1 - Medical Administration.pdf

MEDICAL ADMINISTRATION LECTURER LANDA BROOKS  MEDICAL ADMINISTRATION Medical administration refers to the management and control of healthcare facilities, services, and resources to ensure efficient and effective delivery of medical care. It includes a broad range of dutie...

MEDICAL ADMINISTRATION LECTURER LANDA BROOKS  MEDICAL ADMINISTRATION Medical administration refers to the management and control of healthcare facilities, services, and resources to ensure efficient and effective delivery of medical care. It includes a broad range of duties that are essential for the smooth operation and management of healthcare organizations. A medical administrative specialist (MAS) is a multi-skilled professional who is competent in medical records management, insurance processing, coding and billing, management of practice finances, information processing and fundamental office management tasks. A medical administrative specialist is very familiar with clinical and technical concepts required to coordinate administrative office functions in the health care setting  DUTIES OF MEDICAL ADMINISTARTION SPECIALIST(MAS) Administrative Support: these professionals deliver administrative support to healthcare facilities, including hospitals, clinics, medical offices, and other healthcare settings. They execute various tasks such as scheduling appointments, managing patient records, maintaining electronic health records (EHRs), and handling correspondence. Managing phone calls, emails, and other correspondence, and assisting with administrative tasks such as filing, data entry, and inventory management. DUTIES OF MAS Patient Interaction: They are part of patient interaction, offer customer service and support. This includes greeting patients, answering questions, educate and explain procedures, ensures customer satisfaction and positive outcomes. Patient Registration and Scheduling: Greeting patients, gathering demographic and insurance information, and scheduling appointments.  DUTIES OF MAS Billing and Coding: professionals may be involved in medical billing and coding processes. They ensure accurate coding of procedures and diagnoses, prepare and submit insurance claims, and follow up on payments and reimbursements. https://youtu.be/Xj67rhzr8oY Health Information Management: They are team player in managing health information systems and upholding patient confidentiality. This includes managing electronic health records (EHRs), ensuring data security and privacy compliance (e.g., HIPAA), and facilitating the exchange of medical information as needed. HIPAA HIPAA stands for the Health Insurance Portability and Accountability Act, which is a federal law enacted in 1996. Improve Portability of Health Insurance: HIPAA ensures that individuals can maintain their health insurance coverage when they change or lose their jobs (Title I). Protect Health Information: HIPAA includes provisions (Title II, also known as the Administrative Simplification provisions) that establish national standards for the protection of individuals' health information. HIPAA Key Components of HIPAA: Privacy Rule: The HIPAA Privacy Rule sets national standards for the protection of individuals' medical records and other personal health information (PHI). It outlines who can have access to PHI, how it can be used and disclosed, and patients' rights regarding their health information. Security Rule: The HIPAA Security Rule establishes standards for protecting electronic PHI (ePHI). It requires covered entities (healthcare providers, health plans, and healthcare clearinghouses) to implement safeguards to protect ePHI and ensure its confidentiality, integrity, and availability. Transactions and Code Sets Rule: HIPAA also standardizes electronic transactions for healthcare claims and other administrative processes (such as eligibility inquiries and payment transactions). This simplifies and streamlines the exchange of healthcare information between providers, health plans, and clearinghouses. DUTIES OF MAS Office Management: MAS professionals may oversee the daily operations of medical offices or departments. This can involve managing office supplies, coordinating staff schedules, and ensuring efficient workflow processes. Compliance and Regulations: They ensure that healthcare practices comply with regulatory requirements and organizational policies. This includes staying updated on healthcare regulations, maintaining accurate documentation, and implementing protocols to safeguard patient information and adhere to legal standards.  DUTIES OF MAS Communication and Coordination: they direct and control communication between healthcare providers, patients, and other stakeholders. They may coordinate appointments, referrals, and follow-up care, ensuring effective communication channels are maintained. Quality Improvement: They may contribute to quality improvement strategies within healthcare settings. This entails collecting and analyzing data on patient satisfaction, clinical outcomes, and operational efficiency to identify areas for improvement. Training and Support: to enhance new staff morale, training and support is given to members, in specific attention to administrative processes, medical software systems, and compliance with organizational policies and procedures. Team Collaboration: Working closely with physicians, nurses, and other healthcare professionals to coordinate patient care and administrative tasks PROFESSIONALISM HUMAN RELATION SKILLS Human Relations Skills are critical for the development of positive interactions and effective communication among healthcare professionals, patients, and their families. 