Healthcare Management Purpose 2 Handbook Developing Professional Relationships in the Healthcare Field

Metropolitan College of New York School for Management

Contents

OVERVIEW OF THE PURPOSE

Purpose deliverables, competencies and their assessment

THE PURPOSE DIMENSION

The Constructive Action

THE VALUE AND ETHICS DIMENSION

Public Speaking and the Art of Persuasion

THE SELF & OTHERS DIMENSION

Healthcare Management I

THE SYSTEMS DIMENSION

Medical Insurance THE SKILLS DIMENSION

Health Information Technology

Overview of the Purpose: Developing Professional Relationships in the Healthcare Field Having been introduced to the basics of Self –Assessment and Planning for Professional Development, students are now directed toward the development of professional relationships. The goal of this purpose is improving communications and productivity and continuing in the development of your career as a professional in the healthcare industry. In this purpose the students develop professional relations in the healthcare field using public speaking and art of persuasion, healthcare information technology, awareness of medical insurance and health service management skills. The purpose involves several activities:

1. The skill of public speaking, refining healthcare business writing and the

development of interactive communication skills ( meetings, conferences, oral

presentations);

2. Functions and responsibilities associated with the management of resources in

the healthcare delivery settings;

3. Health insurance management including completing health insurance claims,

their submission and processing, and assurance of HIPAA compliance;

4. Use of electronic health information system in the healthcare, and its

integration with medical record management and computer technology to

facilitate medical office functions while assuring health information availability,

integrity and security.

The Constructive Action

Having performed a self-assessment for career development in Purpose I, students are now directed toward communicating with others in the Healthcare field. They are required to make a plan for developing more effective communications strategies in the healthcare area, implement the plan, and evaluate its results.

Relevance of Courses to CA

In The values and Ethics Dimension, the students examine the development and application of values, work ethics, and codes of conduct to address individual

differences and major ethical issues. These are reinforced through written, verbal and interactive communication. In The Self and Others Dimension, students will be introduced the types of healthcare delivery system in US. They will learn history of healthcare, functions and classifications of modern health care facilities, types of ownership and control and a variety of support personnel involved in this system. Further they will learn standards (licensing, certifying, accrediting, etc) used to operate healthcare facilities; current healthcare legislation, and future development of healthcare facilities. The Systems Dimension teaches students the basics of health insurance, processing insurance claims, coding schemes and HIPAA regulations. Students study types of healthcare payers including managed care systems, private insurance, Medicare, Medicaid, state programs, workers’ compensation, TRICARE and CHAMPVA . The Skills Dimension centers on fundamentals of Health Information Technology. The skills include: use of electronic information system in healthcare field, integration of medical record management and computer technology, as well as methods to ensure confidentiality, integrity and availability of medical information. The skills further focus on the creation, updating, maintenance and utilization of Electronic Health Records (EHR).

Purpose Competencies: This purpose will help students develop the following competencies:

Written, verbal and interactive communication skills;

Recognize types of healthcare delivery healthcare payer systems;

Use diagnostic and procedural coding schemes and Process healthcare claims;

Use Electronic Health record for the creation, updating, modifying, and securing

healthcare information.

Assessment of Purpose Competencies: At the completion of this purpose the students will be able demonstrate ability to:

Effectively communicate in writing display interactive communication through

discussions;

Recognize and manage healthcare delivery systems;

Use ICD and CPT codlings to code diagnostic and procedural codes for the submission of

insurance claims to healthcare payers;

Successfully process insurance claim forms;

Use Electronic Health Record software to create, update and secure health records.

The Purpose Dimension Overview This weekly seminar serves as the workshop for the Constructive Action. Classes and individual sessions with students center on discussions of the processes and materials necessary to accomplish the Purpose of the semester. The Value and Ethics, Self and Others, Systems, and Skills dimensions provide additional framework for analyzing the dynamics of the relationships and situations in which students are involved. The Constructive Action for Purpose 2 focuses on communicating with others in the healthcare field, building appropriate and effective relationships on the job, especially as they relate to organizational productivity and effectiveness.

The Constructive Action (CA)

In this Purpose 2 CA, the students are required to develop effective communication strategies, implement them, and evaluate their results in the healthcare area.

Constructive Action Deliverables Students will be assessed on their use of the objectives in a well-planned and executed Constructive Action to achieve the Purpose. Special attention will be given to the following: 1. The integration of theory in the Constructive Action. 2. The quality of the written document. 3. Timely submission of work to permit monitoring and supervision. 4. Class attendance.

Assessment of Constructive Action Competencies: Assessment of competencies at the completion of purpose 2 CA will encompass:

Write-up of self-assessment in terms of strengths, weakness, aptitude and prospective

future career plans;

Successful completion of the CA project demonstrating planning and execution;

Comprehension and retention of the subject matter through periodic tests and exams;

Written communication through project write-up; and

Oral communication through project presentation using appropriate communication

technologies.

