At Tri-Star Health, Paul Fisher, Director of Medical Cost Management, recently reconstructed the company’s internal codes used to process medical claims. This action not only changed the monetary value of certain codes, but it also altered the numeration assigned to a particular treatment drug. Fisher submitted all the documentation to alter these codes, but failed to submit an update to the physician representatives. Fisher’s busy schedule hindered him from requesting a newsletter explaining how to use the new codes as well as their payment schedule. Shortly after the new codes were implemented, various physicians had their claims denied and subsequently were left unpaid. The contracted physicians were reasonably upset and sought financial settlement with interest for the company’s failure to update their provider network. Discussion Questions Relating to Communications
1. What should Fisher have done when he first decided to tackle this project?
2. What protocols should have been in place to avoid the present situation?
3. What positive resolution can be implemented in order to keep these contracted physicians with the plan? (other than what is already posted)
1. Fisher would have planned for a review meeting wereby he would have got the reviews and opinions from the medical representatives which would have helped in the assessment of the codes, organising them, validating and dessiminating without any failure and each of the medical representative would have known about this launch and they would have best contributed to the project.
2. The protocols which should have been in place are:
* Assessment
* organization
* in depth validation
* pilot study on how it works
* disseminating to the network
* informed consent and autonomy of decision making among other members involved in the patient care.
3. The positive resolution would be:
* educating them on the benetifs * incentives and rewards
* having a better group cohrsiveness
* getting updated with the claims * autonomy to gain more information about it
* collaboration with other members
At Tri-Star Health, Paul Fisher, Director of Medical Cost Management, recently reconstructed the company’s internal codes...