1. EMPATHY : it is crucial for healthcare professionals to show empathy towards patients and their families. This include having respect and sharing the emotional state of others, display compassion, and recognizing and acknowledging their concerns.  HUMAN RELATION SKILLS 2. Active Listening: To foster effective communication active listening is key component. Healthcare providers should listen attentively to patients, family members, and colleagues to comprehend their requirements, apprehensions, and preferences.  HUMAN RELATION SKILLS 3. Clear Communication: Clear and concise communication is vital in healthcare to guarantee that material is correctly conveyed and understood. Healthcare professionals should utilize simple language and avoid medical jargon when interacting with patients and families. HUMAN RELATION SKILLS Respect: Respect for patients' dignity, privacy, and cultural beliefs is important in healthcare settings. Healthcare professionals should treat all individuals with respect and sensitivity. EXAMPLES Maintaining privacy during personal care, treatments, examinations, and confidential conversations. Closing doors, using drapes, and speaking quietly. Being courteous and patient, not rushing care tasks and giving one’s full attention. Introducing oneself and explaining procedures. Involving the patient in care decisions when possible and respecting their choices. Seeking consent. Adjusting communication styles to the patient’s needs and abilities.  HUMAN RELATION SKILLS Preserving confidentiality and modesty by keeping medical records private. Being sensitive to emotional, cultural, religious and personal values and traditions. Treating all patients with equal respect regardless of background or diagnosis. Maintaining dignity even when providing physical or intimate personal care.  HUMAN RELATION SKILLS Teamwork and Collaboration: Healthcare is often delivered by interdisciplinary teams. Effective teamwork requires collaborative skills such as cooperation, flexibility, and willingness to share information and responsibilities.  Team Collaboration: Healthcare is often delivered by interdisciplinary teams. A MAS with emotional intelligence fosters collaboration by respecting diverse perspectives, communicating effectively, and promoting a supportive team environment. They contribute positively to team dynamics and help maintain morale during challenging situations. CONFLICT RESOLUTION Healthcare settings can be stressful, and conflicts may arise between patients, families, and healthcare providers. Skills in managing conflicts constructively, resolving disagreements calmly and respectfully, are essential. HUMAN RELATION SKILLS Cultural Competence: Healthcare professionals should be aware of and respectful towards cultural differences. Cultural competence involves understanding diverse cultural beliefs, values, and practices that may influence healthcare decisions. Cultural health beliefs affect how people think and feel about their health and health problems, when and from whom they seek health care, and how they respond to recommendations for lifestyle change, health-care interventions, and treatment adherence. EXAMPLES Healthcare Seeking Behavior: Healthcare seeking behavior may be influenced by cultural beliefs and preferences. Some individuals may initially seek care from traditional healers or use home remedies before consulting medical professionals. Trust in healthcare providers is important, and building rapport and understanding cultural contexts are crucial for effective healthcare delivery. HUMAN RELATION SKILLS Traditional Medicine: Many people in Trinidad and Tobago incorporate traditional or folk medicine practices into their healthcare. This includes the use of herbal remedies, teas, and poultices believed to have healing properties. Traditional healers, known as "bush doctors" or "spiritual healers," may be consulted for treatments of various ailments. Spirituality and Religion: Spirituality and religious beliefs play a significant role in healthcare decisions. Prayer, rituals, and seeking spiritual guidance from religious leaders are common practices, particularly during times of illness or distress. Spiritual healing is often seen as complementary to medical treatments. Respect for Elders: Respect for elders is a cultural norm that influences healthcare decisions and practices. Elders are often consulted for their wisdom and experience, and their advice is highly valued in matters related to health and well-being. HUMAN RELATION SKILLS Beliefs about Illness and Causes: There may be cultural beliefs about the causes of illness, including supernatural factors such as curses or spiritual imbalance. Illnesses may be seen as a result of violations of social or spiritual norms, and treatments may include rituals or ceremonies to restore balance and harmony. Diet and Nutrition: Traditional diets are valued for their perceived health benefits. Foods such as cassava, plantains, coconut, and various herbs are believed to promote health and healing. Dietary practices may also be influenced by religious observances, such as fasting during certain periods. Views on Mental Health: Stigma surrounding mental health issues exists but is gradually being addressed. Some may attribute mental health challenges to spiritual or supernatural causes and seek healing through religious practices or traditional healers. However, there is increasing awareness and acceptance of modern mental health treatments and therapies.  