Using the Dimensions in Constructive Action Given the overall Purpose, consider the dimensions that you are taking as you plan, carry out, and assess your Constructive Action. How these courses in Value/Ethics, Self and Other, System and Skills apply to the Constructive Action? How did the information gained in these courses help the CA? List the courses individually and analyze their relevance to your CA objectives.

Planning Phase a. Explore opportunities to improve the world. Research the needs of your organization, which can be met by building or strengthening professional relationships. Questions to be addressed are: - How can I identify and describe the hierarchical features of my work site using an organizational chart? How can I describe the social and technological factors at my work site which may help me develop professional relationships? - How can I establish and maintain professional relationships with others at my work site that are necessary to achieve my Purpose? - How are my values and ethics of professionalism related to those of the organization in which I work? How can I analyze the interdependence of various internal and external constituencies of my organization in terms of formal and informal codes of conduct? - How can I apply my managerial and office management skills to healthcare management? - How can I research the needs of my organization, which can be met by building or strengthening professional relationships? During the process of exploration, examine your progress in achieving your objectives, and modify your strategies as required.

b. Choose the best goal. Based on your analysis of various opportunities, choose the short- and long-term goals that will be best to build professional relationships. - Taking into consideration possible outcomes, time frame, resources, risks, constraints, and my

own learning and career needs, which of the possibilities I have reviewed provides the best opportunity for a Constructive Action? - What long-term goal am I working towards in my development of professional relationships? - What are my long-term d short-term goals in my development of professional relationships? - What further information do I need in order to make my plan of action? - What theories do I intend to use to support my plan and actions? - What do I need to learn in order to develop future professional relationships? Maintain a record of your activities. Evaluate developments. Change the plan as required. Explain how your newly acquired knowledge is being used to achieve the Purpose.

c. Agree on a plan.

Based on your study develop a plan to meet your goals. The plan should include clear objectives, realistic strategies, and an evaluation scheme. 1. Objectives Break your short-term goal into specific measurable objectives. It may be helpful to write objectives for each Dimension, depending on your goals. 2. Strategies/Actions: List actions you will take to reach your objectives for this purpose. There should be at least one strategy for each objective. These actions should be as concrete and practical as possible. You may also suggest alternative strategies or multiple strategies for any one objective. Analyze resources and constraints relevant to the accomplishment of each strategy. 3. Evaluation Plan Describe the criteria or benchmarks to be used to monitor progress toward achieving the Constructive Action goal and objectives. That is, how exactly you will know whether or not your strategies have helped you to meet your objectives. Describe the methods to be used for determining whether these criteria have been met. There should be at least one measure for each objective and each strategy. Measures should be both qualitative and quantitative. Evaluation criteria may be altered during the implementation phase.

Implementation Phase d. Carry out the plan. Monitor progress and use of knowledge. Change plan as needed.

Maintain a record of your activities. Evaluate developments. Change the plan as required. Explain how your newly acquired knowledge is being used to achieve the Purpose.

Assessment Phase e. Assess results and plan next steps. Review and evaluate your accomplishments in developing professional relationships. Determine how you will use your knowledge in developing your future professional work. Questions to be answered in this section include: 1. Did you achieve your task objective? If not, how far did you progress? 2. Were you successful in your task, action, participation, learning, etc? 3. What objectives were realistic? Were some abandoned? Redefined? 4. What strategies worked? Would you use them again? Which did not work? 5. What are your next steps in your development of professional relationships? 6. By developing professional relationships, what did you learn about yourself and the process? 7. Overall, how do you assess your ability to develop professional relationships? 8. What series of materials were most helpful/least helpful and why?

Background Research Students will conduct a Literature Review, in which they will summarize and critically evaluate a substantial number of sources, i.e., books and journal articles, which explicitly deal with the Purpose theme: Developing Professional Relationships in the Healthcare Field. Students will show evidence of effective research skills, providing relevant bibliographical information as well

as proper citation methodology.

Assessment of CA The purpose 2 CA will be assessed based on:

Quality of project report

Final Presentation

The Value and Ethics Dimension: Public Speaking and the Art of Persuasion

Overview The course focuses on three primary components of public speaking: development of an understanding of the communication process, development of interpersonal communication skills, and development of public speaking skills. The working assumption of this course is that the skill of public speaking can be learnt.

Objectives: At the end of this course, the students should be able to demonstrate the ability to:

Apply classroom knowledge and interpret information;

Demonstrate how to effectively deliver information to others;

Convey and present information in a healthcare business setting;

Apply public speaking techniques to personal and professional situations.

Relationship to CA While refining the business writing and communication skills acquired in Purpose I, this course will help students develop the skills necessary for successful interactional communication (i.e. meetings, conferences, oral presentations.) in healthcare settings. It will also enable students to communicate effectively with other team members, counterparts and the team leader.

