Introduction Outcomes Module Checklist Tips

M1 Introduction

Chapter 17 Background:

This chapter discusses risk management and quality improvement, both of which are at the heart of patient safety, advancing good medical outcomes and reducing the costs associated with poor quality care. It explores the background, organization and operation of the risk management functions in a healthcare organization and how risk management relates to the overall organizational responsibility of quality improvement. The chapter closes with a discussion of government and private quality improvement efforts designed to protect patients from adverse events while at the same time providing data related to cost, access, quality and patient safety activities.

Chapter 18 Background:

This chapter introduces the importance of corporate compliance programs and the standards, policies, and procedures that healthcare organizations should have in place to assure they are complying with governmentally-funded healthcare programs. It discusses the major laws, rules, and regulations related to corporate compliance and the high risk areas for fraud and abuse such as incorrect reporting of diagnoses or procedures to maximize payments, fraudulent diagnosis, and billing for services not rendered, and false cost reports. The chapter has a focus on fraud and abuse and the importance of correct documentation to prevent fraud and abuse from occurring in healthcare facilities. Because the ramifications of fraud and abuse are so great, organizations must implement compliance programs. The numerous elements of a compliance program are discussed as well as the responsibilities of the US Inspector General in regard to compliance issues.

Chapter 20 Background:

The healthcare industry operates within the constraints of numerous laws and standards designed to support the delivery and financing of quality healthcare while protecting the rights and responsibilities of healthcare consumers and providers. The delivery of quality healthcare depends on personnel or human resources who “do no harm.” Human resources are protected in the workplace by employment laws that function to protect both employee and employer.

Managing department staff requires an understanding of the federal and state laws that govern employment. Most healthcare organizations have a human resources department or someone dedicated to human resources oversight who can assist managers in ensuring that proper labor practices are in place. This chapter provides an overview of common workplace laws. The civil rights of employees are discussed in terms of discrimination related to age, color, national origin, race, religion, and sex. Wage and salary regulations are introduced, along with employee occupational and safety laws. The chapter closes with a discussion of fair labor practices and laws related to union activity and collective bargaining.

Outcomes

By the end of this module, you will be able to...

Examine the unique concepts of and differentiate between quality, quality improvement, risk management, and patient safety.
Demonstrate the typical steps one would take to develop, manage, maintain, and support a risk management program and risk management activities.
Define fraud, waste, and abuse; understand the causes of different types of fraud, waste, and abuse.
Examine corporate compliance plans and create the formatting for an annual compliance plan.
Identify the major laws related to discrimination prevention in the workplace.

Module Checklist

In order to meet our outcomes for this module, we will complete the following activities and assignments:

Read & Watch:

Required Module Readings & Resources:
- Textbook: Fundamentals of Law for HIM Chapter #17 - Risk Management, Quality Improvement, and Patient Safety
- Textbook: Fundamentals of Law for HIM Chapter #18 - Corporate Compliance
- Textbook: Fundamentals of Law for HIM Chapter #20 - Workplace Law

- LECTURE - Link
Optional Readings & Resources:
- Oachs: Chapter #2: Legal Issues in Health Information Management
  - Specific Attention to Key Terms

Complete

Post & Discuss: The 7 Elements of a Compliance Program
- Initial Post: Deadline
- Replies: Deadline
- Must Reply to 2 other student's Initial Posts - Must maintain your own post from date initially posted until the DB closes.
Complete: Application Exercise: Chapter #17
- Due DATE:
Complete: Application Exercise: Chapter #20
- Due DATE:
Complete: Application Exercise Project: Chapter #18
- Due DATE:
Complete: QUIZ
- Due DATE:
Complete: QUIZ #2
- Due DATE:
There is no Comprehensive Exam for this Module due to the Compliance Plan Project (see above).

Tips for Success

To help in the completion of this Module, you should…

Complete all Required Reading and take notes during lectures.
Focus on Key Terms/Vocabulary - know the meanings, definitions, and context for the terms in each chapter
Know the due dates and deadlines of all assignments
Pay close attention to assignment requirements, including the naming conventions for saved/uploaded files
Don't forget to maintain your discussion boards! It's easy for students to lose points by not replying to their peers or maintaining posts from week to week and these missed points can add up in the overall grade for this course.
Don't lose your work - always save a back-up copy of all assignments including your discussion board content.
Ask for assignment clarifications as needed - your instructor is always available to help!

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