Athens Medical Claims Re-engineering

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Athens Medical Claims Re-engineering

Athens Administrators is an open indemnity claims administration services organization. Athens identified a growing trend of future medical claims within their client’s population. The trend had begun to escalate and Athens decided that it was an important issue to bring to the clients attention and to jointly develop a strategy to address the growth of these claims. Athens looked to modify and improve the processes and procedures that were being utilized to address these claims. Read about what they did in their document titled “Future Medical – A Claim on the Rise” located at http://www.athensadmin.com/pdf/Athens-FutureMedical.pdf.

Write a four to five (4-5) page paper in which you:

  1. Provide one (1) sample of a descriptive statement and one (1) sample of a prescriptive statement from the case study descriptions.
  2. Examine three (3):
  1. goals for this case study.
  2. obstacles for this case study.
  3. alternative obstacle resolutions for this case study.
  1. Identify five (5) normal and abnormal scenarios for this case as-is.
  2. Determine five (5) requirements that might need to be prioritized in view of resource limitations.
  3. Use at least three (3) quality resources in this assignment. Note: Wikipedia and similar Websites do not qualify as quality resources.

In this assignment, you will apply this framework to analyze justice issues arising from recent successful efforts to legalize recreational marijuana use in two states and medical marijuana in several other states.

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For this assignment, you will again follow the suggestion to “look at justice through… frameworks that permit careful analysis and evaluation of competing views” (Dreisbach, 2013, Section 2.1). Again, you will apply his framework for analyzing how the concept of justice varies when viewed from the different perspectives of family, community, state, and nation. In this assignment, you will apply this framework to analyze justice issues arising from recent successful efforts to legalize recreational marijuana use in two states and medical marijuana in several other states. Before responding, carefully read the assignment prompt below.

By the end of 2012, 18 states and the District of Columbia had legalized medical marijuana use, under various circumstances, and two states had legalized recreational marijuana use. Legalization proposals are pending in other states.

At the same time, the federal government’s Controlled Substances Act (CSA) bans the possession, production, sale, or distribution of marijuana, even when such activity is technically in compliance with state law. Moreover, the Supreme Court has affirmed the constitutionality of federal enforcement of the CSA against individuals who were in possession of or were growing marijuana for medical use in compliance with California law.

  1. Choose three out of the five scenarios and analyze the retributive, commutative and distributive justice of this complex situation:
    1. A recreational pot smoker who lives in a state that recently legalized growing, possessing, selling, and distributing, through state-regulated dispensaries, limited amounts of marijuana for medical use.
    2. A parent living in the same state, concerned that her 12-year-old will be exposed to new and significant risks of addiction to pot that will be readily available in their community.
    3. An HIV patient, also living in this state, whose doctor advises that smoking small amounts of marijuana will probably relieve some of his pain.
    4. The Chief of Police of the city where these people live, who has urged the City Council to enact new local zoning and other regulations that will make it virtually impossible for medical marijuana dispensaries to operate in the city.
    5. The state’s new Medical Marijuana Board, which is empowered to permit and regulate dispensaries but is without the power to withhold permits, merely because of local opposition in a particular community.
    6. The President and Attorney General of the United States who are responsible for enforcing the CSA as well as upholding the nation’s obligations to implement anti-drug treaties that it has ratified.
  2. Within your analysis, explore the way that moral character may inform the actions or choices of each central actor. Refer to relevant ethical perspectives, as appropriate.
  3. From your analysis of these various perspectives, draw a conclusion about how to achieve the most just resolution to issues involving the availability of marijuana in American society.

Complete an Authorization to Release Medical Records

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Directions: This is a two part assignment. First, in Kinn’s The Medical Assistant Study Guide use the Records Release Authorization to complete Part IV: Releasing Medical Records on page 102. The information on the form should be made up by you. This portion of the assignment is worth 5 points.

Next, in Kinn’s The Medical Assistant textbook, read Procedure 14-2 on page 243 and then use the Informed Consent for Treatment Form to complete. This portion of the assignment is worth 5 points.

Procedure 14-4:  Competency IX.P.IX.3

Part V. Complete an Authorization to Release Medical Records from using your name as the patient.

RECORDS RELEASE AUTHORIZATION

TO_____________________ _____________________________

Doctor or Hospital

_____________________________________________________

                                                                             Address

I HEREBY AUTHOIZE AND REQUEST YOU TO RELEASE TO:

ALL RECORDS IN YOUR POSSESSION CONCERNING _____________

________________________________________ILLNESS AND/OR

TREATMENT DURING THE PERIOD FROM ___________TO_______.

