UNIT 3 ASSIGNMENT: Process Frame Assignment

Context:A framework for a process offers a context for managing complexity, a structure for organizing work and maintaining focus, and a necessity for avoiding confusion and ambiguity.Instructions:Choose one of the five areas/processes you identified in the previous assignment or another process of your choice. Remember a process is ?a collection of interrelated work tasks in response to an event that achieves a specific result for a customer.? (Sharp & McDermott, 2009). Don?t confuse a process with a function which is an occupation or department that concentrates related activities and similar skills.Develop a Process Frame for the process you choose. (Use the Process Frame template below, this is not an essay type assignment.) I understand that you may not have in-depth knowledge of the process or workflow if you are not deeply involved with it, but include information in the process frame that you think would be applicable from your understanding of the process variables. It can be fictitious if necessary. The intent is for you to think about important considerations as you begin to analyze a particular process.*Remember that the process frame identifies the steps in a process as it currently exists. The process frame can be used to demonstrate the need to evaluate a process for potential improvement.******Please use template below to fill out answer and use process frame for guidelines.
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PROCESS FRAME
Process Name
Trigger Event
Milestone Steps / Subprocesses
Case for Action / Assessment
Stakeholders
Mechanisms
Result
Vision / Goals
Measures
PROCESS FRAME
Process Name Send Medicare Outpatient Codes
Trigger Event
Milestone Steps
Obtain and
Result
Abstract Send
and apply codes to
Codes
Review
review MR
I-9 and
Business applied
charges
documentation of
CPT
Services to Bill
visit
codes
DB
Case for Action / Assessment
Vision / Goals
There is a 40% re-work factor when coding Medicare
HIM coding staff will have tools
outpatients. Medical necessity and other pre-bill edits are
that :
applied post-coding in Business services necessitating return Optimize workflow and eliminate
to HIM. HIM uses paper worklists which must be manually re-work
distributed among coders. Worklists are not cumulative are Automate worklists
often misplaced since a new one is generated daily making it Allow pre-billing analysis of
difficult to determine what work is completed and what is
LMRP?s
still outstanding. Because there is no database of coded
Integrate charge data with coded
cases, quality management is also manual as is
data analysis and quality
communication between Bus. Svc. and HIM. These
management
inefficiencies result in unacceptably high receivables and
Facilitate interdepartmental
payment denials for Medicare outpatients.
communication with Bus. Svc.
Stakeholders
Mechanisms
Measures
Reduce re-work by 98%
Worklists
Reduce DNFB by 50%
Business Services
Encoder
Eliminate cases returned for
Compliance
Coding Books Medicare
LMRP/medical necessity No more
Revenue Management
Advisories
than $1M due to outstanding
coding
Medicare
Distribute
outpatient seen in
worklist
clinic

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