HUMAN RELATION SKILLS Emotional Intelligence: Emotional intelligence involves self-awareness, self- regulation, empathy, and social skills. Healthcare professionals with high emotional intelligence can manage their own emotions and understand others' feelings and perspectives. EXAMPLES Managing Patient Interactions: A MAS with high emotional intelligence understands the importance of empathy and compassion when interacting with patients. For example, they may encounter patients who are anxious about procedures or diagnoses. By demonstrating empathy, actively listening to their concerns, and providing reassurance, the MAS can help alleviate patient anxiety and build trust. Handling Difficult Situations: In healthcare settings, MAS professionals may encounter challenging situations, such as patient complaints or conflicts between staff members. Emotional intelligence enables them to remain calm under pressure, assess the situation objectively, and use effective communication skills to de-escalate tensions and find constructive solutions. EMOTINAL INTELLIGENCE (MAS) Managing Stress and Resilience: Healthcare administration can be demanding and stressful. Emotional intelligence helps MAS professionals manage their own emotions, cope with stress effectively, and maintain resilience. This enables them to perform their duties effectively even during hectic or emotionally charged situations. HUMAN RELATION SKILLS Patient Education: Educating patients and families about their health conditions, treatment options, and preventive care requires effective communication skills. Healthcare providers should tailor information to the patient's level of understanding and literacy. Patient Education and Communication: Effective patient education requires clear communication and the ability to tailor information to the patient's needs and understanding. A MAS with emotional intelligence recognizes cultural differences, language barriers, and individual preferences, ensuring that patients receive information in a compassionate and comprehensible manner. HUMAN RELATION SKILLS Trustworthiness and Integrity: Patients and families trust healthcare providers with their health and well-being. Building trust involves being honest, maintaining confidentiality, and following ethical guidelines. Building Rapport and Trust: Establishing rapport and trust with patients, families, and colleagues is crucial in healthcare. MAS professionals with emotional intelligence build relationships based on trust, respect, and empathy. This fosters patient satisfaction, enhances teamwork, and contributes to a positive organizational culture. RATIONAL By applying these human relations skills in healthcare settings, healthcare professionals can build strong relationships with patients, families, and colleagues, promote effective communication, enhance patient satisfaction, and ultimately improve patient outcomes. These skills contribute to a supportive and compassionate healthcare environment where everyone feels respected and valued. BEHAVIORS OF MAS Attention to Detail: MAS professionals must pay careful attention to detail in the management of administrative tasks such as arrangement the of appointments, retaining patient records, and processing medical billing and insurance claims. Precision is vital to ensure patient safety and compliance with regulatory requirements. STRATEGIES Systematic Approach: Construct and follow systematic processes for the management of administrative procedures. Create clear procedures for tasks such as scheduling appointments, maintaining patient records, and processing billing and insurance claims. Having a structured approach helps reduce errors and ensures consistency. Use Checklists: Apply guidelines for your checklist for your daily tasks and make certain nothing goes unnoticed. Checklists can help MAS professionals stay organized, track progress, and verify completion of each step in administrative processes. They serve as a visual reminder to address all necessary details. BEHAVIORS OF MAS Double-Check Information: ensure information is accurate prior to finalizing any administrative task. T o minimize or decrease inconsistencies ensure reviews patient records, appointment details, and financial transactions.This step is critical in maintaining data integrity and preventing mistakes. Documentation: Document all relations, decisions, and actions correctly and comprehensively. Retain detailed records of patient communications, appointments, billing transactions, and administrative procedures. To ensure continuity of care and reliance , clear and accurate documentation is essential. Stay Updated with Regulations: keep updated on health regulations, privacy laws (such as HIPAA), and organizational