NAME_______________________________TELEPHONE_________

ADDRESS_______________________________________________

SIGNATURE______________________________DATE___________

(If relative, state relationship)

WITNESS________________________________DATE___________

I give my consent to Dr. ___________________________________ and assistants,_________________ to perform:

______________________________________________________________________________________________

(Name of treatment/ procedure. Description in lay & medical terms)

I am aware that, during the procedure, other procedures might be needed. I give my consent to do these procedures as needed.

I give my consent to receive anesthesia and/or drugs I may need.  I know that all procedures and anesthetics have risks like stroke, heart attack, respiratory failure and death.  Some other risks are tooth and nerve damage, and skin/soft tissue injury.

I give my consent for blood and/or blood products if I need them.  I know that all blood and blood products can cause allergic response, fever and hives. I k now the blood bank screens donors for infections and diseases like hepatitis and HIV/AIDS, but I am aware there is a risk of infection.

Patient Initials

If I DO NOT want blood or blood products, I will put my initials in this box    

and fill out the “Statement of Refusal for Blood/ Blood Components”

I give my consent for the ­­­­­­­­­­­­­­­­­­____________   facility to use or to dispose of any substance removed as part of my treatment or procedure. The substance might be body fluids, tissues and organs.  I am aware that the substance might be looked at or used in education for other health care providers.  This material will be disposed of using routine methods.

Patient Initials

If I DO NOT want to be told of the risks listed below, I will put my initials in this box.

I know that each person reacts in a different way to treatments and procedures. Therefore, the results cannot be certain.  My questions have been answered about the procedure.  I have been told:

  1. The treatment or procedure that my doctors plan to do
  2. What to expect from the treatment or procedure (the benefits).
  3. The serious risks of this treatment or procedure.  Some of these risks can happen despite all steps                            being taken to prevent them
  4. Other types of treatment that could be used.  This includes no treatment.
  5. Whether or not the treatment or procedure is uncommon.

Some of the known serious possible risks for the procedure are:

Severe loss of blood, infection, stroke or heart attack that can lead to death or permanent or partial disability,

Other known serious possible risks are:

Patient Initials

I know I can change my mind about the consent at any time before treatment.

I know that I must tell the health care staff caring for me if I change my mind.

Health Care Provider obtaining consent (PRINT NAME & INITIAL)                      SIGNATURE of person giving consent (legally authorized to do so)

DATE SIGNED                       TIME                       AM/PM                                    Relationship to patient (if applicable)

Name of interpreter:                                                                                                 Second witness for telephone consent:

Develop a training manual that will be utilized for training new employees (certified medical administrative assistants [CMAAs]) who join the clinic.

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In this assignment, you will develop a training manual that will be utilized for training new employees (certified medical administrative assistants [CMAAs]) who join the clinic.

Physicians are hiring more CMAAs to help manage the increasing complexities of patient care and practice management, while also helping to implement cost-effectiveness and efficiency. The responsibilities of a CMAA can be tailored to the needs of the practice. You will manage front-office functions, manage patient flow, and handle a wide range of tasks that have been discussed in the past few weeks. As a CMAA, you may convey clinical information on behalf of the physician and follow clinical protocol when speaking with patients, but you cannot exercise independent medical judgments. You will also help to optimize patient flow, enabling the physician to see more patients with efficiency, all while following your State’s scope of practice and working under the supervision of a licensed physician.

  • The training manual should include the following topics:
    • An introduction to the health care system
    • The organization’s structure
    • The process of checking patients in and out
    • Scheduling patients
    • Various community and patient resources
    • Processes for how to interact with patients
    • Health insurance plans
    • Financial procedures related to the policies of the organization
    • Clean claims
    • Financial procedures related to the organization’s cash flow
    • Billing policy and procedures
    • Protecting patients’ privacy
    • Accounting and bookkeeping procedures and processes
    • Office procedures for various forms of documentation (release of information, electronic health record)
    • Health Insurance Portability and Accountability Act (HIPAA) rules and regulations
    • HIPAA forms
    • Advance directives
    • Medical record responsibilities
    • Obtaining patient demographics and insurance information
    • Receive, triage, and route phone calls
    • Review records for medical necessity
    • Release of information guidelines