The Crucial Role of the Practice Administrator in Reducing Risk

Slides:



Advertisements
Similar presentations
Because your patients come first. Coding Jeopardy OutpatientObservationInpatientER / CC 200 Final Jeopardy.
Advertisements

Consolidated User Story 1: Chronic Diseases (cancer, occupational health) Chronic Diseases, Outpatient Flow Patient, Provider/Physician, Laboratory, PH.
For the Healthcare Provider
By Jennifer L. Cook, M.D. Florida Joint Care Institute.
HCA Session III Teaching Physician Rules Time Based Coding; Counseling
Frequently Asked Questions…. …about HIPAA Notice of Privacy Practices and Acknowledgement.
Ideal Practice Workflow Revenue Maximization and Cost Efficiency Contact us : 2222 Morris Ave. 2nd Floor, Union, NJ Ph: (908)
Admitting, Transferring, and Discharging Patients
National Health Information Privacy and Security Week Understanding the HIPAA Privacy and Security Rule.
© 2012 Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.
Medical Record Auditing October 30, 2014 Office of the Governor | Mississippi Division of Medicaid.
TELEPHONE PROCEDURES AND SCHEDULING
Documentation.  Nurses are legally and ethically bound to keep patient information confidential  Nurses must work to protect patient records from unauthorized.
Amper, Politziner & Mattia LLP Coders Day September 2009.
Inpatient Coding Strategies American College of Physicians March 1, 2013.
POH/DMC UROLOGY Grand Round Conference Presented by: Spectrum Billing Technologies, LLC.
Massachusetts: Transforming the Healthcare Economy John D. Halamka MD CIO, Harvard Medical School and Beth Israel Deaconess Medical Center.
Introduction. Lectures Display wall Mid-term Final project Office hours Communication Course structure.
Hospital Patient Safety Initiatives: Discharge Planning
Medical Reports Dr. Nasser Al - Jarallah.
Quality Assurance Programs for the Emergency Department Jim Holliman, M.D., F.A.C.E.P. Professor of Military and Emergency Medicine Uniformed Services.
Amelia Broussard, PhD, RN, MPH Christopher Gibbs, JD, MPH
InAHQ Annual Conference May  Identify techniques for developing tracer  Identify how to use tracers to improve organizational readiness  Demonstrate.
The Complete Procedure Coding Book By Shelley C. Safian, MAOM/HSM, CCS-P, CPC-H, CHA Chapter 4 Evaluation & Management Codes Part 1 Copyright © 2009 by.
Kristen Royalty RN, BSN Family Planning Program Division of Women’s Health Department for Public Health.
An Anaesthetist’s perspective on Same Day Surgery
Peer Review Thomas C. Platt, M.D. Chief Medical Officer Cherry Health 100 Cherry St SE Grand Rapids, MI.
Understanding Medicare Billing Issues
Disclaimer This presentation is intended only for use by Tulane University faculty, staff, and students. No copy or use of this presentation should occur.
ACOVE 4: Continuity and Coordination of Care in Vulnerable Elders Continuity is ‘‘care over time by a single individual or team of healthcare professionals’’
A NEW APPROACH TO PATIENT- CENTERED CARE Family Health & Sports Medicine Albert Puerini, MD.
Treating Chronic Pain in Adolescents Amanda Bye, PsyD, Behavioral Medicine Specialist Collaborative Family Healthcare Association 15 th Annual Conference.
MO-260 Medical Office Applications
Risk Management & Clinical Research Duke University Health System Orientation 2008 Clinical Research Coordinators Douglas Borg, MHA, ARM, CPHRM, DFASHRM.
SETMA Provider Training October 19, One of the catch phrases to medical home is that care is coordinated. At SETMA it means more than just coordinating.
University of Hawai’i Integrated Pediatric Residency Program Continuity Care Program Medical Home Module Case 2.
