Prior authorization processes can zap time and resources, wreck your revenue cycle and delay patients’ access to urgent—sometimes life-saving—care.
Download this special report to learn what you can do now to cut costs, elevate the customer experience and reduce revenue leakages.
This document outlines the organization and administration of guidance services. It defines guidance services and their essential components, which include individual inventory, information, counseling, consultation, referral, placement, follow-up, and research/evaluation services. It discusses the necessary elements for organizing a comprehensive guidance program, including establishing an underlying philosophy, objectives, services, staff roles, and community resources. Basic principles for developing and managing an effective guidance program are presented through a sample model that can be used as a guide.
This document summarizes a study on the effect of technology on students' enthusiasm for learning science. The teacher introduced multimedia technology into her middle school science curriculum over six weeks. She surveyed students and parents on enthusiasm at the beginning and end of the study period. During the study, students worked in groups to create multimedia presentations on oceanography topics using HyperStudio. The teacher observed students for problems and reactions. At the end, student presentations were shared and students commented verbally and in writing on their experiences developing the presentations and any problems encountered.
High Expectations at school are important for achieving success.University of Panama
Positive expectations are important for students and teachers. When teachers have high expectations for their students, the students are likely to rise to meet those expectations and perform better academically. Conversely, low or negative expectations can become a self-fulfilling prophecy where students fail to meet low expectations. It is important for teachers to communicate positive expectations to students from the first day of school, such as stating that students will have a successful year and learn a great deal. Setting high standards along with high expectations can encourage students to work hard to achieve those standards.
Current Issues Challenges and Trends in Guidance and CounselingMaisaLao
This document discusses current issues and trends in guidance and counseling in the Philippines. It outlines several challenges, including a shortage of guidance counselors compared to the recommended student-counselor ratio. Counselor education programs need reforms to better prepare counselors for emerging roles in areas like online counseling, disaster response, and helping students transition under the K-12 educational reform. The Philippines also recently passed a mental health act to strengthen protections for individuals seeking mental health services. Overall, the document analyzes how counselor education must adapt to changing needs and contexts in the Philippines.
Learning is define as “the process of acquiring knowledge through experience which leads to a lasting change in behaviour” (Huczynski & Buchanan, 2013).
17 Tips to be an effective teacher - Part IIKidzrio
The document provides 17 tips for teachers to be effective, beginning with making lessons humorous and engaging students. It emphasizes listening to students, using facial expressions and body language, telling relevant stories, having a global outlook, and using jokes to ease tension. Other tips include being proactive, taking risks to teach slow learners, effective communication, praise and positivity, time management, understanding individual differences, and solving behavioral issues with care rather than punishment. The overall message is that teachers should believe in students and help them through challenges rather than criticize.
School culture refers to the beliefs, attitudes and unwritten rules that shape how a school functions. Key elements that frame school culture include structure, values, behavioral expectations and trust between staff and parents. A positive school culture is conducive to learning and well-being. It has four pillars - being strength-based, collaborative, focused and innovative. Creating positive culture involves investing in relationships, sharing a vision, role modeling good behaviors, and praising accomplishments. A positive culture guides people and increases motivation.
This document outlines the organization and administration of guidance services. It defines guidance services and their essential components, which include individual inventory, information, counseling, consultation, referral, placement, follow-up, and research/evaluation services. It discusses the necessary elements for organizing a comprehensive guidance program, including establishing an underlying philosophy, objectives, services, staff roles, and community resources. Basic principles for developing and managing an effective guidance program are presented through a sample model that can be used as a guide.
This document summarizes a study on the effect of technology on students' enthusiasm for learning science. The teacher introduced multimedia technology into her middle school science curriculum over six weeks. She surveyed students and parents on enthusiasm at the beginning and end of the study period. During the study, students worked in groups to create multimedia presentations on oceanography topics using HyperStudio. The teacher observed students for problems and reactions. At the end, student presentations were shared and students commented verbally and in writing on their experiences developing the presentations and any problems encountered.
