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Follow COB rules to determine when care may be covered by another payer. Coordination of benefits (COB) can be described as when two or more insurance plans work together to determine the order of coverage liability. This coordination between plans exists to avoid duplicate payment, which could result in a provider receiving payment in excess […]
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Medicare has been issuing beneficiaries new member cards with Medicare Beneficiary Identifiers (MBI) in place of Social Security Numbers (SSNs) for more than two years. 2019 was a phase-in period when Medicare would accept either a beneficiary’s Social Security Number or their new MBI on claims. Starting Jan. 1, 2020, CMS will reject any Medicare […]
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thank you
Robin
Five simple tips to help healthcare organizations prevent fraud
by Elizabeth Stepp, senior counsel at Oberheiden Law Group, in Dallas
It’s impossible to calculate the amount of healthcare fraud that exists, as much of it slips under the radar. However, healthcare fraud poses a serious problem, putting the health and welfare of beneficiaries at risk while costing taxpayers billions of dollars.
Preventing healthcare fraud and abuse is challenging, especially for hospitals, hospices, and other similar organizations. While there are a lot of honest and well-intentioned healthcare providers, there are quite a few perpetrators?ranging from street criminals to large companies. As such, owners of healthcare organizations need to be on their guard at all times. After all, allegations of fraud and abuse against low-level or top brass employees can affect the reputation of any healthcare organization.
But if you’re the owner of a small or large healthcare organization, don’t let this worry you. The following are some tips to help you prevent your organization’s reputation from taking a hit, and to avoid costly lawsuits.
Perform background checks before hiring
Pre-employment screening for employees, as well as contingent or temporary workers, is a common best practice for healthcare organizations. That being said, not all organizations have the time and resources to perform thorough background checks. Add to this a shortage of quality caregivers plus an increase in the number of patients, and employers find it easy to rely on trust instead of facts.
Since a single scam artist can taint your organization’s reputation, avoid employing or hiring individuals just because they appear to be trustworthy. Make sure pre-employment background checks include the following:
Additionally, check personal references, verify Social Security numbers, and have individuals undergo drug tests.
Have policies and procedures in place
Formalized policies and procedures promote regulatory compliance and workplace safety, and above all guarantee safe and quality patient care. Healthcare organizations also need to have policies and procedures in place to safeguard protected information. Start with defining access and authorization controls, and separate duties in order to reduce opportunities of fraud.
Make sure that policies and procedures are up-to-date and well written, so as to reduce practice variability. Practice that varies from one person to another can lead to sub-standard care and reliance on memory, which in turn can cause errors and oversights. Apart from this, organizations should have a defined set of internal controls to produce accurate financial reports, help comply with laws and regulations, oversee asset protection, and so on.
If you’re not sure about which policies to implement, getting in touch with a healthcare fraud defense attorney will be helpful. These lawyers can defend your case, and they know what it takes to prevent becoming a victim of fraud.
Perform audits regularly
Accurate and complete clinical documentation is important if you want to provide quality healthcare. The best way to improve documentation, and the care that your organization provides, is to conduct regular medical audits. Medical audits can also improve the financial health of your organization, and determine areas that need corrections and improvements.
Ensure that medical auditing and monitoring in your healthcare organizations is:
Protect data
For healthcare organizations, protecting data can mean reducing the number of emergent care cases, improving patient outcomes, providing better oversight and care, and increasing revenue. This makes it necessary for all healthcare organizations?big and small?to protect data. That being said, a lot of small- and mid-sized healthcare organizations think spending on data protection is pointless, as even organizations that take the appropriate steps are attacked by fraudsters.
Sure, data breaches keep happening. But, if you do what’s right, you can definitely protect your organization from being an easy target?and healthcare abusers like easy targets.
Here are some things to keep in mind:
Make it easy to report fraud
Reporting fraud and abuse?or any suspicious activity?should be an easy process. You’ll also have to set up a system so that vendors, employees, and patients and their family members can report abuse anonymously.
Most importantly, take required action on all complaints received. By addressing issues promptly, you’ll instill confidence among your employees and patients.
Protect your healthcare organization today
As an honest healthcare provider, you’d certainly want your healthcare organization to be free of fraud and abuse. Having the right intentions alone won’t be able to help you achieve your goals; you’ll have to take the necessary steps too.
With the information given here, you now know what you need to do to ensure that your healthcare organization is safe. Implement these tips right away, and say goodbye to fraud and abuse!
