Office Practice Setting
The physician office practice setting is an area where an increasing number of adverse risk management and patient safety events are being experienced. Establishing a culture of safety in this setting, to include physicians, nurses, and all members of the health care team, is necessary to avoid harm to patients as they receive care on an outpatient basis.
When office procedures are well organized, enforced and documented, lines of safety are established and safety is created at every level. Everyone knows their job, who to go to with patient problems or concerns, where information needs to go, and when it must go back to the practitioner who initiated the inquiry. Best practices are established when patients are informed about the care provided to them, including the results of both positive and negative test results.
The ELM course, Managing Labs and Test Results, reinforces that it is critical to patient safety that every ordered test is completed, that every completed test is reviewed, that every reviewed test is accurately filed and communicated appropriately to the patient with any necessary action to be taken. A physician is responsible for establishing office procedures to ensure test results are received, adequate treatment follow-up is arranged and the patient and referring healthcare provider are notified.
Although varied depending on available resources, the mechanism for managing laboratory tests and their findings, from ordering the test to taking action on a test result, is necessary to safeguard patients and their privacy.
In addition to the clinical processes in place in an office practice setting, business practices may be in place that put a physician at risk. The primary function of the coding process that takes place after patient care is delivered is to bill insurers for reimbursement for the care provided. This coded information may be to the benefit of the patient but may also be to the detriment of the patient. Federal statutes outline how individual providers are responsible for knowing how to code medical records for billing purposes. When this is carried out inappropriately, or by individuals who have not been properly training, civil and/or criminal penalties may apply.
The ELM course, Coding: Fraud and Abuse, shows how healthcare providers view CPT (Current Procedural Terminology) and ICD (International Classification of Diseases) coding requirements. Although complex, physicians are expected to oversee the billing process and assure correct coding, particularly in an office setting. Physicians are also responsible for ensuring that office staff or third-party billing services are sufficiently trained to assign and submit accurate billing codes.
Code information is confidential patient information. Hence, code use outside of the intended billing purpose should comply with pertinent laws and should be undertaken with due caution. Using codes to improperly over-bill for healthcare services may result in civil penalties and, in certain circumstances, criminal prosecution. Analysis of a physician’s submitted codes can provide insight into the frequency with which a physician performs certain procedures and individually profile the scope of a physician’s practice.
When establishing risk management and patient safety programs in the physician practice setting, ELM courses can help your providers understand the risks associated with existing practices, and provide insight and understanding about how to avoid these risks.
Course Recommendations
Sample Year One courses:
Duties to Non Patients I
Managing Labs & Test Results I
Coding: Fraud & Abuse I