High Expectations at school are important for achieving success.University of Panama
Positive expectations are important for students and teachers. When teachers have high expectations for their students, the students are likely to rise to meet those expectations and perform better academically. Conversely, low or negative expectations can become a self-fulfilling prophecy where students fail to meet low expectations. It is important for teachers to communicate positive expectations to students from the first day of school, such as stating that students will have a successful year and learn a great deal. Setting high standards along with high expectations can encourage students to work hard to achieve those standards.
Current Issues Challenges and Trends in Guidance and CounselingMaisaLao
This document discusses current issues and trends in guidance and counseling in the Philippines. It outlines several challenges, including a shortage of guidance counselors compared to the recommended student-counselor ratio. Counselor education programs need reforms to better prepare counselors for emerging roles in areas like online counseling, disaster response, and helping students transition under the K-12 educational reform. The Philippines also recently passed a mental health act to strengthen protections for individuals seeking mental health services. Overall, the document analyzes how counselor education must adapt to changing needs and contexts in the Philippines.
Learning is define as “the process of acquiring knowledge through experience which leads to a lasting change in behaviour” (Huczynski & Buchanan, 2013).
17 Tips to be an effective teacher - Part IIKidzrio
The document provides 17 tips for teachers to be effective, beginning with making lessons humorous and engaging students. It emphasizes listening to students, using facial expressions and body language, telling relevant stories, having a global outlook, and using jokes to ease tension. Other tips include being proactive, taking risks to teach slow learners, effective communication, praise and positivity, time management, understanding individual differences, and solving behavioral issues with care rather than punishment. The overall message is that teachers should believe in students and help them through challenges rather than criticize.
School culture refers to the beliefs, attitudes and unwritten rules that shape how a school functions. Key elements that frame school culture include structure, values, behavioral expectations and trust between staff and parents. A positive school culture is conducive to learning and well-being. It has four pillars - being strength-based, collaborative, focused and innovative. Creating positive culture involves investing in relationships, sharing a vision, role modeling good behaviors, and praising accomplishments. A positive culture guides people and increases motivation.
This document provides information on creating and maintaining safe and orderly schools. It discusses the importance of school culture and climate, defining clear expectations and rules, using positive behavior supports, and recognizing students and staff. The goals are to understand the principal's role in safety and order, consider renewal activities, and discuss strategies like rewards, discipline, and emergency plans that contribute to an orderly learning environment.
Professional education set e (without highlighted answers)Lucille Clavero
This document contains multiple choice questions from a teacher exam covering various topics:
- Teachers' responsibilities outside of teaching and compensation
- Dog behavior and conditioning processes
- Reading comprehension strategies
- Influences on developing graduates' character
- Learning theories as they relate to punishment
- Appropriate ways to help students below grade level
- Foundational principles of morality in reporting illegal activities
- Names for instructional methods like Socratic and indirect instruction
- Classroom management techniques
- Learning taxonomies and domains
- Standardized testing practices
- Intellectual development and diagram use according to Bruner
- Synthesizing skills and mean, median, and mode calculations
This lesson plan is for a 10th grade social studies class and focuses on teenage pregnancy. It will analyze the learners, set objectives, and identify instructional methods and materials used. The lesson will discuss teenage pregnancy, contributing factors, and the effects on teens and families. Students will be placed into groups to discuss consequences and complete a worksheet. They will then recommend preventative measures for teenage pregnancy.
This document contains multiple choice questions about various philosophies and concepts related to education. It tests knowledge in areas like:
- Educational philosophies like essentialism, existentialism, pragmatism, and more.
- Philosophies that underlie certain classroom practices and theories.
- Cultural transmission processes, goals, and reforms in different periods of Philippine education history.
- Key concepts in education like development, growth, learning, and maturation.
- Situations that illustrate balancing responsibilities and upholding principles.
The questions cover a wide range of topics to assess understanding of foundations and principles that guide educational practice.
The document discusses 6 key features of curriculum design: the teacher, learners, knowledge/skills/values, strategies/methods, performance, and community partnerships. It also outlines 3 approaches to curriculum design: learner-centered focuses on student needs/interests; subject-centered prioritizes subject matter; and problem-centered uses problem-solving to develop independent, civic-minded learners.
Curriculum
Meaning, Definition and Nature
Dictionary meaning of the word curriculum stands for ‘chariot for racing’.
Derived from the Latin word ‘currere’.
