Construct organizational training strategies that resolve emerging issues in a health care environment.

GEL-1.02: Demonstrate college-level communication through the composition of original materials in Standard American English.

Instructions

You are a health care executive of a large hospital, serving as director of health information. You have been advised that there are serious concerns regarding the competence of the facilitys billing and coding staff. To address these concerns, you will develop an action plan. Please complete your action plan as indicated below in Parts 13.

Part 1

Instructions

Evaluate at least three types of abuse or fraud that may occur during the course of medical coding and billing activities. Determine at least three organizational policies and procedures that monitor such activities and critique the effectiveness of each.

Part 2

Instructions

Based upon the trends of abuse or fraud that you identified in Part 1, develop both a new employee orientation program and an ongoing training program for medical billing and coding employees. Design outlines of each training program and construct the learning activities involved. You should also indicate a leadership approach that you would use in the implementation of the programs.

Part 3

Instructions

Develop a plan to evaluate the training programs at time of launch and again at periodic times over the next 2 years. Describe the methods used to evaluate the effectiveness of each training program.

Part 4

Background

An information asset is a body of information defined and managed as a standalone, single unit that can be shared and exploited to the organizations benefit. It is referred to as an asset because it has financial value to the organization. Enterprise-wide information assets that are common to large health care organizations include billing systems, EHR/EMR, master patient index, clinical automation systems, patient portals, personal health records, telemedicine, health information exchange (HIE), clinical applications (lab, pharmacy), etc.

The enterprise data warehouse (EDW) is a repository of high-value data from different information assets and corporate systems or applications. The data contained in an EDW can be integrated for many strategic uses across the enterprise. For example, strategic objectives might include activities and initiatives to improve quality, safety, cost, productivity, etc.

To complete Part 4, conduct research into the topic of data warehousing in health care organizations and then answer the following:

List the benefits of an EDW to a health care organization.

Prepare a strategic objective and explain how it could be facilitated through use of a data warehouse.

Select two information assets from the list above. Then, through a data warehouse, analyze and demonstrate how data from those two assets could accomplish the identified strategic objective.

Rubric

Billing and Coding

Competency

Analyzes at least three types of abuse or fraud that may occur during the

course of medical coding and billing activities.

Determines at least three organizational policies and procedures that

monitor such activities and critique the effectiveness of each

policy/procedure.

Mastery

Determines more than three organizational policies and procedures that

monitor such activities and critique the effectiveness of each

policy/procedure.

Orientation and Training Program

Competency

Examines the collaboration and facilitation of the creation of both a new

employee orientation program and an ongoing training program for medical

billing and coding employees.

Indicates a leadership approach that you would use in the implementation

of the programs.

Mastery

Indicates more than one leadership approach in the implementation of the

programs.

Evaluation

Competency

Develops a plan to evaluate the training programs at "time of launch" and

again at periodic times over the next two years.

Proposes the methods used to evaluate the effectiveness and create

performance benchmarks for each training program.

Mastery

Provides additional methods used to evaluate the effectiveness and create

performance benchmarks for each training program.

Enterprise- wide Information Assets

Competency

Lists the benefits of an enterprise data warehouse to a health care

organization and provides a strategic objective that could be facilitated

through use of a data warehouse.

Selects two information assets that a data warehouse could be used to

accomplish the identified strategic objective.

Mastery

Selects more than two information assets that a data warehouse could be

used to accomplish the identified strategic objective.