The statistics are unsettling. According to the Joint Commission of Accreditation of Healthcare Organizations, 65% of hospital deaths and injuries are directly related to communication breakdowns. Nearly 55% of medication errors are caused by faulty communication. These are preventable, treatable problems that would not have occurred if the communication had been clear.
We all know that more paperwork is not the answer. But how can we prevent the needless deaths? What can be done to reduce errors and improve patient outcomes?
One area that must be addressed is that of foreign-born doctors’ accented English. Even those who are proficient in English often still speak with such a thick accent that it is difficult for nurses and patients to understand what they are saying. Unfortunately, it is difficult for them to see the problem because, often, they’ve been speaking English since they were a child and it was good enough to get them through medical school.
But here’s the reality. It’s not an issue of a deficit in their expertise or knowledge and it’s not an issue of their needing “speech therapy”; it’s simply a matter of needing some extra training to improve communication skills.
For example, let’s suppose that a doctor treating a patient turns to his nurse and asks her to administer fifteen milligrams of a medication. She misunderstands him and proceeds to give the patient fifty milligrams of the medication. Now, the doctor knew exactly what he was doing, and the nurse followed instructions as precisely as she could. The problem occurred because of one simple mispronunciation – and could have had disastrous results.
The solution? Providing onsite or online accent reduction training for foreign-born medical professionals. With programs tailored specifically to the medical community, accent reduction specialists can provide the pronunciation training that healthcare workers need while adapting to their hectic schedule.
Depending on the needs of a particular hospital or private practice, training can often be provided individually, in small groups, or even in a large group seminar. With virtual training now available via Skype, classes can literally be scheduled anytime and anywhere in the world, as long as there is internet available.
Please don’t expect your staff speech pathologists to provide this service. They have enough on their plates, and asking them to “treat” the doctors would reinforce the stigma that something is wrong and requires therapy. Instead, locate a speech pathologist off site whose specialty is accent reduction training. That way, this person is brought in as an expert trainer offering continuing education opportunities.
Communication breakdowns are one of the biggest causes of error in medical settings – and many of them are preventable. Accent reduction training is one effective way to reduce the number of communication -related mistakes. What are you doing to improve the communication skills of the foreign-born healthcare workers in your practice?
To find out more about Medically Speaking classes, accent reduction classes for the medical community, please visit http://www.losemyaccent.com. You can also get a FREE online accent screening with personalized tips for practice.
Lisa Scott is a nationally certified speech pathologist who specializes in accent reduction training. Frustrated with your accent or with trying to understand your co-workers? Lisa is passionate about helping you increase your confidence by removing communication barriers. If you are tired of being misunderstood and are ready for a change, please visit http://www.losemyaccent.com.
According to the Centers for Disease Control and Prevention (CDC), around 1.7 million infection cases are found in American hospitals, leading to 99,000 deaths each year. Of these, 22% of the infections are surgical site infections. Medical professionals are looking for means to reduce these heartrending statistics by opting for medical disposable supplies. Disposable products are used only once and then discarded to ensure 100% safety for patients as well as the hospital staff.
Advantages of Using Medical Disposable Supplies
Previously, medical practitioners used to boil their medical tools at a specific temperature and for a particular duration of time to sterilize them. Although this method worked to 99.98% efficiency, it was not possible to sterilize all equipment in this way. Rubber gloves, for instance, could not be boiled, as they would melt in the process of sterilization. To overcome this limitation, hospitals have turned to medical disposable supplies, which offer many advantages over reusable products, such as:
Hygiene: In the modern medical world, everything from lab coats to gloves and scalpel to thermometer are used as disposable products. This ensures that infection is kept at a minimum.
Cost effective: Although the disposable products are single use items, they are not expensive at all. The manufacturing costs of these products are much lower than that of reusable medical products. Many hospitals purchase syringes, gloves, needles and blades in bulk and gain from the heavy discounts on such items.
Time saving: There is no need to sterilize disposable products after using them on a patient. Moreover, these products are also as efficient in use as reusable medical products. This saves a plenty of time and effort on the part of the hospital staff.
Medical Disposable Supplies for Non-Surgical Purposes
Other than surgical use, disposable products are also beneficial for those who are involved in the activities such as acupuncture, tattoo art or body piercing. Reputable acupuncturists and tattoo artists use disposable needles to avoid the risk of contamination and cross infection during the process. This ensures safety for their clients.
