Enhancing the (6-8) System and Health of the Population

The assignment content emphasizes the importance of effective communication with patients, training of physicians, education, proper documentation, transparency in the system, and avoiding under-coding or over-coding. It highlights the need for clear and accurate information entry to ensure correct insurance claims submissions and transparent coding practices. The content also stresses the significance of addressing social determinants of health and promoting health equity.

Contents
Introduction of health promotion.....................................................................................................2
Need of health promotion................................................................................................................3
Steps involved in the health promotion...........................................................................................4
Health inequality..............................................................................................................................4
Evaluation........................................................................................................................................6
Impact of coding on health care funding.........................................................................................7
Homeless people-problems..............................................................................................................8
Methodology for homeless people by hospitals..............................................................................9
Management of health care funding and quality management......................................................10
Planning health promotion.............................................................................................................11
References......................................................................................................................................13
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Introduction of health promotion
The process of providing knowledge and enabling people to control and improve their health is
known as Health promotion. This is the approach to bring a social change in the society and
helps in resolving the health problems.
The World Health Organization introduced seven important principles of health promotion and
those principles are as follows: World Health Organization Principles of Health Promotion
First initiative or principle is an Empowerment, Health promotion that helps to enable people
and community to assume more powers for the various factors that affecting the health such as
personal, socioeconomic and environmental factors.
Secondly, Participative Health promotion principles involve in the engagement of people in
planning, implementation and evaluation. A holistic Health promotion initiative helps in
improving health physically, mentally, socially and spiritually. Inter-sectoral Health promotion
initiatives are the initiative taken by the collective involvement of agencies from relevant sectors.
Equitable Health promotion initiatives take place to show a concern for equity and social justice.
Sustainable Health promotion is helping individuals and communities in maintaining initial
funding. Multi-strategy Health promotion initiatives is a step that uses a variety of ways in
combination with one another. The variety of approaches are like policy development,
organizational change, community development, education and communication. Looking at all
the initiatives the motive of health promotion is to encourage positive health and protecting
people from ill health. Moreover, health promotion plays a key role in establishing preventive
health measures such as screening and immunization (Kumar & Preetha, 2012).
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For the promotion and the improvement of the health of people, there is a strategic framework
has been developed by the organization which has one objective is to promote the health and
remove the inequalities. The health promotion, strategic framework sets many objectives and
these all objectives are clear, consistent and accurate in nature and they are focusing more on the
health of the promotion. This framework is not only focused on the activity is to be done by the
organization, but also pays attention on how to assess and analyze the needs of people by doing
research on the target market where they live, work and play, these all are considered as the
settings of the health promotion.
Need for health promotion
In short, the purpose of the health promotion, strategic framework is to set out the means by
which the organization will:
 To meet its strategic objectives to protect, promote and improve the health of the
population
 Make sure that all health promotion practice during providing health services is in
collaboration with international standards.
 Increase the ability of the organization to enhance the health and wellbeing of the people
in the organization or outside the organization.
 Collaborate into all aspects of its health promotion service (Murphy, 2011).
 Development of the multi-sectoral approach to tackle with the all social determinants of
health and health inequalities
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 Maximize the use of resources in an effective and efficient way to promote the health and
minimizes the cost of reducing or curing the disease.
 Value for money is to be ensured with the aim of reducing workforce.
.
Steps involved in the health promotion.
In order to deliver the health promotion framework and an organization wants to all the activities
will be taking place at the national level then the following actions are required.
1. Clear, accurate and consistent planning, monitoring and evaluation of programs
2. Development of plans for business
3. Role of governance
4. Processes across health and social care staff groups and make sure about safe and
effective health promotion practice
5. Promote work in partnership to improve health across both within the organization and
external to the organization (Pooler & Korda, 2011).
6. Planning to support involvement from local areas to relevant national plans and policies
7. Assistance with the activities such as impact of health, addressing health inequalities,
development of community etc.
