By definition, healthcare is human work and is characterized by relatively high influx, turnover, absenteeism, personnel changes and fluctuating roles. All this leads to changes in access rights for available information and communication technology (ICT) and healthcare systems. Organizations with fewer than 300 employees can track changes and rights manually, but for larger organizations, manual processing takes an enormous amount of effort and introduces the risk of errors.

Read more: Identity Verified

As of January 1, 2009, most healthcare facilities that are accredited by the Joint Commission should have in place processes that address disruptive and intimidating behavior by staff, including medical staff members and individuals in positions of power. Although the requirement is new, the challenge has long existed. The Joint Commission’s adoption of this requirement, and its finding that disruptive behavior detracts from quality of care, offers healthcare executives a unique opportunity to establish legally protected mechanisms to address disruptive behavior.  

Read more: Justifiable Action

With healthcare budgets squeezed by the falling economy and declining reimbursements, alert executives are pruning costs in other areas. Legal costs, a traditional budget buster due to litigation and regulatory requirements, are a prime target for a number of reasons, including more progressive attitudes and the growth of domestic outsourcing.

Read more: Trimming Costs

Hospitals are required to provide emergency medical services to all persons who present in the ED, regardless of immigration status. Once admitted, the illegal immigrant patient often becomes hostage to a system that does not provide Medicaid coverage for medically necessary post-hospital services. 

Read more: Discharge Dilemma

As the overall healthcare delivery system places a greater emphasis on quality measurement, quality-based reimbursement, and regionalized networks such as accountable care organizations, the importance of carefully developed inter-provider patient transfer and discharge arrangements will increase. 

Read more: On the Move

Real healthcare fraud exists in the United States. Whether in for-profit or nonprofit healthcare settings, billing for services that were not provided or were not medically necessary or intentionally billing more than appropriate through code manipulation is plainly wrong. The Department of Justice (DoJ) and the Office of the Inspector General of the Department of Health and Human Services (HHS OIG) are right to investigate and punish those involved in such corrupt activities, which cost the taxpayers billions of dollars, inhibit the delivery of necessary care, and taint the healthcare industry.

Read more: Raising the Stakes

Is your revenue cycle in dire straits? The solution is simple: take a deep breath, start at the front end, and troubleshoot your way to improvement. One of healthcare’s greatest long-term challenges is balancing the economics of healthcare. There are initiatives under way by the federal government and various payors, such as pay for performance, attempting to get it straight, but many view P4P as a set-up for pay for compliance—putting rules in place for physicians to follow and penalizing them when they don’t get it right. 

Read more: One Step At a Time

As hospitals cope with an influx of self-pay patients, eligibility determination and upfront payments are the order of the day. As the insurance landscape changed over the past decade, traditional plans gave way to PPOs and HMOs. Employees paid a small co-pay upfront, and insurance paid for the rest.

Read more: Seismic Shift

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