To the Instructor... vii. Lesson Planning and Answers to Review Questions. Introduction to Health Information Management

Transcription

1 Contents To the Instructor... vii Lesson Planning and Answers to Review Questions PART 1 Introduction to Health Information Management CHAPTER 1 Health Care Delivery Systems...3 CHAPTER 2 The Health Information Management Profession...7 CHAPTER 3 Legal Issues...10 Chapter 4 Ethical Standards...15 PART 2 Clinical Data Management Chapter 5 Health Care Data Content and Structures...19 Chapter 6 Nomenclatures and Classif ication Systems Chapter 7 Quality Management Chapter 8 Health Statistics Chapter 9 Research PART 3 Technology Chapter 10 Database Management Chapter 11 Information Systems and Technology...41 Chapter 12 Informatics PART 4 Management CHAPTER 13 Management Organization Chapter 14 Human Resource Management Chapter 15 Financial Management Chapter 16 Reimbursement Methodologies...60 v

2 vi Contents Certification Connection Mapping Grid...63 Answers to Workbook Assignment Sheets Chapter 1 Health Care Delivery Systems Chapter 2 The Health Information Management Profession...81 Chapter 3 Legal Issues Chapter 4 Ethical Standards...96 Chapter 5 Health Care Data Content and Structures Chapter 6 Nomenclatures and Classification Systems Chapter 7 Quality Health Care Management Chapter 8 Health Statistics Chapter 9 Research Chapter 10 Database Management Chapter 11 Information Systems and Technology Chapter 12 Informatics Chapter 13 Management Organization Chapter 14 Human Resource Management Chapter 15 Financial Management Chapter 16 Reimbursement Methodologies Appendices Appendix A Appendix B Appendix C Appendix D Appendix E Health Care Trends Matching Chart Legal Scenarios Ethical Orientation Survey Key Skills Matching Chart Chargemaster Exercise...227

3 TO THE INSTRUCTOR This Instructor s Manual complements the textbook Today s Health Information Management: An Integrated Approach, Second Edition. The textbook closely follows the curriculum models established by the American Health Information Management Association (AHIMA) for the baccalaureate degree (HIA) and associate degree (HIT) programs. The domains, subdomains, and knowledge clusters for both programs have been incorporated into the textbook chapters, and instructors may determine the emphasis level of each chapter when teaching during the semester. Special notes concerning knowledge clusters are included where appropriate. Lesson Planning and Answers to Review Questions The Lesson Planning portion of this manual is organized according to chapter. The domains, subdomains, and knowledge clusters are identified at the beginning, followed by a chapter summary. The activities discussed in this manual are designed to deepen the student s understanding of the material in the text and its application to their lives, both within and beyond the classroom walls. Each activity is identified at the beginning with a corresponding skill level, using the competency levels established by AHIMA and Bloom s Taxonomy of Cognitive Skills as reference points. The manual also contains answers to the review questions located at the end of each textbook chapter, along with thoughts to consider for each case study. Certification Connection Mapping Grid This mapping grid charts each chapter of the textbook to the RHIA/RHIT AHIMA credentialing guidelines and the CAHIIM program guidelines for easy classroom planning. Answers to Workbook Assignment Sheets The Answers to Workbook Assignment Sheets section includes both questions and answers. The Workbook helps students learn and reinforce the essential concepts presented in the book. Students are asked to recall abbreviations, vocabulary, and key concepts that are presented in the text. Multiple-choice and true/false quizzes, as well as shortanswer questions and similar activities, test the knowledge gained from each chapter. Students are asked to employ critical thinking in the Web Assignments section. The StudyWARE Challenge exercises are included to give students a multimedia experience using the interactive software posted online. The software includes learning activities and quizzes to help study key concepts. The content corresponds with each chapter of the book, and students are asked to complete various activities within each chapter. The Workbook instructs students to take quizzes in test mode and report their scores, as well as print out a copy to turn in to the instructor. Other Instructor Support The Instructor s Resources CD-ROM is loaded with content to provide instructors complete support in the classroom. Use the electronic Instructor s Manual files to help prepare for class. Deliver effective presentations with chapter PowerPoint presentations that include visuals and video clips. Create quizzes and tests to monitor student progress with the Computerized Test Bank questions (in ExamView ). Each question in the test bank is identified by cognitive level. vii