The Self and Others Dimension:

Healthcare Services Management -1

Overview This course examines the history of healthcare, functions and classifications of modern health care facilities, types of ownership and control and a variety of support personnel involved in this system. The course emphasizes standards (licensing, certifying, accrediting, etc) used to operate healthcare facilities; current healthcare legislation, and future development of healthcare facilities. It also addresses medical education, scientific advances, rising medical costs, changing population demographics, and values and assumptions regarding healthcare.

Objectives

Upon completion of this course, a student will be able to demonstrate the ability to:

1. Identify the elements of the US healthcare delivery system – types of institutions, kinds of personnel and their functions, types of care provided, and current trends and issues in health care.

2. Recognize and monitor the impact of national health information initiatives on the healthcare delivery system for application to information system policies and procedures.

3. Identify legislation which historically has affected or currently affects healthcare delivery in the United States.

4. Interpret, communicate and apply current laws, accreditation, licensure and certification standards related to healthcare at the national, state, local, and facility levels.

5. Utilize general and health-related resources to locate information on topics relating to health care.

6. Understand and appreciate the role of various providers and disciplines throughout the continuum of the healthcare services.

7. Exchange information and knowledge concerning healthcare.

COURSE & RELATIONSHIP TO THE CA This course builds on the Purpose 2 Constructive Action (CA) “Developing Professional Relationships in Healthcare” by conceptualizing the framework for healthcare delivery process. The course involves dealing with different healthcare organizations, third-party payers and other agencies related to healthcare delivery and payments. The entire health services supply chain warrants building relationships and communicating with professionals of diverse background and trainings, the theme of Purpose 2 CA.

The Systems Dimension: Medical Insurance

Overview This course teaches students the basics of health insurance, medical insurance claims processing (completing and submission) manually and electronically. It introduces the students to HIPAA regulations and a variety of payers’ settings: public, private, government (Medicaid, Medicare, Workers’ compensation, CHAMPVA, TRICARE). Computerized ICD-9-CM and CPT coding is emphasized.

Objectives

At the conclusion of this course, students should be able to demonstrate the ability to:

Descibe major insurance programs and federal healthcare legislation;

Respond to legal, ethical and confidentiality issues;

Discuss utilization review principles;

Process insurance claims both manually and electronically;

Describe the concept of RBRVS;

Define Diagnosis Related Groups(DRGs);

Obtain preauthorization and its complete its documentation;

Use assertive communication with managed care and/or insurance providers.

Relationship to CA The course introduces the students to US based healthcare settings, a variety of medical insurance programs, claim filing, processing and reimbursement methodologies. Students learn coding types and techniques and completion of health insurance forms both manually and electronically. They will also understand and implement HIPAA regulations.

The Skills Dimension: Health Information Technology

Overview This course focuses on the use of electronic information systems in the healthcare field. It integrates medical record management and computer technology into widely used medical office functions. The course entails methods that ensure efficient medical office management through electronic record creation, updating, maintenance and utilization.

Objectives

At the conclusion of this dimension, the students should be able to demonstrate the ability to:

Use Electronic Health Record (EHR) software to create, update, maintain and use medical records effectively;

Use EHR for clinical and administrative functions;

Use EHR for diagnostic, insurance and billing purposes;

Relationship to CA

The courses in this CA teach the students skills to use the Electronic Health Record software, the future of healthcare industry, for maintaining healthcare record, performing evidence-based diagnosis and treatments. Students gain skills to electronically process and submit medical insurance claims. They also learn basics of

health insurance, HIPAA regulations, and a variety of private and public payers’ settings.

Recommended Textbooks

Locker, Kitty O. 2006. Business and Administrative Communication, 7th Edition.

New York: McGraw Hill.

Servellen, G. V. 2009. Communication Skills for Healthcare Professional, 2nd Edition: Concepts, Practice, and Evidence. Jones and Bartlett Publishers. ISBN: 0-7637-5557-7 Whitte, P. and Cook, D. (Editors). 2004. Understanding Health Communication Technologies. Jones and Bartlett Oublishers. ISBN: 0-7879-7105-7 Green, Michelle A. & Rowell, JoAnn. 2011. Understanding Health Insurance: A Guide to

Billing and Reimbursement, 10th Edition. Delmar-Cengage Learning.

Sultz, H. A. & Young, K. M. 2011. Health Care USA: Understanding Its Organization and Delivery (Seventh Edition). Boston: Jones & Bartlett Publishers.

Byron R. Hamilton. 2009. Electronic Health Records. McGraw-Hill Higher Education, New

York.

Merida L. Johns. 2011. Health Information Management Technology: An Applied Approach, 3rd

Ed. American Health Information Management association (AHIMA)..

Career Websites

www.healthcareers.com

WWW.AHIMA.Org

WWW.HIMSS.Org

WWW.AMT.ORG

WWW.NHA.Org

WWW.CPHQ.Org

WWW.Healthitcertification.com