Strategic Training: Key to Instilling Healthcare Policies and Procedures - Report Sample

Introduction

Every contemporary culture of an organization requires policies and procedures to be instilled for the smooth running of the firm. The healthcare industry is not left behind when it comes to installing ad implementing regulations, policies and procedures. Administrators in the healthcare systems are required to follow the rules to the latter as set in the statutes in the United States. One crucial role in fostering this implementation is by offering strategic training to employees. Through that, employees obtain the chance of expanding their competence alongside their knowledge base. The paper focuses on the strategic training of healthcare employees to comply with policies set.

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Frauds and Abuse in Medical Coding and Billing Activities and Policies to Curb Them

In the management of health care information, employees can engage in fraudulent activities due to lack of knowledge. Commonly, the frauds that are found in medical billing and coding are false information, collusion with the patients, third party payers’ conspiracy, including others. Falsifying of data may occur for no specific reason, instances where billers happen to do it when they are drained to look out for patients’ medical information necessary for the coding procedure (Humphreys et al., 2017). As such, the medical billers put in figures that do not precisely reflect the actual services that are before what the patient sends or receives in respect to companies that offer insurance. It collides with the principle of utmost faith.

The medical billers can also arise of frauds where patients pay less or more. In this case, where patients pay more, the hospital ends up being paid more than what it was supposed to be rightfully paid as per the patient’s health condition (Humphreys et al., 2017). Vice versa is also true in cases where the medical billers charge less to the patients causing the insurance companies to pay fewer amounts to the hospitals for the services rendered to the patient. As a result, the additional payment has to be paid by the patient.

Such violation and frauds by medical billers can be curbed by formulating procedures and policies that can help in protection against this. Administrators in these facilities should lay down procedures and formulate continuous assessment methods to assess the health records that will aid in streamlining and facilitating efficient coding processes to avoid unnecessary mistakes.

Besides, assessments which are unscheduled, where the healthcare administrator does surprise checks to the medical billers to ensure that they provide accurate information of the patients should be implemented (Humphreys et al., 2017). Also, periodic submission of patients’ data by the healthcare facilities can go way long ahead in helping in assessment of the billing information periodically rather than waiting for the information to be provided in bulk.

Employee Orientation Program

The medical billers, in conjunction with the insurance companies, can defraud patients. To help curb this, training of the billers should be done so that they can be trusted, responsible, have accountability and avoid being influenced by the people in the insurance companies in engaging in fraudulent acts against the patients (Sahni et al., 2017). The program should entail details such as the consequences that befall an individual who engages in acts of frauds with the insurance company at the expense of the patient. The organizational policies should clearly outline the implications of such actions.

In this leadership process, one may bring in a case where they cite the examples of some individuals who have engaged in such fraud scenarios and the consequences that have come in hand with that (Sahni et al., 2017). In conclusion, the provision of falsified information is one of the fraud actions that occur among medical employees.

Because of this reason, there is a need to train the employees on confidentiality. The training should equip the employees with a clear understanding of the high level of maintenance of information regarding the patients. It teaches them the consequences of misquoting and mishandling of health information regarding the patients as per the privacy and security statutes of HIPAA (Sahni et al., 2017).

The leadership whose medical employees will apply in the above context would embrace the importance of transparency, integrity and trustworthiness of the medical employees when handling information regarding the patients. To help curb the collusion of payers of health insurance and the ones who get the medical billers to engage in fraudulent coding, this training program enlightens them by being knowledgeable in detecting any unethical activity committed by the insurance companies (Sahni et al., 2017). Through this, the medical employees thus abscond any abuse and fraud of the billing process. Transformational leadership would as such be recommendable to ensure employees acceptance to the change

Evaluation of the Training Programs

Various approaches need to be evaluated to identify how training programs are feasible. There are several methods viable to be applied to ascertain their feasibility. They include social ownership method, skills method and virtual confirmation method. Furthermore, the health executive can allow competency tests to be carried out (Ghazvini & Shukur, 2017). The tests would assess how skills are grasped by the employees undergoing the training programs. The tests would be implemented in both the continuous and initial programs. They are tests which are useful in determining the capability of each employee; hence, they help to determine the basis of improvement.

Several experts can train employees. It is applied in the social ownership method. In this method, the healthcare workers are educated and trained by professionals about policies in healthcare. The understanding of the concepts by the experts is essential. It is because it determines how they are good at teaching others.

