Jacaranda Clinic is a family practice that incorporates both general practice as well as OB/GYN services. The facility has three practicing resident physicians ,2 OB/GYN and a consultant pediatrician. The facility averages upto 300 visitors a week. It has a limited in patient facility of 15 beds where patients are briefly accomodated after delivery services. The facility also holds seriously ill patients temporarily before they are transferred to larger facilities for critical care. All patient records are stored in electronic form.
The clinic has developed a compliance plan to adress various issues. The first to be handled is ethical standards. The facility will ensure that all patients are handled in a humane and compassionate way. This will be done through enforcement and monitoring of policy that is currently in place. The ethical code of standards includes guidelines to ensure that all employees comply with every written law. The code also gives the terms and conditions that govern the exchange of gifts and favours among co workers and patients. The code is thorough about this and the rules extend to the vendors and all other procurement and business partners. The ethics code also outlines the circumstances that would be considered a conflict of interest. They include procurement of similar services and outsourcing of the same (Lyu et al., 2017).
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Privacy and security of patient information is an integral part of the compliance law. The facility ensures that patient information is kept private even as the support staff carry out the doctor's instructions. The patients records are also protected by codes which only allow specific members of staff to access or alter them. The billing information that is communicated to the financing bodies like Medicaid include coded narrative that protect patient identification. The narrative may be slightly detailed to include unique combination of conditions and treatment options.
Patients are entitled to privacy and confidentiality of their conditions. The use of safety nets such as code of conduct ensures that the patient gets access to all the different procedures that have been paid for. The patient also has a right to access information on their diagnoses, treatment and care. They should be allowed to seek a second opinion based on the provided diagnosis. Labor laws must be followed strictly. The staff are not allowed to discuss their patients with each other unless they are in a collaboration for treatment (Mitra et al., 2018).
Billing is expected to be done in compliance with all public and private policy. The collaboration adheres strictly to the Medicaid rules. The billing summary must include details on the patients treatment, procedures carried out and the type of condition being addressed. Codes will be provided to indicate the nature of various diagnoses. All treatment will be done with adherence to medical necessity and the billing will represent the same. Cost reports and claim submission forms will be filled in accordance with the Medicare and Medicaid regulations.
Policy enforcement measures in place include strict guidelines to prevent fraud and identity theft. The employees are taught how to accurately determine the true identity of a patient. The employee also employ tactics that verify patient documentation and independently determine the correct billing information. All staff are trained in the false claims act. This prevents fraud and the process is further enhanced by a periodic visit from an independent auditor. This ensures that effective monitoring takes place. Consequences of violations are detailed in the comprehensive compliance tracking policy. This shows application of internal disciplinary measures as well as the intervention of any written laws. The compliance plan details all of the requirements that govern each step at the clinic.
References
Lyu, H. G., Cooper, M. A., Mayer-Blackwell, B., Jiam, N., Hechenbleikner, E. M., Wick, E. C., & Makary, M. A. (2017). Medical harm: patient perceptions and follow-up actions. Journal of patient safety , 13 (4), 199-201.
Mitra, S., Mishra, S., & Kumar, P. (2018). Healthcare Improvement Through Integration of Quality Initiatives. In Healthcare Systems Management: Methodologies and Applications (pp. 45-58). Springer, Singapore.
