OPERATIONS
HIPPA automatically pops up when people talk about healthcare operations because it bundles the most number of functions into the team “healthcare operations”. Healthcare operations includes the following:
- Conducting quality assessment and improvement activities, including outcomes evaluation and development of clinical guidelines or protocols, provided that the obtaining of generalizable knowledge is not the primary purpose of any studies such as research.
- Population-based activities relating to improving public health or reducing healthcare costs.
- Case management and care coordination.
- Contacting of health care providers or patients with information about treatment alternatives.
- Reviewing the competence or qualifications of health care professionals.
- Evaluating practitioner and provider performance
- Evaluating health plan performance
- Conducting training programs for students, trainees, or health or non-health practitioners.
- Accreditation, certification, licensing, or credentialing activities.
- Underwriting, premium rating, and other activities relating to health insurance contracting.
- Conducting or arranging for medical review, legal services, auditing functions or other compliance programs
- Business planning and development, cost-management and planning-related analyses
- Development or improvement of methods of payment or coverage policies
- Business management and general administrative activities of the entity
- Business activities relating to compliance with HIPAA
- Customer service, including the provision of data analyses for policy holders, plan sponsors, or other customers
- Resolution of internal grievances
TRAINING AND DEVELOPMENT
One may wonder what is training and development in healthcare all about since technically teaching a student about MCAT (Medical College Admission Test) is training and development in healthcare. Training and development in the health care industry is a continuing and ongoing process and cannot be overestimated. It is necessary since the health care industry grows rapidly and specialization of different parts of the industry keeps evolving just like how the all in one family doctor is now evolved into different specialties and sub-specialties. With this in mind, it is a must that constant training and development of healthcare workers is done effectively.
DOW Healthcare are staffed with all the healthcare professionals from physicians in various specialties and sub-specialties to healthcare administrators. This makes us better understand why training and development is essential for a healthcare organization. We are the solution! So make the right choice today and choose DOW Healthcare for your management needs.
HUMAN RESOURCES
One may wonder what is training and development in healthcare all about since technically teaching a student about MCAT (Medical College Admission Test) is training and development in healthcare. Training and development in the health care industry is a continuing and ongoing process and cannot be overestimated. It is necessary since the health care industry grows rapidly and specialization of different parts of the industry keeps evolving just like how the all in one family doctor is now evolved into different specialties and subspecialties. With this in mind, it is a must that constant training and development of healthcare workers is done effectively.
DOW Healthcare are staffed with all the healthcare professionals from physicians in various specialties and subspecialties to healthcare administrators. This makes us better understand why training and development is essential for a healthcare organization. We are the solution! So make the right choice today and choose DOW Healthcare for your management needs.
COMPLIANCE
Regardless of what specialty or the size of one’s practice or facility, there are always healthcare compliance concerns that all medical related organization face. From eliminating cloned electronic health records and poor documentation to following the Emergency Medical Treatment and Active Labor Act, Stark Law and Anti-Kickback Statutes, health care organizations must be compliant with changing health care trends, guidelines, laws, and government regulations to minimize their risk.
To stay out of harm’s way from government scrutiny and liability risk, your practice or facility can benefit from a medical compliance plan and the services of a health care compliance officer. It’s the best way to ensure your claims and processes are clean and compliant with government and payer requirements, to decrease your risk of malpractice claims and insurance fraud and abuse, and to save you from costly lawsuits. In order for one to become a healthcare compliance officer, one needs to obtain expertise in areas such as:
- Office of Inspector General compliance guidance.
- Health care fraud and abuse laws including associated penalties
- Provider Enrollment and Chain Ownership System verification
- How the Affordable Care Act will affect medical practices
- Health Insurance Portability and Accountability Act, EMTALA, and Clinical Laboratory Improvement Amendments
- Handling investigations, including self-disclosure protocols
- Government investigative audit programs
- Risk areas such as receiving gifts or gratuities, conflicts of interest, use of Advance Beneficiary Notices, teaching physician guidelines, and incident-to services.