4 viii To the Instructor Visit or contact your Cengage Delmar Learning sales representative to order the Instructor Resources CD-ROM. The Premium Website provides Web links, updates, and additional material, and is accessible through Items listed as Instructor Resources are password-protected. To access the protected instructor resources, go to to create a unique single-user sign-on. Log-in instructions for Student Resources listed on the Premium Website are located in the Printed Access Card bound into the textbook. Contact your sales representative for more information. WebTutor WebTutor is available as a downloadable course cartridge or e-pack for schools that use Blackboard, ecollege, WebCT, or another platform (e.g., Angel, Desire2Learn, Educator) as an online learning management system. Go to to order WebTutor. CourseMate CourseMate helps students make the grade with several components: (1) an interactive ebook, with highlighting, notetaking, and search capabilities; (2) interactive learning tools including Quizzes, Flash Cards, Videos, Games, and Presentations; and (3) Engagement Tracker, a first-of-its-kind tool that monitors student engagement in the course. To access CourseMate visit At the CengageBrain.com homepage search for Today s Health Information Management, Second Edition (ISBN ) using the search box at the top of the page. This will take you to the product page where all of the textbook s additional resources, including CourseMate, can be found.

5 Lesson Planning and Answers to Review Questions

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7 Chapter 1 Health Care Delivery Systems Curriculum Crosswalk HIA Program Domain: Health Services Organization and Delivery Subdomain: Health Care Delivery Systems Knowledge Clusters: Organization and delivery of health care systems Components and operation of health care organizations, including e-health delivery Accreditation standards (e.g., JCAHO, AOA, NCQA, CARF, CHAP, URAC) Regulatory and licensure requirements (e.g., COP, state health departments) HIT Program Domain: Health Services Organization and Delivery Subdomain: Health Care Delivery Systems Knowledge Clusters: Organization of health care delivery in the United States Health care organizations structure and operation External standards, regulations, and initiatives (e.g., licensure, certification, accreditation, HIPAA, ARRA) Health care providers and disciplines Domain: Health Data Management Subdomain: Reimbursement Methodologies Knowledge Clusters: Payment and reimbursement systems Special Notes Payment and reimbursement systems are covered in more detail in Chapter 16, Reimbursement Methodologies. HIPAA and ARRA are integrated throughout the text and also emphasized in Chapter 3, Legal Issues, as are accreditation standards. Chapter 2, The Health Information Management Profession, offers the health information management (HIM) perspective to the knowledge clusters of components and operation of health care organizations and certification requirements. Summary of Chapter The delivery of health care and the practice of medicine can be traced back several thousand years, beginning with the responses of primitive man to the emergence of early physicians and hospitals. Health care in the United States has progressed through four stages, with developments in the 21st century including the use of tracer methodology in the 3

8 4 Lesson Planning and Answers to Review Questions accreditation process, the use of outsourcing, changes in financing, and the rise of a consumer culture resulting in a cultural shift in health care delivery. New areas of concentration have emerged, including public health, mental health, and occupational health. Also emerging are new organizations, entities, and professionals who deliver health care services, and new settings in which they work, adding to the complexity of health care in the United States. One mainstay throughout these changes is the position of physician, who provides care in multiple environments. Where such care has been provided in hospitals, physicians have been governed by medical staff organizations and their bylaws and rules addressing credentials and privileges. This chapter provides an understanding of the historical development of the health care delivery system, both in the United States and in other regions of the world. Some focus is given to specified areas of health care, including public health, mental health, and occupational health. A discussion of the organizations, entities, and professionals who deliver health care services and the settings in which they work follows, allowing the learner to better understand the complexity of health care. A section concerning a hospital s medical staff explains its organization, its governing mechanisms, and the credentialing process. Integrated as appropriate within the entire chapter is a discussion of the influences of technology, financing concerns, and the role of the federal government in the health care delivery system. Suggested Enrichment Activities 1. AHIMA level: Detailed understanding (4) Bloom s Taxonomy level: Analyzing The stages in the delivery of health care help the reader understand how trends can develop. Ask the students to complete the Matching Chart found in Appendix A as a way to connect the stages in health care delivery with trends. The answer key is included immediately after the Matching Chart. Answer Key for Review Questions in the Book 1. How did primitive man attempt to cure disease? Primitive man took one of the three approaches: (1) looked to nature for answers, (2) looked to the supernatural, or (3) looked to the offended spirits of gods or the dead. 2. What movement swept the health care delivery system at the end of the 19th century? Mental health reform. 3. What is the significance of the Flexner Report? The Flexner Report indicated serious deficiencies in medical education. This resulted in revisions of medical school curricula and affiliation with universities. 4. Name and identify the purposes of two organizations formed in the mid-19th century to improve health care. The American Medical Association (AMA) began in 1847 with efforts to improve the poor quality of medical education and examine the questionable ethics of practicing physicians. The American Hospital Association (AHA) began in 1848 with efforts to improve public welfare by providing better health care in hospitals. 5. What two organizations played the largest roles in the accreditation process in the 20th century? The Joint Commission (JC), formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), and the American Osteopathic Association (AOA).