The Chariot takes us from what we are to what we shall be.
According to Secondary Education Commission (1952-53) “Curriculum does not mean only the academic subjects traditionally taught in the school, but it includes the totality of the experiences that learner receives through the manifold activities that go in the school, in the classroom, library, laboratory, workshop, playground and in the numerous informal contacts between the teacher and the learners”.
According to Cunningham “Curriculum is the tool in the hands of the artist (the teacher) to mould his material (the students) according to his ideals (aims and objectives) in his studio (the school)”.
According to Krug “Curriculum is subject matter content which is taught to a person in order to educate him”.
According to Kerr “Curriculum comprises all the course offered to the learner which is planned and guided by the school, whether it is carried on in groups or individually, inside or outside the school”.
According to Crow and Crow “Curriculum includes all the learners’ experience which the child gets under the guidance of a teacher, in or outside school, that are included in the programme which has been devised to help him develop mentally, physically, emotionally, socially, spiritually and morally”.
According to Saylor and Alexander “Curriculum is the Environment in which the education takes place”.
According to Saylor, Alexander and Lewis “Curriculum is planned opportunities for learning for persons to be educated”.
According to Smith “Curriculum deals with the learning outcomes which are to be achieved through instruction or experience”.
Nature
Curriculum is a means to achieve some end.
Curriculum is a series of experiences.
Curriculum is a process of living.
Curriculum is a dynamic process.
Curriculum helps in the development of a balanced personality
Curriculum and the society are interrelated and inter-dependent.
This document discusses effective questioning techniques for math teachers. It begins by stating that a teacher's effectiveness can be gauged by their ability to ask good questions. It then provides information on what questioning is, the skill of questioning, different uses of questions, characteristics of good questions, techniques for questioning, handling student responses, and handling student questions. The document emphasizes that questioning should motivate student thinking, be clear and challenging, and that teachers should appreciate student answers while ensuring incorrect answers are addressed. Overall, the document stresses that questioning is an art that takes practice to develop effective lessons centered around student participation.
The document discusses the social forces that influence curriculum planning and development. It identifies several levels of social forces - national, national agencies, and stakeholders. At the national level, forces include social diversity, religion, culture, economics, politics, technology, environment, and child psychology. National agencies that influence the curriculum include the Department of Education, Commission on Higher Education, and state universities. Key stakeholders are teachers, students, parents, community, and private organizations. The curriculum is also influenced by laws like the Governance of Basic Education Act. Social science concepts like social, political, economic, technological, environmental, and child development factors shape curriculum goals and learning experiences.
Topic: What is guidance ?
Student Name: Ume Farwa
Class: M.Ed.
Project Name: “Young Teachers' Professional Development (TPD)"
"Project Founder: Prof. Dr. Amjad Ali Arain
Faculty of Education, University of Sindh, Pakistan
This document discusses the counseling service as a component of a school's guidance program. It outlines four aspects that must be considered in administering counseling services: development, components, relationships, and evaluation. Regarding development, the document details 10 functions for establishing an effective counseling program, including studying the environment, defining problems, establishing parameters, designing a counseling model, testing the program prototype, pilot testing, introducing, operating, evaluating, and eliminating the system if needed. It also discusses considerations for counseling program components like personnel, physical setting, time utilization, and professional orientation.
The school purposes in curriculum developmentMica Navarro
This document discusses different levels and types of educational objectives. It defines objectives as specific, measurable targets that advance a school towards its goals. Objectives are categorized into three domains: cognitive, affective, and psychomotor. The cognitive domain involves thought processes like knowledge, comprehension, and evaluation. The affective domain relates to values, attitudes, and appreciation. The psychomotor domain refers to physical skills. Educational objectives must be specific, observable, and able to verify achievement within a given timeframe and conditions.
Educational guidance & counseling study material for mid term b.ed. 6th (e.g....13023901-016
Various individuals like teachers, advisors, deans, parents, and professionals provide guidance and counseling through methods such as interviews, letters, phones, media, and computers. The document defines guidance, counseling, and discusses their purposes including helping students with educational, psychological, and sociological issues. It outlines the characteristics and differences between guidance and counseling. The roles of counselors and guidance personnel in providing services to students are also described.
