Question

The recovery audit program requires audits of healthcare providers using a fee-for-service (FFS) Medicare plan. The recovery auditors will identify underpayment or overpayment made on claims of services for Medicare beneficiaries. Assuming the role of a healthcare administrator in a hospital environment, imagine that your organization is facing an audit. How would you prepare your organization for the audit? What role will collaboration between specific departments play in helping your organization meet compliance challenges?

what more info so you need?

Answer 1

Medical audit is an opportunity for identifying lacks and taking steps towards improvement, and create a mechanism through which action is taken to make sustainable improvements are implemented.

Question 1

How would you prepare your organization for the audit?

The roles of hospital administrator are

1. Prepare for initial quality assessment which includes

a. Performance appraisal

b. Statistical quality control

c. Quality assurance

d. Quality improvement

2. The hospital administrator follows rules like time management, just in time approach, and zero deficit

3. The audit is directional and is directed with professional motive, social motive and pragmatic motive

4. The various factors that are audited are

a. Medical accounting

b. Analysis of needs

c. Infrastructure

d. Patient satisfactions

Note in the current scenario underpayment or overpayment made on claims of services for Medicare beneficiaries is audited

5. Hospital administrator arranges a good team comprising of technicians, administrative support, medical record librarian, hospital planning research team.

6. Collect the data and process and prepare a slide show showing the problems identified and management steps accordingly

Question 2

What role will collaboration between specific departments play in helping your organization meet compliance challenges?

Hospital administrator works in tandem along with other departments of the organisation, the steps that the hospital administrator follows to complete the tasks of collaborative management between specific departments are

a. Criteria development

b. Selection of collaborative departments

c. Worksheet preparation on priority basis

d. Case evaluation

e. Collection of data

f. Presentation of report

The roles of hospital administrator in general are

a) To facilitate and provide good working environment

b) To provide physical facilities and resources

c) To motivate medical care provider

d) Patient satisfaction survey

e) Frame achievable objectives and goals

f) Mark and make changes suggested