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4.1 Health Industry Fundamentals
Understanding the basic components and culture of the Health Industry.
Critical Work Functions
- 4.1.1 Understand the components of the Health Industry: the key stake holders, command and control processes, and workflow.
- Provide an overview of the organization and infrastructure of the health care system, including policies and procedures.
- 4.1.2 Understand the components of the Health Industry and services provided by each.
- Identify the structure and function of various health care delivery systems.
- Compare and contrast the structure and function of health care delivery systems.
- 4.1.3 Understand the difference between independent practices and practices that require patient-referral (dependent).
- 4.1.4 Understand the importance of licensure, registration, and certification requirements.
- Differentiate between licensure, registration and certification.
- Compare and contrast the limits of licensure, registration and certification.
- Recognize the impact of scope of practice in the health care delivery system.
- Explain the importance of continued licensure, registration, and certification.
- 4.1.5 Maintain and improve professional knowledge and skills.
- Articulate the need to remain current in the professional practice by: reading journal articles, studying text books related to the field, attending continuing education courses, participating in professional organizations, etc.
- Critically evaluate and appropriately implement new techniques and technologies supported by research-based evidence.
- 4.1.6 Understand the purpose, function and types of health insurance.
- Identify various types of health insurance i.e. federal, state, private, etc.
- Articulate the role and purpose of health care insurance.
- Compare and contrast types of health insurance and their function and impact.
- 4.1.7 Understand patient-billing processes and means of paying for care.
- Identify the processes for payment of health care services.
- Identify resources for payment support.
- 4.1.8 Understand compliance issues with third party payer (insurance) requirements.
- Describe the impact of third party payer requirements on patient care options.
- 4.1.9 Differentiate between various health care delivery systems to include the following:
- Practitioners Dependent – by referral
- Independent
- 4.1.10 Treatment Facilities
- Hospitals
- Critical Access and Long Term Acute Care
- Psychiatric and Substance Abuse
- Outpatient Centers
- Ambulatory Surgery Centers
- Home Health Care Services
- Medical and Diagnostic Laboratories
- Other Ambulatory Services
- Primary Care Medical Home (PCMH)
- Rural Health Care Facilities
- Nursing and Residential Care Facilities
- Residential Care Facilities (assisted living) for the Elderly
- Residential Facilities for People with Disabilities
- Skilled Nursing Facilities
- 4.1.11 Discuss health professions requirements related to the following:
- Education and continuing education requirements
- Professional regulation (e.g., licensure, registration, certification) and facility/program accreditation requirements
- State and federal legislation and regulations that govern the delivery of health services
- Discuss the role and impact of related health care providers including Health industry product vendors
- Health research organizations
- Pharmaceutical research companies
- Public health agencies
- 4.1.12 Outline the role of the health care provider related to insurance processes.
- Health insurance options (HMO, PPO, EOP, POS, etc.)
- Medicaid/Medicare compliance guidelines
- Record-keeping
- Referrals
- 4.1.13 Discuss the impact of health care standards on patient care.
- Culture of safety
- Patient-centric service
- Quality outcomes
- Service excellence