ORAL DEFENSE ON DIFFERENTIATED INSTRUCTIONWENDELL TARAYA
This document summarizes a study on differentiating instruction for an 8th grade social studies class in the Philippines. The study found that students who received differentiated instruction performed significantly better on post-tests compared to students who received conventional teaching. Specifically, most students receiving differentiated instruction achieved outstanding scores, while students receiving conventional teaching mostly achieved very satisfactory scores. The study also identified the least learned competencies to help teachers develop an enhanced instructional plan to address students' diverse needs and learning preferences.
This document provides a review for the LET (Licensure Examination for Teachers) exam covering General Education topics in English and Filipino. It includes 30 multiple choice questions in English and 14 questions in Filipino covering topics like literature, grammar, vocabulary and comprehension. The questions are designed to help exam takers prepare for the LET by testing their knowledge of key concepts in both subjects.
The document discusses educational leadership and identifies three types: the educational statesman, teacher, and administrator. The educational statesman persuades others through rational arguments, while a teacher leads through expertise in pedagogy. An administrator provides democratic leadership and guides the school toward common educational goals by coordinating teachers, students, and parents. Key responsibilities of educational leaders are to develop curriculum, represent the school externally, support educators, and establish organizational structures that facilitate strategic planning.
TEACHING IS A CHANCE TO GET INVOLVED IN THE FUTURE – A SERVICE – AND IS THE NOBLEST OF ALL PROFESSIONS. HENCE I AM PROUD TO SAY THAT I AM A TEACHER.
A TEACHER SHOULD FOCUS ON WHAT THE STUDENTS CAN DO AND NOT ON WHAT THEY CANNOT.
This document discusses instructional planning and management of instruction. It emphasizes that a teacher's instructional competence is important for controlling misbehavior and maximizing learning opportunities. When instruction is characterized by a high degree of competence, the chances of controlling negative influences and deterring behaviors that hinder learning are greater. The document outlines several principles for effective instruction, including understanding student needs, using positive teaching approaches, and facilitating student achievement. It also describes the instructional planning process, which involves diagnosing student needs, setting objectives, preparing lessons, guiding learning activities, and evaluating student performance. Teachers are encouraged to carefully plan units and lesson plans to provide organization and direction for both teachers and students.
The document discusses checklists and rating scales used for performance evaluation. It defines checklists as lists that check for the presence or absence of traits, and rating scales as tools that assess levels of performance. Checklists are useful for objective evaluations but only assess limited aspects, while rating scales provide flexibility in judging performance qualitatively through descriptive or numerical scales. Both tools have advantages like structure and adaptability, but also limitations such as subjectivity.
The document discusses different aspects of curriculum including definitions, designs, and models. It defines curriculum as the planned learning experiences and intended outcomes designed by schools. Three common curriculum designs are discussed - subject-centered focusing on content, learner-centered centered on learners, and problem-centered organizing around problems. Four curriculum development models are summarized - Tyler's model originating in 1949 uses objectives, Taba's grassroots model engages teachers, Saylor, Alexander, and Lewis's model specifies goals before design, and Oliva's deductive model allows faculty input.
Patient access areas are facing increasing challenges due to new clinical information requirements from payers before authorizing costly diagnostic tests. Payers are requiring more detailed documentation such as prior treatment attempts, test objectives, and rationale for choosing specific tests over less expensive alternatives. They are also performing more peer-to-peer reviews and suggesting lower-cost or preferred facilities. This has increased the workload and number of rescheduled appointments for patient access staff. To address these changes, some hospitals are capturing more clinical data from providers, providing scheduling with authorization timelines, and screening for necessary waivers at registration. Educating provider offices on payer needs through "lunch and learns" and ensuring patient access staff have access to full patient charts can help
A Detailed Guide On Prior Authorization Process In RCM.pptxRichard Smith
In no small measure, the difficulty of providing patients with the proper care at the appropriate time has skyrocketed up the graph, and the conflict between cost-conscious insurance companies, patients, and their doctors won’t go away any time soon. Sounds like a dilemma? We all can agree to the stemmed fact that finding innovative ways to improve care delivery has been a goal for many healthcare executives as the healthcare landscape continues to get more complex.
