Module 5: Assignment

Assignment:

Each assignment must contain an INTRODUCTION and CONCLUSION page. Make sure you follow the Grading Rubrics to write the homework. Each paragraph must have at least 2-3 in-text APA citation from the References list.

Learning Materials

  • Clark, M. (2015). Population and Community Health Nursing (6th ed.). Pearson. ISBN: 9780133846584. Read Chapters 10 & 13.

Additional Resources:

  • Case Management Society of America. (2016). Standards of practice for case management. https://www.abqaurp.org/DOCS/2016%20CM%20standards%20of%20practice.pdf
  • ENTP Life. (2020, March 23). How to start a home care agency | Episode 1 – Getting started 7 key steps [Video]. YouTube. https://youtu.be/H2PQbatWAWs
  • ENTP Life. (2020, April 5). How to start a home care agency | Episode 2-researching state regulations & application process [Video]. YouTube. https://youtu.be/pod6ozqf_0Q
  •  ENTP Life. (2020, April 19). How to start a home care agency | Episode 3-building effective teams [Video]. YouTube. https://youtu.be/Wjir-_Xc748
  • ENTP Life. (2020, April 22). How to start a home care agency | Episode 4-which is better corporation or LLC [Video]. YouTube. https://youtu.be/d54892-kEeU
  • ENTP Life. (2020). How to start a home care agency | Episode 7 -policies and procedures [Video]. YouTube. https://youtu.be/F9gbtb0TBkw
  • Scope and standards of practice for registered nurses in care coordination and transition management. (2015). ProQuest Ebook Central.

Start by reading and following these instructions:

  1. Quickly skim the questions or assignment below and the assignment rubric to help you focus.
  2. Read the required chapter(s) of the textbook and any additional recommended resources. Some answers may require you to do additional research on the Internet or in other reference sources. Choose your sources carefully.
  3. Consider the course discussions so far and any insights gained from it.
  4. Create your Assignment submission and be sure to cite your sources if needed, use APA style as required, and check your spelling.

Assignment:

This scholarly submission should be at least 1500 words and should contain 2 sources outside of the materials used for this module.

The graduate level nurse is well suited to assume many different roles within the home health agency. Review the clinical and administrative roles outlined in the following article:

Scope and standards of practice for registered nurses in care coordination and transition management. (2015). Retrieved from ProQuest Ebook Central.

  • To find the titles, you can click into ProQuest Ebook Central, linked on the library page, A-Z list of databases and search for the book titles enclosed in quotation marks.

Choose a clinical and administrative role that is of interest to you and discuss how these roles, their associated responsibilities, and functional areas contribute to effective home health care delivery.

Assignment Expectations

Length: 1500 – 1750 words; answers must thoroughly address the questions in a clear, concise manner.

Structure: Include a title page and reference page in APA style. These do not count towards the minimum word count for this assignment.

References: Use the appropriate APA style in-text citations and references for all resources utilized to answer the questions. Include at least two (2) scholarly sources to support your claims.

Format: Save your assignment as a Microsoft Word document (.doc or .docx).

File name: Name your saved file according to your first initial, last name, and the assignment number (for example, “RHall Assignment 1.docx”)

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Medical Administrative Specialist

Author’s Name

Department, University

Course Code

Instructor

Date

Introduction

              Medical administrative specialists play an important role in promoting health care in hospital environments, clinics, non-governmental organizations, medical offices amongst others (US Bureau of Labor Statistics, n.d.).  As a multi-skilled practitioner, his/her role is of great importance to effective home health care delivery. The professional familiarity with clinical and technical concepts is important for continuity and coordination of care even at homes.  The medical administrative specialist nature of work applies to patients who want to know the complexities of therapy and self-management procedures. The professional attributes such as attention to detail, compassion and outgoing make the individual assist meet needs of patients receiving care from their homes (Betterteam, n.d.). This paper aims to discuss how medical administrative roles, associated responsibilities, and functional areas contribute to effective home health care delivery.

Setting Appointment Times

           The medical administrative specialist role in setting appointment time can ensure effective scheduling and timely show up of a nurse in a home care environment. Medical administrative specialists ensure seamless appointments when scheduling home care visits. The scheduling ensures the patients at home maintain engagement with healthcare practitioners. Medical administrative specialists want health care provider to accept that home patients are still customers. Remote scheduling seeks to improve healthcare accessibility (Demirbilek, Branke, & Strauss, 2019). Automating scheduling with interfaces helps patients recovering at home know when and who will come to care services at their homes.  With the help of automatic scheduling, patients can filter a nurse or physician based on their interest and inferences.