policies. Professionals should have a clear understanding of the legal requirements and standards applicable to their administrative responsibilities. BEHAVIOURS OF MAS Clarification: seek explanations from healthcare providers, supervisors, or colleagues if unsure of any task, procedure or information when necessary. Manage Stress: impairment of one's judgement can occur in the presents of stress and fatigue. Engage in regular breaks during the workday to refresh your mind and maintain focus. Practice stress management techniques such as deep breathing or brief walks to reduce tension and enhance concentration. Continue Education: Join training programs, workshops, or online courses to improve your administrative skills and knowledge. Seek updated advances in healthcare technology, software applications, and best practices in healthcare administration. Continuous learning improves proficiency and attention to detail. BEHAVIORS OF MAS Use Technology Wisely: Utilize healthcare management software and digital tools effectively. Electronic health records (EHRs), scheduling systems, and billing software streamline administrative tasks but require attention to detail when inputting and retrieving information. Ensure data accuracy and follow system protocols to prevent errors. Peer Review and Feedback: Coworkers can offer valuable understandings, recognize potential errors, and offer suggestions for improvement. Collaborative review processes promote accountability and enhance overall quality in healthcare administration. BEHAVIORS OF MAS Organizational Skills: Effective organization is important for MAS professionals to accomplish numerous tasks, prioritize responsibilities, and guarantee smooth workflows within healthcare settings. They may organize schedules, arrange meetings, and maintain efficient office operations. STRATEGIES Establish Priorities: complete tasks based on urgency, importance, and deadlines. Create task lists, calendars, or digital task management apps to organize and arrange daily, weekly, and long-term responsibilities. Create and Maintain Systems: utilize a systematic approaches for arranging routine tasks such as scheduling appointments, managing patient records, and processing paperwork. BEHAVIORS OF MAS Time Management Techniques: Practice effective time management techniques to maximize productivity. Set realistic timelines for tasks, allocate specific time blocks for different activities, and avoid procrastination. Use techniques such as the Pomodoro Technique (working in focused intervals with breaks) to maintain focus and productivity. Use Checklists and Templates: for routine task develop a checklist. Checklists help ensure all necessary steps are completed. Generate templates as this cam streamline document creation and standardize formatting. Adapt templates for tasks like patient intake forms, billing invoices, and correspondence to save time and maintain consistency. Organize Physical and Digital Workspaces: Maintain tidy and organized physical workspaces to minimize clutter and improve efficiency. Use filing systems, labels, and storage solutions to keep documents and supplies easily accessible. Similarly, organize digital files and emails in folders with clear naming conventions for quick retrieval. BEHAVIORS OF MAS Delegate and Collaborate: distribute tasks appropriately and collaborate with colleagues to control collective capability and ensure proper use of resources. Effective allocation and teamwork help manage workloads, enhance efficiency, and achieve shared goals within healthcare teams. Practice Adaptability: Healthcare environments can be dynamic and unpredictable. Develop adaptability skills to respond flexibly to changes in patient schedules, priorities, or emergencies. Remain calm under pressure and adjust plans as needed to maintain efficient operations. Seek Feedback and Reflect: obtain feedback from supervisors, peers, or stakeholders to identify areas for improvement in organizational skills. Regular Self Reflection on your performance to assess strengths, challenges, and opportunities for growth. BEHAVIORS OF MAS Communication Skills: MAS professionals must possess strong verbal and written communication skills. Clear and concise communication is necessary to convey information accurately, address inquiries, and facilitate effective collaboration. Additionally, MAS interacts with all shareholders and stakeholders daily and competences are needed to ensure a smooth workflow. Customer Service Orientation: MAS professionals often serve as the initial point of contact for patients and visitors. They should exhibit a customer service mindset, demonstrating empathy, professionalism, and patience when addressing patient needs, concerns, and inquiries. BEHAVIORS OF MAS Ethical Behavior: Upholding ethical standards is fundamental in healthcare administration. MAS professionals handle sensitive patient information with confidentiality and adhere to privacy regulations such as HIPAA (Health Insurance Portability and Accountability Act). They maintain integrity in all interactions and decisions. HIPAA (Health Insurance Portability and Accountability Act) sets standards for protecting sensitive patient information, known as protected health information (PHI), in healthcare settings. BEHAVIORS OF MAS