Health inequality
Though we have been witnessing a remarkable change in health status of people, but in many
parts of many countries, health inequalities are still prevailing. Many factors are attributed to
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such inequalities for example, unequal distribution of income, high exposure to risk and many
more. Many countries have adopted this as their priority to improve the health of its citizens, the
health care department of the country and the nation as a whole. It is very important to create
awareness among people, especially uneducated people as to what are the factors that can affect
their health to such an extent that it can prove fatal for them. On the other hand, it is also very
important to inform them about the facilities being provided for the improvement of health of
poor people. The people who belong to high elite class are well aware of all the facilities and
they even have income to deal with health issues, but the problem arises when it comes to people
for whom many things are totally new and advanced healthcare department is one of them. Good
health is very important for people to participate in the employment opportunities given to them
by the government (Ramirez, et al., 2008). For any being, health should be the topmost priority
because a person cannot succeed if he doesn't have a fit body. People who are mentally and
physically unfit may unable to produce good results and remain unemployed, which keep them
away from adding to the economy of the nation.
There are many factors leading to bad health for example bad eating habits, drinking and
smoking, unhygenic environment, etc. Such factors need to be eradicated for living beings to live
healthy and live longer. People need to change their living styles to improve their health.
Government in many countries has started opening healthcare centers at easily reachable points,
where cheap and economical but best health care services will be provided and all are made
especially for the benefit of poor people. Healthy mind can do wonders and people need to stay
healthy to bring about change. Many people cannot afford to improve their health as they cannot
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afford the high fees, so the government has been making efforts to provide best services in a less
price (Jakab, 2016).
Evaluation
Medical coding is not only about getting the reimbursements for the services delivered, but it
also includes the giving of accurate information to the insurance payer to let him know the
actual injury and accurate treatment for that. Generally the practice of over-coding is followed to
get unnecessary reimbursements from insurance payers and under-coding is basically done to
evade payment of taxes.
Cost weight methodology: The cost/weight methodology provides a comprehensive foundation
for standardization keeping in mind the reduction of cost and maximizing the output. The
assignment of resource indicators and clinical profiles to a person is made crystal clear
transparent to ensure the clients customize the methods to meet their required needs. The coding
involves an amount of money, but it should be utilized to get the desired results with the least
amount of wastage representing the true information to let the payer know exact information and
discouraging the false representation of the information. The methods should be clear and
understandable (Russo, 2016).
Medical coding is not only about getting the reimbursements for the services delivered, but it
also includes the giving of accurate information to the insurance payer to let him know the
actual injury and accurate treatment for that. Generally the practice of over-coding is followed to
get unnecessary reimbursements from insurance payers and under-coding is basically done to
evade payment of taxes
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Over-coding basically implies the representation of a higher code than what is actually done by a
physician. It involves a high amount of risk because one will be reimbursed with more money
than the actual reimbursement. This will lead to allegations of fraud giving rise to legal penalties
(Nicoletti, 2014).
On the other hand, under-coding is when the decision taken by the physician is not properly
represented which leads to loss of revenue. It implies delivering more services, but coding for the
less than they have actually delivered.
Impact of coding on health care funding
Medication errors: Over-coding and under-coding has a very negative impact on the medication
system as the representation of the facts is false and the true facts are not represented. Basically
the coding practices are incorporated in the system to avoid medication errors and false practices
in the coding system are of no help and serve no purpose if not accurately performed. Coding
practices ensure that the right patient gets the right drug and this purpose can only be achieved if
the coding is done accurately and not over coding or under coding.
Unnecessary diagnostic tests: Diagnostic tests are performed to know whether a person is
suffering from any disease or free from any disease. The code of diagnosis supplements the
medical necessity and helps the insurance payer to know why the services are delivered. The
health care system should comply with the guidelines related to diagnosis tests (Elsevier, 2012).
The coding should be done accurately to a greater level of specificity and neither under coding
nor over coding. The use of inaccurate codes will help in getting the current claims paid in many
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situations, but will not be of any help during risky and serious contracts. So the coding should be
apt and correct.
Unnecessary medication: The inappropriate coding is famous at every level of medication in
this era, especially transcribing, ordering, dispensing, administration, etc. the correct coding will
help the payer know at what stage of recovery the patient is and how much time will he take to
recover and heal perfectly. It is very important to address the right patient for the right medicine
and the documentation should be proper to effect correct results rather than leading to the way of
wrong assumptions and results. Incorporating right drugs is the most imperative thing done in the
health care system. The delivery of correct information to the payer is very important for
ensuring the smooth running of health care funding system. The storage of medication and in
proper condition is of paramount importance with an experienced supervision (Bartlett, 2012).