           Medical administrative specialists ensure communication is more available by leveraging open access to health services. Patients needing care from home prefer to liaise with a person who will remove access barriers.  Patients needing emergency care from home want immediate interventions from supplements staff in healthcare facilities. Home patients want an active engagement with nursing practitioners’. A medical administrative specialist implements an open access method for patients needing care from home. An open-access method eliminates weekly or monthly scheduling for needy scheduling (Sauré, Begen, & Patrick, 2020). A medical administrative can determine cases which need urgent and routine appointment based on an interaction between the patient and the care provider. Managed care for patients at home breaks away from the usual bureaucratic ways of delivering care. A medical administrative specialist is supposed to prioritize appointments. For effective home health care delivery, patient visits should vary based on the severity of the condition, level of care needed and degree of time needed. The professional use their best judgement to evaluate patient requests and call to determine which patient deserves urgent care, more time and special intervention. 

           Medical administrative specialist contributes to urgent and advanced interventions which patients with complicated conditions need. S/he confirms appointment through calls, texts or emails hence preventing no show or delayed intervention for patients needing care from home (Erdogan, Krupski, & Lobo, 2018). An effective patient waiting list is generated for the patients to get notifications about time, designated provider and time of visiting and cancellation. The schedule can be improvised to involve a recall system for the home patients to return for their usual therapy.

Fill Out, Handle and Submit Insurance Information

           A medical administrative specialist should facilitate health insurance claim. Home patients need people to help in requesting reimbursements for the care services delivered. For effective home care delivery and payment, the medical administrative specialist helps patients get prior authorization, prevent coding errors and missing information (US Bureau of Labor Statistics, n.d.).The professional must ensure the insurance claim meets the medically necessary treatment. The medical administrative specialist reads and interprets insurance policies on behalf of home patients to determine whether their plan covers a specific treatment.

Facilitating Patient-Provider Relationships

               Even though a medical administrative specialist is obliged to greet patients and ensure providers provide consumer/patient-centric care, home patients want positive experiences influenced by good relationships. A strong patient-provider relationship is the basis of effective and quality home care delivery. When the medical administrative specialist motivates nurses to meet patient’s needs, a strong relationship is built. Patients in remote environments want a medical administrative specialist who is knowledgeable, understands their plight, and find the appropriate nurse or physician. The medical administrative specialist ensures care providers express empathy when delivering home care. Physicians should connect with the feelings of the patients (Nicoloro-SantaBarbara et al., 2017). The medical administrative specialist should monitor whether practitioners exhibit cognitive empathy. When clinicians recognize, internalize and act to meet the patient’s needs, the medical administrative specialist appeal is met.

           When a medical administrative specialist uses strong communication skills between clinicians and home patients, a positive relationship is created. Effective communication skills when dealing with the two individuals prevents conflicts. Fostering overarching communications skills ensure clinicians aver the right medical instructions, provide patient education, collect, synthesize and share information with home patients. (Nicoloro-SantaBarbara et al., 2017). Since the medical administrative specialist act as an intermediary between the clinician and the home patient, biases concerns can be identified and reprimanded. Poor communication will hinder determining the cause of the health problem. Patients who prefer meaningful conversations and clinicians who focus on health instruction prevent conflicts. Therefore, when communication is strictly professional and ethical, positive relationships are built for effective home care delivery.

            An effective home care delivery can be implemented by a medical administrative specialist who drives shared decision making. The evolving nursing scope necessitates team centred care which meets the needs of home patients. The medical administrative specialist should lobby for patient voice in decision making and home care delivery. Shared decision making whereby the patient has the right to give his/her opinions is crucial for effective home care delivery. However, the medical administrative specialist insists on engaging the community/family, implementing patient education and factoring in patient cultural and personal preferences (Kalid et al., 2018). Integrating patients key characteristics result in positive experiences/outcomes, a strong relationship is built, patient satisfaction increases due to effective home care delivery.

Promoting Follow up Care

            Medical administrative specialists foster follow up in-home care since it happens to be a forgotten touch point for checking up on discharged patients. Follow up is part of offering a comprehensive medical practice. Initiating follow up in-home care is of key importance to medication adherence and instruction compliance (Crable et al., 2020). The medical administrative specialist ensures a vibrant practice when they maintain constant communication with patients at home. Follow up builds the reputation of a health care organization for its prowess in customer service and care. The medical administrative specialist is tasked with sending thank you texts and emails to patients when a physician completes a visit.  The specialist is supported to notify the patients about the next appointment. Also, the professional should send directives on self-management and the importance of performing physical exercises, and healthy eating (Crable et al., 2020). It is important to seek feedback through a brief satisfaction survey to determine the degree of home care delivery. Follow up helps in identify loopholes, inefficiencies and improving service delivery.

Ensuring HIPPA, Compliance, Privacy, and Confidentiality Standards

            In home care delivery, the medical administrative specialist should ensure healthcare insurance is reliable and safe for discharged patients and those receiving care from home. The specialist initiates the need to secure patients information and prevents its disclosure (Mbonihankuye, Nkunzimana, & Ndagijimana, 2019). Therefore, HIPAA should apply to home patients to maintain the confidentiality and integrity of their data. The medical administrative specialist has to ensure HIPPA laws are enforced in home setups failure to which should attract punishment. Clinicians should also follow HIPAA and protect patient’s information. Even if clinicians have different operations, the data of home care patients should not be compromised.