ETHICAL BEHAVIOR STRATEGIES Access Control: MAS professionals should only access patient information when necessary for their job duties. They should not browse or access patient records out of curiosity or without authorization. Physical Security: Ensure that physical access to areas where patient records are stored (such as filing cabinets or offices) is restricted to authorized personnel only. This includes locking offices, cabinets, and secure areas when not in use. Electronic Security: Maintain strong passwords and follow authentication protocols to access electronic health records (EHRs) or computer systems containing PHI. Avoid sharing passwords and log out of systems when leaving workstations unattended. BEHAVIORS OF MAS Patient Consent: Obtain patient consent before disclosing PHI to third parties, except when permitted by law (e.g., for treatment, payment, or healthcare operations). Explain to patients how their information will be used and obtain their authorization when required. Minimize Disclosure: Only disclose the minimum necessary PHI to fulfill a specific purpose. Avoid unnecessary sharing of patient information and limit discussions of patient details to those directly involved in the patient's care or authorized for administrative purposes. Training and Awareness: Participate in HIPAA training and education programs provided by your organization. Stay informed about updates to HIPAA regulations and organizational policies related to privacy and confidentiality. BEHAVIORS OF MAS Report Security Incidents: Promptly report any suspected or actual breaches of PHI, unauthorized access, or security incidents to designated privacy officers or supervisors. Follow established procedures for incident reporting and investigation. Patient Rights: Respect patients' rights under HIPAA, including their right to access their own medical records, request amendments to their records, and receive an accounting of disclosures of their PHI. Ethical Decision-Making: When faced with ethical dilemmas involving privacy or confidentiality, prioritize patient privacy and ethical standards. Consult with privacy officers or supervisors to address concerns and ensure compliance with HIPAA regulations. BEHAVIORS OF MAS Problem-Solving Abilities: Healthcare environments present various challenges and unexpected situations. MAS professionals should be adept at identifying issues, analyzing root causes, and implementing solutions efficiently. They may troubleshoot scheduling conflicts, billing discrepancies, or patient concerns effectively. STRATEGIES Identify the Problem: Clearly define the issue or challenge you are facing. Gather relevant information, facts, and details to understand the root cause of the problem. Analyze the Situation: Break down the problem into manageable components. Consider factors such as patient needs, organizational policies, regulatory requirements, and stakeholder perspectives that may be influencing the situation. BEHAVIORS OF MAS Generate Solutions: Brainstorm possible answers or courses of action to solve the problem. Involve relevant interested party, such as healthcare providers or colleagues, to gain different perspectives and ideas. Evaluate Options: Evaluate the advantages and disadvantages of each probable solution. Consider factors such as feasibility, cost-effectiveness, impact on patient care, and alignment with organizational goals and values Prioritize and Select a Solution: examine the availability of resources and constraints to solve the problem using the best solutions. Utilize the most suitable solutions that supports the safety of patients, increase productivity, and supports the ethical and regulatory standard. BEHAVIORS OF MAS Develop an Action Plan: Generate a comprehensive action plan outlining steps, timelines, and duties for applying the chosen solution. Inform the relevant stakeholders of the the desired action plan and ensure clear communication. Indicate their role and expectation in ensuring a successful outcome. Implement the Solution: perform the intended action plan. Monitor progress closely to ensure tasks are completed as scheduled and adjustments are made as needed. Monitor and Evaluate: Continuously assess the effectiveness of the implemented solution. Assess and observe the outcomes, collect response and reactions from stakeholders, and determine if the problem ha been solved. BEHAVIORS OF MAS Adapt and Improve: incorporated your action plan if necessary. If action plan results did not work, revisit the problem-solving process, gather additional information, and explore alternative strategies. Reflect and Learn: reflect on the process and outcomes. Examine the strengths and weakness in the action plan. BEHAVIORS OF MAS Teamwork and Collaboration: MAS professionals often work as part of interdisciplinary teams in healthcare settings. They collaborate with healthcare providers, administrative staff, and support personnel to ensure coordinated patient care and operational efficiency. They contribute positively to team dynamics, share information, and support colleagues as needed. Adaptability and Flexibility: Healthcare administration can be dynamic and fast-paced. MAS professionals should demonstrate adaptability to changes in healthcare policies, procedures, and technology. They adjust