STANDARD COMPETENCIES:

 

 

 1. Identify the regulators of healthcare, governmental (federal, state, local ) and non-governmental and legislation

    that affects or regulates healthcare delivery systems.

 2. Differentiate between the various health care organizations' classification and infrastructure .

 3. Differentiate the roles and responsibilities of the governing bodies and administrative heads employed in the health care organizations.

 4. Assess the organizational structure of the professional staff, including the membership, clinical privileges, services, committees, and bylaws.

 5. Determine categories and functions of the health workforce (clinical and ancillary support services); and, address education,

    licensing and certification requirements, and areas of expertise.

 6. Evaluate current reimbursement processes in financing healthcare.

 7. Describe specific healthcare system information technologies including policies and procedures required by national health information initiatives.

 8. Apply current laws, accreditation , licensure, and certification standards (national, state, local, facility) to various

    healthcare providers/disciplines in order to facilitate their health information needs.

 9. Apply policies and procedures to comply with the changing regulations among various payment systems for healthcare

    services such as Medicare, Medicaid, managed care and private healthcare insurers.

 10. Promote organizational preparation for accreditation, licensing, and/or certification surveys.

 TOPICAL OUTLINE:

 

 I. A distinctive system of health care delivery

 II. System foundations

       a. Beliefs, Values, and Health

       b. The evolution of health services in the United States

 III. Healthcare  Resources

       a. Legislation and regulatory bodies

       b. Health services, administrative, and regulatory Professionals

                   i. Categories and Functions

                  ii. Areas of expertise, education, licensing, certification requirements

       c. Health Information technology

       d. Health services financing/reimbursement

 IV. System Processes

       a. Outpatient and primary care services

       b. Inpatient facilities and services

                   i. Acute health care facilities including bed size, ownership and control, population served, and services offered.

       c. Managed care and integrated organizations

       d. Long-term care

       e. Health services for special populations

       f. Health information technology processes

 V. System Outcomes

       a. Cost, access and quality

       b. Health policies and procedures

                   i. Adherence to policies and procedures for healthcare data collection and payment systems

 VI. System outlook

       a. The future of health services delivery