concepts healthcare organizations

Step 1: Put the following steps in the order of a routine patient care flow, from the beginning through to the end of the patient encounter flow. 

  • New patient paperwork is signed and returned to front desk with insurance information for verification of benefits
  • Patient pays standard co-pay if applicable
  • Hard copy record is pulled, or made if new patient
  • Patient called to back office
  • Height, weight, and blood pressure taken by CNA or CMA
  • CMS 1500 form is coded and sent to insurance for reimbursement
  • Signs in at reception desk
  • Patient released from exam room
  • Call in to schedule appointment
  • Doctor, NP, or Physician’s Assistant examines patient
  • Shown to patient care room
  • Reason for visit reviewed with patient by CNA, CMA, or NP
  • Any refunds due to patient or insurance sent out
  • Collections efforts initiated if patient’s charges not paid, and any insurance appeals are processed
  • Patient checks out and pays any deductible verified
  • Explanation of benefits returns with breakdown of payments
  • Height, weight, and blood pressure taken by CNA or CMA
  • Practice manager applies payments, writes off amounts required by contract with insurance companies, adjusts patient’s account records, and initiates billing to patient that indicates insurance has processed charges

Step 2: Write an essay of 1–2 pages explaining how a new office would be set up or organized. Some of the elements included could be: 

  • The physical appearance of the office
  • The types of personnel that would be needed
  • The types of activities, policies, or procedures that would be put into place to mentor employees and promote teamwork
  • Create and describe the demographics of the patients that would receive care at this facility. 
    • Remember that demographics include any and all of the following: type of population (rural, suburban, urban); male or female; adult or child; type of insurance, public assistance, or no insurance; emergency care needed or preventative care; and many others.
  • Describe the specialized training that you, the office manager, need to help this particular facility accomplish its mission of efficient integrated medical care to its patient population. 
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