection on Professional
Claims are an important part of the healthcare process. Claims are a “request of payment, or itemized statement of healthcare services and their costs, provided by a hospital, physician’s office, or other healthcare provider” (Castro and Forrestal, 304). Understanding the difference between professional and facility healthcare claims are important the utilization processes of reimbursement. Professional and facility healthcare claims are submitted differently. Professional claims are submitted on an individual basis.