9 Chapter 1 Health Care Delivery Systems 5 6. How did the rise of private health insurance impact health care? A majority of Americans received private health insurance as part of employer fringe benefits. This coverage permitted many Americans to receive health care services in an economical fashion. It also resulted in the delivery of health care services becoming a factor in the American economy. 7. What is the difference between the Medicare and Medicaid programs? The Medicare program is designed to provide financing for health care for all persons over the age of 64, regardless of financial need. The Medicaid program is designed to provide financing for health care of poor or impoverished persons. 8. What is the significance of TEFRA? The Tax Equity and Fiscal Responsibility Act (TEFRA) established a mechanism for controlling the costs of the Medicare program, namely, the prospective payment system (PPS). 9. What agencies oversee public health care at the federal level? The U.S. Department of Health and Human Services (HHS) and its component agencies: Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the National Institutes of Health (NIH), and the Health Care Financing Administration (HCFA) through the Centers for Medicare and Medicaid Services (CMS). 10. Name examples of professional associations, voluntary health agencies, philanthropic foundations, and international health agencies. Examples of professional associations include the American Medical Association (AMA), the American College of Surgeons (ACS), the American Hospital Association (AHA), the American Osteopathic Association (AOA), and the American Health Information Management Association (AHIMA). Examples of voluntary health agencies include the American Lung Association and the American Red Cross. Examples of philanthropic foundations include the Robert Wood Johnson Foundation, the Rockefeller Foundation, the Ford Foundation, and the Foundation of Research and Education in Health Information Management (FORE). Examples of international health agencies include the World Health Organization (WHO), the United Nations Children s Fund (UNICEF), Doctors Without Borders, Project Hope, and International Medical Corps. 11. How do the terms licensing, registration, and accreditation differ? Licensing refers to the action of a governmental entity to confer a right to practice an occupation or provide a service. Registration refers to the action of a nongovernmental entity (e.g., a professional association) to recognize those individuals who meet specified standards, such as education and experience. Accreditation refers to the process by which an external entity reviews an organization or program of study to determine if the organization or program meets certain predetermined standards. Both licensing and accreditation may include organizations, whereas registration involves individuals. 12. What is the role of a medical staff coordinator? A member of a hospital s administrative staff who coordinates all efforts related to procuring written documentation of a physician s qualifications to provide clinical services.

10 6 Lesson Planning and Answers to Review Questions Case Study You are employed at a hospital that offers community education on matters relating to both patient care and health care administration. You have been asked to present a lecture to the community addressing the variety of health care delivery systems in the United States, including settings and categories of health care professionals. Discuss how you would structure and present such a lecture to a community audience, including what topics you would cover and why. Things to Consider Because this is a community audience, it will be composed of a wide variety of people with diverse backgrounds. For this reason, you must assume that the audience has little to no knowledge of the subject matter you will lecture on and structure your lecture accordingly. Your lecture should provide a brief history of health care development in the United States, followed by a discussion of health care as it exists today. At this point, you should address the variety of settings in which a patient may receive care and the variety of professionals who deliver that patient care.