Chapter 1, Problem 11R

When a patient is being admitted from home, the social worker should arrange for the medical records on the patient's last hospitalization. the facility should begin recording the patient's past history and background. prior medical records are generally not available. the social worker should obtain medical records from the admitting physician's office.

To process claims accurately and effectively, billing professionals must understand how a clean claim is prepared and what issues can contribute to a dirty claim. When managing a team of billing professionals, it is important to understand how internal and external factors contribute to a smooth process vs. a rejection or denial. Summarize internal factors (within your organization/facility) that can positively or negatively influence the life cycle of a claim. Summarize external factors (outside of your organization/facility) that can positively or negatively influence the life cycle of a claim. From a leadership perspective, how can you ensure your team is effectively trained and confident in navigating internal and external challenges with claim processing? Please be sure to validate your opinions and ideas with citations and references in APA format.

How does health Insurance Portability and Accountability Act (HIPAA) facilitate electronic transactions? A Gives providers access to a centralized patient database B Gives covered providers unique identifiers to use with coding system C Allows anyone with computer access to file claims D Generates paper reports as a back up system