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 9 Continuity of Care.
E&M Coding. Cover office visits Hospital visits Physicals Counseling.
Chief Residents’/Fellows’ Meeting on Patient Safety JCI Preparation of Trainees 9 June 2015.
Medical Documentation Chapter 4 Elsevier items and derived items © 2010, 2008 by Saunders, an imprint of Elsevier Inc.
Medical Documentation Chapter 4 Elsevier items and derived items © 2010, 2008 by Saunders, an imprint of Elsevier Inc.
1Revised April 2011TUMG Compliance Disclaimer This presentation is intended only for use by Tulane University faculty, staff, and students. No copy or.
Patient discharge. objective By the end of this lecture you will be able to : Explain the ideal process of patient discharge.
Your Guide. Table of Contents Welcome to MyChart…………………………….…..3 How to Sign Up………………………………… MyChart Homepage (navigating through MyChart)……...
MedLifeCard in real-life scenarios Cost Saving Improved Patient Care.
Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
Comprehensive Health Insurance: Billing, Coding, and Reimbursement Deborah Vines, Elizabeth Rollins, Ann Braceland, Nancy H. Wright, and Judith S. Haynes.
THE SPORTS CHIROPRACTOR CONTACT SPORTS. ä SPORTS ARE A HIGH RISK FOR THE GENERAL PRACTITIONER ä THE STRATIGIES ARE THE SAME ä HOWEVER A HEIGHTENED AWARENESS.
4/2000Copyright 2000 Scott Hainz, D.C> NATIONAL COMMITTEE FOR QUALITY ASSURANCE Guidelines for Medical Record Review.
Discharge Summaries.  Discharge Summaries –Can be challenging  What happens during a hospital course is now more complex and more detailed than in the.
0 Ethics Lecture Essentials of Informed Consent. ACADEMY OF OPHTHALMOLOGY Disclosures  The speaker has no financial interest in the.
Digital Retinal Imaging for Diabetics in a Family Medicine Residency Patient Centered Medical Home Nick Patel, MD Robert Newman, MD April 25,2010.
Curbside Consultations May Faculty  John VanBuskirk, DO – Family Medicine/OB  Residency Program TFM MMA Disclosure/Off Label Information:  In.
Disclaimer This presentation is intended only for use by Tulane University faculty, staff, and students. No copy or use of this presentation should occur.
HI250 Medical Coding II Seminar 9. Unit 9 E/M codes E/M codes Evaluation and Management coding Evaluation and Management coding Documentation in the patient’s.
Clinical Aspect Medical Office Assisting State the need for a health history. State the need for a health history. Describe the components of the health.
 Proposed Rule by the Centers for Medicare & Medicaid Services on 11/03/2015Centers for Medicare & Medicaid Services11/03/2015  Revises the discharge.
 The medical record is a legal document and provides evidence of the continuity of care of a patient. Copyright © 2007 by Saunders, an imprint of Elsevier.
Prolonged Service without Direct Patient Contact
Clinical Documentation Tool Box
Evaluation & Management Codes
6th Annual National Congress on Health Care Compliance
Chapter 7 Appointments.
Disclaimer This presentation is intended only for use by Tulane University faculty, staff, and students. No copy or use of this presentation should occur.
Patient Medical Records
RISK MANAGEMENT and PATIENT SAFETY PROGRAM BASICS
Disclaimer This presentation is intended only for use by Tulane University faculty, staff, and students. No copy or use of this presentation should occur.
Concurrent Care For Children Who Are Enrolled In Hospice
MAKING QAPI PAINLESS It doesn’t have to hurt!! Joan Balducci, RN, BS
Patient Registration and Data Entry
Presentation transcript:

The Crucial Role of the Practice Administrator in Reducing Risk American Association of Orthopaedic Executives April 14, 2008 MEDICAL CONSULTANTS OF NEW ENGLAND, LLC MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

Elements of Risk Management Risk Prevention Claims Defense MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

MEDICAL CONSULTANTS OF NEW ENGLAND, LLC Risk Prevention Office significant source of Malpractice 35% of allegations stem from substandard office systems Good systems will save time and financial loss As healthcare becomes more complex good systems are essential to prevention MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

Develop Practice Philosophy Practice brochure Insurance policies, billing policies, hours, Rx refills Establish patient expectation The informed patient is much less likely to file a claim with a poor outcome totally unrelated to medical negligence MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

MEDICAL CONSULTANTS OF NEW ENGLAND, LLC Employees Validate & document professional credentials Background checks Document training and policy & procedures Name tags and position MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

MEDICAL CONSULTANTS OF NEW ENGLAND, LLC Systems Procedures Diagnostic testing follow up X-ray Transportation of patients Chaperon Casting, DME Medical Record: EMR, allergies Equipment Proper training (cast saw) Maintenance and PM MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

MEDICAL CONSULTANTS OF NEW ENGLAND, LLC Systems Telephone Triage of calls & responsibility Documentation of calls Method of communication: e-mail, fax, Compliance HIPAA OSHA Discharge of Patients MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

MEDICAL CONSULTANTS OF NEW ENGLAND, LLC Claims Defense Supportable policies and procedures Well defined process for claim management MEDICAL CONSULTANTS OF NEW ENGLAND, LLC

Medical Records What will opposing counsel ask? Will try to show: Minute details about events occurring many years ago; Seemingly unimportant details can become a focal point; Will try to show: That if the medical record contained additional important information, that the patient’s outcome would have changed; Inadequate follow-up; Inadequate consent process and; Ultimately that the medical record and thus the care provided was inadequate. A thorough, complete medical record can form the cornerstone of a strong defense.

Medical Records A 2 year old is seen by an Anesthesiologist prior to undergoing an elective outpatient procedure. The patients mother reports that there is a family history of Prolonged QT syndrome. The Anesthesiologist called the primary physician requesting an EKG, which was ordered through the pediatrician’s office. The EKG was late coming back to the pediatrician’s office and was placed in the medical record without being seen by the physician. During a follow-up visit 6 months later, there was no mention of the EKG by either the physician or the patient’s mother. 2 months later, the child died with a V-fib arrest and ultimately was shown to have prolonged QT syndrome on the EKG in his chart.

Medical Records History, Physical, appropriate labs and x-rays are all well documented. Preoperative evaluation and clearances are complete. (All abnormal exams are referred to the appropriate primary care physician or appropriate specialist.) The nature of the discussions with the patient and as appropriate the patient’s family, regarding informed consent, are well documented. Lastly, the documentation in a hospital setting must meet the same standards you use in your office.

Office Calls Post-operative It is common for patients to receive discharge/post-op instructions to call the physician’s office if varied sxs. occur. Is there a policy to guide the office on how these calls are processed and the patients managed? Are their criteria, including a list of diagnoses/complaints, where patients are directed to either come into the office or be referred to the ER? Can a secretary take down the information and leave it for the physician? Example: Pt calls the office with chest pain after getting home. The physician is not in the office and a PA or ARNP asks the patient to come in. An EKG is performed and the patient sent home with instructions to see the physician tomorrow. This patient died that evening resulting in a large settlement.

Labs and X-ray Exams Was the test performed? Were the results seen by the physician? Were actions taken because these results were abnormal? Including communication with referring physicians.

Labs and X-ray Exams A 50 year old patient presented to their physician’s office for weakness and lethargy on a Friday afternoon. Labs were drawn and sent to an outside lab. The patient was sent home. The patient was found to have a sodium of 110. The lab called the answering service and asked the service to relay the results to the physician, which never occurred. The patient’s condition deteriorated and they arrived at the ER on Sunday, was admitted to the ICU and subsequently expired. Settlement: $2,500,000 split between the physician, the pathologist and the lab.

Patient Responsibility Make the patient responsible; Discharge instructions Consent forms Have them sign