Educational Program on Risk Management Essay

 In this assignment, you will develop an outline for an \"in‐service\"‐style educational risk management program for employees of a particular health care organization that will then form the basis for a PowerPoint presentation in Topic 5. Select your topic for this educational session from one of the proposed recommendations or changes you suggested in the Risk Management Program Analysis – Part One assignment to enhance, improve, or secure compliance standards in your chosen risk management plan example.


The specific areas that this risk management program addresses are duplicate billing, wrong procedure coding inaccurate coding, defective billing, and incorrect/ improper claims.

The proposed recommendations were to enhance, improve, and secure compliance standards include: having internal audits, and audits having the ability to identify weaknesses in the coding and billing procedures. 

(I live in New York and would like the paper to be about some New York organization)

Create a 500‐750-word comprehensive outline that communicates the following about your chosen topic:
1.	Introduction: Identify the risk management topic you have chosen to address and why it is important within your health care sector.
2.	Rationale: Illustrate how this risk management strategy is lacking within your selected organization\'s current risk management plan and explain how its implementation will better meet local, state, and federal compliance standards.
3.	Support: Provide data that indicate the need for this proposed risk management initiative and demonstrate how it falls under the organization\'s legal responsibility to provide a safe health care facility and work environment.
4.	Implementation: Describe the steps to implement the proposed strategy in your selected health care organization.
5.	Challenges: Predict obstacles the health care organization may face in executing this risk management strategy and propose solutions to navigate or preempt these potentially difficult outcomes.
6.	Evaluation: Outline your plan to evaluate the success of the proposed risk management program and how well it meets the organization\'s short-term, long-term, and end goals.
7.	Opportunities: Recommend additional risk management improvements in adjacent areas of influence that the organization could or should address moving forward.

Educational Program on Risk Management – Part One: Outline of Topic

This paper focuses on risk management in St. Lawrence Health Systems, New York, with regard to enhancing compliance standards in billing and coding in the event of disruption in Internet and computer networks as experienced on October 27^th, 2020. Educational Program on Risk Management Essay. The failure of online billing and coding software presents a challenge in healthcare provision, necessitating maintenance of manual records or codes and bills. Such back-up systems need proper auditing to mitigate compliance risks.

With COVID-19 upon the country, shelter-in-place orders were issued, which led to some unprecedented changes in social and economic activity. Physicians adapted their services to tele-health whilst observing strict novel coronavirus protocols. As with most healthcare organizations, St Lawrence Health Systems computer networks were not using up-to-date cyber-security protocols making them vulnerable to attack (Lallie, 2020). Coding and billing, which are usually done online, were affected. Without computer networks, auditing and the capacity to identify weaknesses in coding and billing procedures was severely compromised. It is for this reason that having an up-to-date manual fallback process and auditing capacity is crucial in risk management in health-care.

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During the ransomware attack on October 27, 2020, numerous activities had to be done using old manual processes that most new staff are not conversant with (Dyrda, 2020). Technological advances have allowed for seamless billing and the adoption of such advances in healthcare have helped curb fraudulent activity such as duplicate billing, inaccurate coding and improper claims. Auditing software systems is considerable easier that auditing paperwork. Stevenson (2020) asserts that given that healthcare systems remain a prime target for cybersecurity threats and the critical role that computer networks play in modern healthcare provision, it is necessary to have a fallback manual system in place. This involves maintaining up-to-date manual records of claim codes to lower the incidence of denied claims and possible legal action under the False Claims Act. Educational Program on Risk Management Essay.

There are three steps to implementing a risk management program with regard to billing and coding, cognizant of possible access denial cyber-attacks. Step one is specifying activities related to creating and maintaining manual records of updated claims codes. These should be updated on a daily basis. Step two is assigning specific individuals the task of updating and maintaining manual records. Step three is availing the manual records of claim codes to check against actual claims in the event of breached cyber-security.

Challenges with executing this risk management plan include the assigning additional duties to employees and more work hours therefore raising expenses for the organization. Moreover, the use of paper records has been systematically minimized because it’s slow and inefficient. It introduces slack and thus may not be welcomed. Notably, having such pain-points but be able to provide services in the event of failed computer networks is a better option to total incapacitation (Bhuyan, 2020).

The success of the proposed risk management plan will be evaluated by its capacity to keep operations running in the event of failed computer networks and minimal lost revenue through postponed services, or legal action from improper billing and coding.

Tele-health is the new norm in healthcare and there exist numerous potential cyber-attack areas with serious consequences on the organization continuity and capacity to provide health services. Educational Program on Risk Management Essay. St Lawrence Health Systems should invest in cyber-security systems, including an in-house team. Healthcare is as critical as banking in an economy, if not more, the banking industry spends 16% to 21% of their annual IT budget on cyber-security compared to the healthcare industry, which spends 4% to 7% of the IT budget on cyber-security (Ring & Renault, 2020)

References

Bhuyan, S. S., Kabir, U. Y., Escareno, J. M., Ector, K., Palakodeti, S., Wyant, D., Kumar, S., Levy, M., Kedia, S., Dasgupta, D. & Dobalian, A. (2020). Transforming healthcare cybersecurity from reactive to proactive: current status and future recommendations. Journal of Medical Systems, 44, 1-9.

Dyrda, L. (2020). The 5 most significant cyberattacks in healthcare for 2020. https://www.beckershospitalreview.com/cybersecurity/the-5-most-significant-cyberattacks-in-healthcare-for-2020.html

Lallie, H. S., Shepherd, L. A., Nurse, J. R., Erola, A., Epiphaniou, G., Maple, C., & Bellekens, X. (2020). Cyber security in the age of covid-19: A timeline and analysis of cyber-crime and cyber-attacks during the pandemic. arXiv preprint arXiv:2006.11929.

Ring, W., & Renault, M. (2020). As They Focus on COVID-19 Surge, Hospitals Become Targets for Cyber Attacks.  https://www.insurancejournal.com/news/national/2020/12/08/593183.htm

Stevenson, K. (2020) Healthcare Cyber-Attacks and the COVID-19 Pandemic: An Urgent Threat to Global Health. Educational Program on Risk Management Essay.