Question

Identifies and describes regulatory issues faced by health information management professionals employed by managed care and dialysis clinics in at least 4 substantive paragraphs (a paragraph is at least 5 sentences)

Answer 1

Health information management professionals employed by managed care and dialysis clinics are responsible for managing healthcare quality. Along with several other roles they actively play one of the most challenging tasks is to deal with regulatory issues. Some of the regulatory issues that they come across are discussed as follows:

• CMS Condition for coverage: HIM professional is responsible for sticking to compliance with federal regulation related to Centres for Medicare & Medicaid Services (CMS) Conditions. The federal government highly regulates managed care and dialysis sector. The reason behind this is Medicare beneficiaries have to be genuine. Therefore, HIM professional has to ensure that federal government SMS conditions for coverage are met. And the patients who are not eligible for medical benefits are charged appropriately.
• Privacy of patients: HIM professional is responsible to protect the information related to patient under “Covered entities”. The law is very strict in this area and HIM professional is obligated to stick to it. Health Information Technology for Economic and Clinical Health (HITECH) ensures privacy and security rule are followed religiously. Penalties are also enforced in case of noncompliance. Patient’s personal and medical information are subject to legal issues.
• Physician referrals/leakage: It is another regulatory issue that HIM professionals face as it has laws to question the reason behind referrals. In many cases affiliated physicians that are employed with one managed care are referring cases to another system. HIM professional study statistics to keep a check those referrals are genuine and abide to the law and are not commission based. The government also intervenes in this area as it is related to patient’s financial condition. Also patients right to get best care is involved in this.
• Maintaining records: HIM professional is obligated to ensure that the managed care or dialysis clinic is collecting, and maintaining the medical records as per guidelines of federal government. It is important to make sure that medical records are accurate and complete. They should be protected as per HITECH guidelines. So that patients don’t suffer any societal discrimination. Therefore, to maintain medical records is another regulatory issue faced by HIM professional.