Homeless people-problems
The expenses related to healthcare are increasing day by day and the patients are growing
enormously in number and therefore, it has become imperative to figure out new and cost
effective ways to manage the records and costs related areas. This helps in the improvement of
problems which are being faced by homeless and hospitals which are related to costs. There is a
dire need of the DRG process as it helps to analyze that whether the information given by
healthcare industries correspond to the information which is given in the records which are
maintained regarding the patients. The main purpose of the DRG audit is to figure out what are
the errors related to sequencing and coding which has an influence over the assignments of DRG.
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As the number of audit cases has been escalated exponentially with time and also the hospitals
have been scrutinized by the auditors very closely to ensure that they are following the right
practices and are not over charging or under charging (Martin, 2005). There is always a great
possibility that coders often under code in the system with the fear that auditor while scrutinizing
might curtail down the diagnosis-related group (DRG) or refuse the claim in its entirety. DRG
auditors make the reports and documentation accurately and properly in a report which includes
information about all the factors affecting the DRG assignment and the reimbursements related
to the medical records.
Methodology for homeless people in hospitals
For Homeless people, DRGs is basically a scheme that classifies the patients, providing a
medium which relates to what type of patients a specific hospital is treating with the expenses
that are incurred by hospitals. The hospitals are using three versions of DRGs which are as
follows:
 Basic DRGs which are used for payments done for medical beneficiaries and used by
organizations for Medicaid services and Medicare.
 All patient DRGs which is usually considered to be the expanded form of the
aforementioned DRG and representative of non-Medicare patients.
 All patient refined DRGs (Promotion, 2015).
It is the basic unit of payment in the hospital system with regards to reimbursement process
Given that the aim of the DRGs is to link a hospital’s case mix to its resources, it is imperative to
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inculcate an operational medium to determine the types of patients treated and linking every
patient kind of the resources consumed by them. While all patients are different, clusters of
patients have diagnostic, demographic and therapeutic characteristics in common that analyze
their stage of resource intensity. By making clinically same groups of patients with the same
intensity, patients can be accumulated into resourceful patient clusters. Moreover, if the specified
groups cover the whole range of patients visible in an inpatient setting, then wholly they would
turn into a patient classification scheme that would give a medium of setting up and helps in
measuring hospital case mix complexities. The DRGs is established as a patient classification
scheme which consists of groups of patients who are same, both in terms of consuming the
resources of hospitals as well as clinically.
During this process of inculcating the DRG patient classification scheme, many other forms to
establishing the groups of patients are investigated. In the early days, a normative approach was
used that involved clinicians who used to define the DRGs with the usage of the patient attributes
which they thought were necessary for analyzing resource intensity.
Management of health care funding and quality management
The coding system is considered to be accurate, if it helps to make the medication process
effective and reduce of medication errors. The true coding system helps to create a strong
foundation for maximizing profits and ensuring correct information about the health of patients
thereby leading to high quality. The correct diagnosis report helps to provide truthful information
to the insurance payer with clear medical treatment.
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The above mentioned indicators if clearly stated and interpreted enhances the health care funding
and leads to true reimbursement of the sum negating the negative gross revenue. The quality of
the system if improved leading to lower risks if the records and documentation done is true and
not at all false.
Planning health promotion
To improve the management of the system and health of the population following are some of
the actions that can be taken by the organization:-
Communication with patients: By knowing and trying to understand the policies related to
payments of the payers, the staff close to the point of action should work more closely with
patients to enter the true and correct information related to insurance as well as let the patients
know clearly the coverage policies of every plan, and submission of claims correctly so the claim
adjudicates accurately on the initial submission. The policies should be clear, understandable and
knowledgeable as well as transparent.
Training of physicians: To get the benefits of better coding both after and before the switch to
ICD-10, training is necessary and that should be additional. The accurate way to aid the
physicians to help them improve the accuracy of is to utilize at least 10 minutes every month at
meetings of physicians to let them read a note which is blinded and coding it along with an order
that is certified. At times, physicians are also benefitted from having a shadow which is a coder
shadow and scribing the visit in addition to the documentation process to effectuate comparison
what one comes up with (Government, 2015).