their approach to accommodate evolving patient needs and organizational priorities. BEHAVIORS OF MAS Professional Development: MAS professionals exhibit a commitment to ongoing learning and professional development. They stay informed about healthcare industry trends, regulatory updates, and technological advancements. They may pursue continuing education opportunities to enhance their skills and knowledge. STRATEGIES Continuing Education: Join workshops, seminars, conferences, and webinars related to healthcare administration, medical billing and coding, HIPAA regulations, and other relevant topics. Certification Programs: Pursue certifications relevant to healthcare administration, such as Certified Medical Administrative Assistant (CMAA) or Certified Medical Office Manager (CMOM). Online Courses and E-Learning BEHAVIORS OF MAS Networking: Build professional relationships and network with collogues. Join American Association of Healthcare Administrative Management) and participate in online forums or LinkedIn groups. Mentorship and Coaching Skills Development Cross-Training and Job Rotation: Explore opportunities for cross- training in different areas of healthcare administration or job rotation within your organization. Professional Conferences and Workshops BEHAVIORS OF MAS Cultural Competence: Healthcare is diverse, and MAS professionals should be culturally competent. They respect and understand cultural differences among patients, colleagues, and stakeholders. This includes sensitivity to language barriers, religious practices, and healthcare beliefs that may influence patient care. STRATEGIES Education and Awareness: Educate yourself about cultural diversity, including beliefs, values, practices, and healthcare customs of different cultural groups. Self-Reflection: Reflect on your own cultural beliefs, biases, and assumptions. Recognize how these factors may influence your interactions with individuals from different cultural backgrounds. Cultivate an open mindset and willingness to learn from diverse perspectives. BEHAVIORS OF MAS Respect and Sensitivity Effective Communication: Develop effective communication skills that are culturally sensitive and responsive. Use clear and simple language, avoid medical jargon or slang, and verify understanding by asking open-ended questions and actively listening to patients' concerns. Language Access: Address language barriers by providing language assistance services, such as interpreters or multilingual staff. Cultural Assessment: Conduct cultural assessments to gather information about patients' cultural backgrounds, beliefs, and healthcare practices. Use this information to personalize care plans and adapt services to meet patients' cultural needs and preference. Awareness of Health Disparities: Be aware of healthcare disparities that may affect diverse populations.  CONTINUING EDUCATION Continuing education is crucial for Medical Administrative Specialists (MAS) to keep updated with productive trends, improve their skills, and career advancement within healthcare administration. Healthcare Administration Courses: join classes that are specific to Medical Administration. These cover topic areas such as medical terminology, healthcare ethics and law, healthcare management and leadership, healthcare finance, and healthcare information systems. Certification Programs: Pursue certifications relevant to MAS roles, such as: Certified Medical Administrative Assistant (CMAA): specific to healthcare. Certified Healthcare Administrative Professional (CHAP): highlights healthcare administration, including leadership and management. Certified Medical Office Manager (CMOM): Targets individuals overseeing medical offices or healthcare practices.  CONTINUING EDUCATION Health Information Technology (HIT) Training: HIT explore topics such as EHR implementation, data security, and healthcare IT management. A Health Information System (HIS) is a comprehensive system designed to manage healthcare data. It integrates various healthcare-related functions, processes, and resources into a unified system. Digital versions of patients' paper charts that contain medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results EHRs allow healthcare providers to record, store, and retrieve patient information in a secure and accessible manner.. CONTINUING EDUCATION Regulatory and Compliance Training: Go to workshops or courses focused on healthcare regulations, such as HIPAA (Health Insurance Portability and Accountability Act), patient privacy, and healthcare billing and coding compliance healthcare technology and electronic health records (EHR) systems Networking and Conferences: Attend conferences, seminars, and networking events. Online Learning Platforms: Local Workshops and Community College Programs: These programs offer practical, hands-on training and networking opportunities within your community.  CONTINUING EDUCATION Professional Development Workshops and Webinars: Participate in workshops and webinars offered by professional associations, healthcare organizations, and online platforms. Leadership and Management Courses: Develop leadership and management skills through courses focusing on team building, strategic planning, project management, and organizational development within healthcare contexts. MAS Q&A