Thus, peer teaching is the comprehensive evaluation of social ownership method (Ghazvini & Shukur, 2017). To address how the problem of knowledge gaps in the subject of procedures and policies effectively, medical coders can be taught via a training program to each. In some instances, an employee can progress without the help of a trainer. In such a process, visual confirmation is involved.

Through this, the employees can grow beyond in the field of observing the regulation and policies as per the training program. In an event where they are unable to grow by themselves, the training program could be perceived as ineffective. Restructuring it would be the only solution as it would be both crucial and a requirement for the employees to comply efficiently with the regulations.

Data Warehousing in Health Care Organizations

To achieve the strategic goals which are outlined and targeted in the objectives, an organization is required to align and orient all its assets into the strategic plan that it has established. For a strategic plan to be effective, the available assets alongside how they are efficiently used matter a lot. Enterprise Data Warehouse (EDW) is an essential entity; it forms part in the list of vital assets. Furthermore, it plays a primary role while ensuring that all the strategic objectives set by an organization are attained.

The benefits of EDW in the healthcare industry are numerous. All healthcare facilities keep an extensive database of patient’s information and details. EDW offers ample storage for such information. Through EDW, the stored data can be accessed in a simplified technique, which does not entail obtaining disputes. EDW does not lead to loss of data. Many data get lost while being accessed by multiple users.

Since every healthcare facility is characterized by having multiple employees, each is eligible to use the data. In the past, this type of data access led to disputes among the employees after being linked to data losses. However, EDW reduces conflicts which can emanate from the loss of data (Sahni et al., 2017). Because of that, the management of the healthcare facilities would be more efficient and better.

Reducing the complaints by a percentage of 20% would be a strategic objective which can be achieved after employing the use of data warehouse (Barlow, 2017). Through the simplified access of data and information, the process and use of a data warehouse would attribute to more organized access to the health information. As a result, complaints arising from the access of the information would be reduced. By the use of data warehouse, the objective of reducing the wait time by a total of 25% would be achieved (Barlow, 2017).

Due to the ease of access to healthcare information by the employees, it would mean that the amount of time used to access a patient’s medical record would be reduced. Through that, the consultation time would be minimized as well. The result would be decreasing the total time of waiting in line among the patients (Barlow, 2017). The effect of that would be associated with the facility being able to serve many patients within a short duration.

The information assets of interest are Clinical automation systems and personal health records (Barlow, 2017). Enabling a personal health record would reduce the wait time by 25% since a patient would get consultation faster, leading to the ones in line to wait for less. The automation leads to quick delivery of consultation among other healthcare-related services.

Clinical automation systems is an information asset that would ensure that the health data of a patient is exchanged among healthcare providers in several departments within a single healthcare facility in real-time (Barlow, 2017). Through automation, patients get faster services since there are no delays associated. As a result, there occurs an improvement in health care outcomes. Thus, information assets simplify the delivery process in healthcare systems.

Conclusion

Failure to the understanding of procedures and policies, workers, can face challenges which are inevitable in the healthcare industry. Though the strategic training may appear expensive and most employees find the challenge of raising the required amount to afford them or joining the training seminars, they need to understand the repercussions of not acting per the regulations and policies. It is essential to recognize how severe the implications of bypassing the rules are expensive (Humphreys et al., 2017). Since the health care sector requires effective delivery of care to patients, every professional must familiarize themselves with the accepted standards and statutes of the industry. Effective healthcare delivery relies on how the underlined policies are adhered to and followed (Humphreys et al., 2017).

References

Humphreys, J., Wakerman, J., Pashen, D., & Buykx, P. (2017). Retention strategies and incentives for health workers in rural and remote areas: what works?.
https://openresearch-repository.anu.edu.au/bitstream/1885/119206/3/international_retention_strategies_research_pdf_10642(1).pdf.

Sahni, N. R., Huckman, R. S., Chigurupati, A., & Cutler, D. M. (2017). The IT transformation health care needs. Harvard Bus Rev, (Nov–Dec 2017), 128-138. https://www.commonwealthfund.org/sites/default/files/documents/___media_files_2017_international_symposium_att_g12_the_it_transformation_health_care_needs.pdf.

Ghazvini, A., & Shukur, Z. (2017, November). Review of information security guidelines for awareness training program in healthcare industry. In 2017 6th International Conference.