Verify Patient Information and Updating Demographic Information

            The medical administrative specialist role in collecting and managing patient for verification is essential for home care delivery. The process improves medical record accuracy and prevents medical identity breach. When the specialist verifies patients, s/he acts per HIPAA guidelines. Effective home care delivery should factor in verifying patient’s information and identity before any medical process (Yum, 2015). Verifications prevent insurance fraud, incorrect medical procedures; instead, the process leads to a positive patient experience.

Information verification is not enough without the storage of accurate records.  Verification is needed to combat discrepancies in medical records, information duplication, overlays and delays in treatment. Therefore, the medical administrator specialist role in verifying patient’s information and correctly matching it related records would prevent unethical and fraudulent activities in home care delivery.

            Medical administrative specialist responsibility to update demographic contribute to effective home care delivery. Like in any other nursing scope, the clinicians should first know who the patients are and where are they located. The information medical administrative specialist collect from home patients helps uncover their needs for enhanced quality service, treatment and specialized care.  In home care delivery the following demographics should be updated. They include address, medical history, education, sex, age, employment, and insurance provider (Albany.edu .n.d.).Updated demographics in home care allow practitioners to build relationships/trust with groups then make decisions based on the patient’s needs. The health provider tailors the care to ensure the patients receive quality and effective care. Also, updating demographic information signifies the care provider is culturally competent to provide solutions for patient’s unique problems. The process is essential to amass the necessary recourses needed for home care services. The more information is collected from home patients the better service they will receive.

Conclusion

            A medical administrative specialist is one amongst professional practice who understands care operations. Based on the specialist role and responsibilities, practitioners can implement well-informed procedures in home care setup while meeting the needs of patients. A medical administrative specialist acts as an intermediary who takes care of both clinicians and patients. Above all, effective home care delivery is founded on offering connected care; continue quality care, and following HIPAA policies and guidelines.

References

Albany.edu. Why Hospitals Should Collect Demographic Data

https://www.albany.edu/cphce/mrt_tools/staff_tools/English/Justification%20for%20frontline%20staff%20FINAL.pdf.

Betterteam. Medical Office Specialist Job Description. Betterteam. https://www.betterteam.com/medical-office-specialist-job-description.

Crable, E. L., Feeney, T., Harvey, J., Grim, V., Drainoni, M. L., Walkey, A. J., … & Drake, F. T. (2020). Management Strategies to Promote Follow-Up Care for Incidental Findings: A Scoping Review. Journal of the American College of Radiology. https://doi.org/10.1016/j.jacr.2020.11.006

Demirbilek, M., Branke, J., & Strauss, A. (2019). Dynamically accepting and scheduling patients for home healthcare. Health care management science22(1), 140-155. https://doi.org/10.1007/s10729-017-9428-0

Erdogan, S. A., Krupski, T. L., & Lobo, J. M. (2018). Optimization of telemedicine appointments in rural areas. Service Science10(3), 261-276. https://doi.org/10.1287/serv.2018.0222

http://www.americanmedtech.org/Portals/0/PDF/Get%20Cert/CMAS%20Flyer%20for%20website.pdf.

Kalid, N., Zaidan, A. A., Zaidan, B. B., Salman, O. H., Hashim, M., & Muzammil, H. J. J. O. M. S. (2018). Based real time remote health monitoring systems: A review on patients prioritization and related” big data” using body sensors information and communication technology. Journal of medical systems42(2), 30. https://doi.org/10.1007/s10916-017-0883-4

Mbonihankuye, S., Nkunzimana, A., & Ndagijimana, A. (2019). Healthcare data security technology: HIPAA compliance. Wireless Communications and Mobile Computing2019. https://doi.org/10.1155/2019/1927495

Nicoloro-SantaBarbara, J., Rosenthal, L., Auerbach, M. V., Kocis, C., Busso, C., & Lobel, M. (2017). Patient-provider communication, maternal anxiety, and self-care in pregnancy. Social Science & Medicine190, 133-140. https://doi.org/10.1016/j.socscimed.2017.08.011

Sauré, A., Begen, M. A., & Patrick, J. (2020). Dynamic multi-priority, multi-class patient scheduling with stochastic service times. European Journal of Operational Research280(1), 254-265. https://doi.org/10.1016/j.ejor.2019.06.040

US Bureau of Labor Statistics:. Americanmedtech.org.

Yum, H. (2015). Concept and importance of patient identification for patient safety. Journal of the Korean Medical Association 58(2) http://dx.doi.org/10.5124/jkma.2015.58.2.93