The World Health Organization (WHO) recommends the use of disposable syringes in hospitals to prevent the risk of hospital acquired infections. People today are more health and hygiene conscious than before and this has led to an increased demand of medical disposable supplies. Express Medical Supplies, a leading name in the professional medical community, offers a vast collection of medical disposables to deal with the unique medical needs. For more information on the company and its products, visit http://www.expressmedicalsupplies.com/
You can check my latest article on website www.ExpressMedicalSupplies.com where i advice people on making the right decision when buying disposable medical supplies.
Medical errors are killing some 100,000 Americans every year. Anyone can easily determine by seeing through this figure of death toll, that if the most developed country of the world is going through such health crisis, then what healthcare and safety problems world is facing. Especially the developing countries all over the world, who don’t have resources and the education to get rid of these preventable medical errors. This precise and targeted information will surely create a lease of hope for the people globally.
To err is human, to forgive is divine. While this may apply in general, forgiving, forgetting or ignoring errors in medicine isn’t acceptable, since consequences could be disastrous.
Errors in medicine, then, are evidence that something has gone wrong in patient and community healthcare and that something has caused harm and should be prevented and corrected.
A medical error is a product of various “external” circumstances, including the environment, working conditions, and pressures, rapidly evolving technology; and managerial, administrative, or system functioning.
Medical errors are not limited to diagnosis or treatment decisions. They may occur at any stage of medical work: assessing the risk of disease, understanding its causes, and effectiveness of intervention to prevent or cure or otherwise control health problem or its prognosis at an individual or at community level.
The biggest cause of medical errors is LACK of Awareness
The greatest barrier to improving patient safety is a lack of awareness of the extent to which medical errors occur in all health care organizations.
It is difficult to remedy problems that are not known to exist.
This lack of awareness occurs because, in most cases, errors are not reported.
Reporting of errors should be developed in six stages as a culture for their recognition, acknowledgement, recording, reporting, analysis and a reflective response within a just and flexible learning environment.
How can anyone help protect himself against medical errors?
The distinct way to prevent medical errors is to be an active member of your health care treatment which means to take part in every decision about your health care. Research shows that patients who are more involved with their care tend to get better results. Here are some BE-SAFE tips which strengthen the prevention measures of medical errors;
Beware, Be Cautious and Be Careful
Errors do happen. You are the best link in preventing medical and medication errors. Be alert: Pause, Ask, Question and Confirm before opting for any medical or health care problem.
Education is a Must!
Before you need health care or hospital services, seek information and tips about health care. Learn the basics of error prevention in case of an emergency. Learn about your illness or injury. Use health care community services or professional organizations to become educated about your condition. Talk to your doctor or health care professional about your treatments and tests.
Speak up for yourself
Tell your doctor, your nurse, or any person giving you medicine about your allergies. Tell your doctor and health care workers about your medical history, illnesses, surgeries and injuries. Make a written list of all your medicines, vitamins, herbs and supplements. List the amounts of medicines you take and the times that you take them. Bring the list with you when you receive health care or hospital services. Keep the list current.
Act promptly, when there is a need!
Take action. If something is out of place, take steps to stop or fix the situation. If the situation is not resolved, ask other professionals. If something seems unusual about your medication or medical procedure/ treatment, take action. Ask your nurse, doctor or the pharmacist.
Facts and Side Effects, Know them for your Health & Safety
When undergoing surgery or a procedure or going into the hospital, get the facts about what to expect. Talk to your doctor about the details of what will happen and what are the side effects or complications you should watch out for. Know who and when to if something is wrong or suspicious happen.
Error-Free Environment, Your Contribution is Essential
Work with patient safety groups to help reduce medical errors. Help identify hidden dangers. Tell your doctor or health care professional if you see something that causes concern. You can help to prevent medical errors.
Conclusion and Recommendations!
Preventing medical errors is a pre-requisite for developing a safer healthcare system; the medical errors are not acceptable and cannot be tolerated any longer. Despite the cost pressures, accountability restraints, confrontation to change and other seemingly overwhelming barriers, it is simply not acceptable for patients to be harmed by the same healthcare system that is supposed to offer that assurance and security to public.
Recommendations are for the external environment to create sufficient pressure to make errors costly to healthcare organizations and providers, so they are compelled to take action to improve safety. At the same time there is a need to enhance knowledge and tools to improve safety and break down legal and cultural barriers that impede safety improvement.
Muhammad Saad Khan is a Research Analyst at Q2 Group. Q2 is specialized in medical credentialing, primary source verification, and medical license verification according to the standards of joint commission international. For more about medical errors and malpractice cases, please visit (http://medicallicenseverification.com).