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Education: The education sector plays a very important role in the growth of the nation and it is
imperative to incorporate new strategies as per the changing environment. New facilities are
introduced in order to provide best education to the youth and government is spending more on
education sector since past few years. E-classrooms have become significant these days for
providing better classrooms for children. For such classrooms, expert personnel are required to
be appointed to deal with such machinery equipped with e-classrooms. Students find it easy and
convenient to study in such environment as it is full of life and enjoyment.
Proper documentation: The documents to be made should be clear and correct without any
complexities and the data entered should be true without any false representations. If the
information entered is correct, it will help the insurance payers know the true information so I
would like to recommend that whenever the information is entered, it should be as per the
policies and should not be against the needs and requirements of the guidelines made regarding
the coding.
Transparency of the system: The system of entering information, insurance policies, coding
should be crystal clear and should be confidential and the patients should know about the
diagnosis and the results should be clear to the patients and the payers should know with what
treatment the patients are going through and how much time will be required to get through the
treatment (Public Health Ontario, 2012).
No under-coding or over-coding: The physicians should not engage themselves in over-coding or
under-coding and should better represent the true information to not to mislead anyone and this
helps in improving the quality of the management and reducing the level of risk and allegations
of fraud and legal penalties.
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References
Bartlett, J. &., 2012. Introduction to health education, health promotion and theory, Available at:
http://samples.jbpub.com/9780763796112/96112_CH01_FINAL.pdf?
bcsi_scan_64741547a7fe261b=0&bcsi_scan_filename=96112_CH01_FINAL.pdf
Elsevier, 2012. What is health promotion?. Available at:
http://booksite.elsevier.com/samplechapters/9780702044564/Promoting%20Health%20-
%20Sample%20Chapter.pdf
Government, O., 2015. At A Glance: The six steps for planning a health promotion program,
Available at:
https://www.publichealthontario.ca/en/eRepository/Six_steps_planning_health_promotion_progr
ams_2015.pdf
Jakab, Z., 2016. Promoting health and reducing health inequities by addressing the social
determinants of health: WHO, Available at:
http://www.euro.who.int/__data/assets/pdf_file/0016/141226/Brochure_promoting_health.pdf
Kumar, S. & Preetha, G., 2012. Health Promotion: An Effective Tool for Global Health. PMC
Journal, March, 37(1), p. 5–12.
Martin, M., 2005. The National Health Promotion Strategy, Available at: http://health.gov.ie/wp-
content/uploads/2014/03/The-National-Health-Promotion-Strategy-2000-2005-Report.pdf
Murphy, J., 2011. The Health Promotion Strategic Framework: HSE National Health Promotion
Office, Available at: http://www.healthpromotion.ie/hp-files/docs/HPSF_HSE.pdf
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Nicoletti, B., 2014. Diagnosis Coding: Why It Is So Important, Available at:
http://www.physicianspractice.com/coding/diagnosis-coding-why-it-so-important
Pooler, J. & Korda, H., 2011. Plan to Address Health Disparities and Promote Health Equity in
New Hampshire, Available at: http://www.dhhs.nh.gov/omh/documents/disparities.pdf
Promotion, O. A. f. H. P. A., 2015. Planning health promotion programs: introductory
workbook: Queen's Printer for Ontario, Available at:
https://www.publichealthontario.ca/en/eRepository/Planning_health_promotion_programs_work
book_En_2015.pdf
Public Health Ontario, 2012. Planning health promotion programs, Available at:
https://www.publichealthontario.ca/fr/eRepository/Planning_health_promotion_programs_2012.
pdf
Ramirez, L., Baker, E. & Metzler, M., 2008. Promoting Health Equity: A Resource to Help
Communities Address Social Determinants of Health: Social Determinants of Health, Available
at: https://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/SDOH-
workbook.pdf
Russo, R., 2016. Documentation and Data Improvement Fundamentals, Available at:
http://library.ahima.org/doc?oid=60174#.WGXkS0-7rIU
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