PLEASE PROVIDE ANY REFERENCES USED AND EXAMPLES. INCLUDE IN TEXT
CITATIONS. This is just a discussion question that needs answered. Please provide all
references that you use and at least two peer review resource within 2016-2021. PLEASE
ALSO INCLUDE SUBTITLES SO THAT I CAN KNOW THE DIFFERENCE AND INCLUDE AT
LEAST 2 REFERENCES AND IN TEXT CITATIONS.
SUBTITLE 1 (T3DQ1 – HCI 665 -FARNAZ):
A healthcare clearinghouse is regarded as an intermediary between the healthcare providers and the insurance payers. In most cases, a clearinghouse reviews the medical claims for errors and ensures that the payer accurately processes claims. The Health Insurance Portability and Accountability Act (HIPAA) privacy rule safeguards individually identifiable health information (HHS.gov, 2017). Its scope covers all the identifiable health information created, received, maintained, or transmitted by a covered entity in an electronic format. Healthcare clearinghouse plays several roles in the protection of electronically protected health information (e-PHI). First, it determines eligibility verification to ascertain the patient’s portion before the appointment. It also helps in knowing the claim status report at any given time. The clearinghouses have enhanced e-PHI access through online platforms. It also helps in accessing patient statement services at any time and prompts support to clients.
The primary role of healthcare clearinghouses is converting non-standard information received from other agencies into a required standard. In most cases, health care clearinghouses focus their operations on individually identifiable health information when offering services like storage to a health facility or a health plan. Most situations entail only particular privacy aspects based on the use and disclosure of confidential health information outlined under the HIPAA laws (Clearinghouses.org, 2014). Health care clearinghouses work hand-in-hand with billing agencies, information systems for community health management, reproaching businesses, and switches and value-added networks that undertake clearinghouse responsibilities.
On the other hand, any health care provider that engages in the electronic transmission of health data in partnership with specific organizations is regarded as a covered entity. In most cases, health care providers engage in transactions entailing claims, assessing compensation eligibility, and applications for referral authorization (HHS.gov, 2017). The HIPAA privacy laws also protect health care providers if they send payments electronically or use a billing system, or involves an intermediary to do so on their behalf. Health care providers’ scope is also provided since it consists of all service and medical service providers outlined by Medicare or other individual entities.
References
Clearinghouses.org (2014). What is a clearinghouse for medical claims, and what do they do? https://coa.org/docs/WhitePapers/Clearinghouses.pdf
HHS.gov (2017). Covered entities and business associates. https://www.hhs.gov/hipaa/for-professionals/covered-entities/index.html
SUBTITLE 1 (T3DQ1 – 680 – JANINE):
Key components of an organizational strategic plan according to (Jessee, n.d.) are to first have an understanding of what direction youre trying to go in. This is called the analysis and assessment phase, this is where the majority of time should be spent. You need focus in your plan, not just a vague statement. This phase is essentially the future of the organization, where do we want to go with this, who will benefit, what is the overall vision. The next step would be the strategy formulation phase. This is where you want to document the strategic plan and identify the goals and metrics that you will track. Now that you have a strategic plan in place the team can come up with SMART goals to focus on what the team is trying to accomplish. These goals are specific, measurable, attainable, realistic, and timed. This helps the plan stay on track. Make sure the right people are on the team at this point. Assign people to what they are responsible for. This cuts out confusion and too many people working on the same thing.
The next phase is the strategy execution phase. This is where the team focuses on action items, track progress and look for areas of improvement or change that needs to happen. Be open to feedback from others not on the team during this phase, they may identify something that the team has not considered. This is where some of the SMART goals may need to be changed a bit, that is alright, it doesnt mean failure. These are areas of improvement. The last phase will be the plan evaluation phase. This will be where you can finalize the plan with any updates or changes that needed to be made in the previous phase. Look at the goals and make sure they align with what your plan is. This is a never ending phase, an organization should look at their plans over and over again and re-evaluate to make sure that it is meeting the goals and going in the direction that the organization wants.
Jessee, T. (n.d.). Healthcare strategic planning: Step-by-step advice. Clear Point Strategy. https://www.clearpointstrategy.com/strategic-plan-techniques-examples-in-healthcare/