This document provides information on creating and maintaining safe and orderly schools. It discusses the importance of school culture and climate, defining clear expectations and rules, using positive behavior supports, and recognizing students and staff. The goals are to understand the principal's role in safety and order, consider renewal activities, and discuss strategies like rewards, discipline, and emergency plans that contribute to an orderly learning environment.
Professional education set e (without highlighted answers)Lucille Clavero
This document contains multiple choice questions from a teacher exam covering various topics:
- Teachers' responsibilities outside of teaching and compensation
- Dog behavior and conditioning processes
- Reading comprehension strategies
- Influences on developing graduates' character
- Learning theories as they relate to punishment
- Appropriate ways to help students below grade level
- Foundational principles of morality in reporting illegal activities
- Names for instructional methods like Socratic and indirect instruction
- Classroom management techniques
- Learning taxonomies and domains
- Standardized testing practices
- Intellectual development and diagram use according to Bruner
- Synthesizing skills and mean, median, and mode calculations
This lesson plan is for a 10th grade social studies class and focuses on teenage pregnancy. It will analyze the learners, set objectives, and identify instructional methods and materials used. The lesson will discuss teenage pregnancy, contributing factors, and the effects on teens and families. Students will be placed into groups to discuss consequences and complete a worksheet. They will then recommend preventative measures for teenage pregnancy.
This document contains multiple choice questions about various philosophies and concepts related to education. It tests knowledge in areas like:
- Educational philosophies like essentialism, existentialism, pragmatism, and more.
- Philosophies that underlie certain classroom practices and theories.
- Cultural transmission processes, goals, and reforms in different periods of Philippine education history.
- Key concepts in education like development, growth, learning, and maturation.
- Situations that illustrate balancing responsibilities and upholding principles.
The questions cover a wide range of topics to assess understanding of foundations and principles that guide educational practice.
The document discusses 6 key features of curriculum design: the teacher, learners, knowledge/skills/values, strategies/methods, performance, and community partnerships. It also outlines 3 approaches to curriculum design: learner-centered focuses on student needs/interests; subject-centered prioritizes subject matter; and problem-centered uses problem-solving to develop independent, civic-minded learners.
Curriculum
Meaning, Definition and Nature
Dictionary meaning of the word curriculum stands for ‘chariot for racing’.
Derived from the Latin word ‘currere’.
The Chariot takes us from what we are to what we shall be.
According to Secondary Education Commission (1952-53) “Curriculum does not mean only the academic subjects traditionally taught in the school, but it includes the totality of the experiences that learner receives through the manifold activities that go in the school, in the classroom, library, laboratory, workshop, playground and in the numerous informal contacts between the teacher and the learners”.
According to Cunningham “Curriculum is the tool in the hands of the artist (the teacher) to mould his material (the students) according to his ideals (aims and objectives) in his studio (the school)”.
According to Krug “Curriculum is subject matter content which is taught to a person in order to educate him”.
According to Kerr “Curriculum comprises all the course offered to the learner which is planned and guided by the school, whether it is carried on in groups or individually, inside or outside the school”.
According to Crow and Crow “Curriculum includes all the learners’ experience which the child gets under the guidance of a teacher, in or outside school, that are included in the programme which has been devised to help him develop mentally, physically, emotionally, socially, spiritually and morally”.
According to Saylor and Alexander “Curriculum is the Environment in which the education takes place”.
According to Saylor, Alexander and Lewis “Curriculum is planned opportunities for learning for persons to be educated”.
According to Smith “Curriculum deals with the learning outcomes which are to be achieved through instruction or experience”.
Nature
Curriculum is a means to achieve some end.
Curriculum is a series of experiences.
Curriculum is a process of living.
Curriculum is a dynamic process.
Curriculum helps in the development of a balanced personality
Curriculum and the society are interrelated and inter-dependent.
This document discusses effective questioning techniques for math teachers. It begins by stating that a teacher's effectiveness can be gauged by their ability to ask good questions. It then provides information on what questioning is, the skill of questioning, different uses of questions, characteristics of good questions, techniques for questioning, handling student responses, and handling student questions. The document emphasizes that questioning should motivate student thinking, be clear and challenging, and that teachers should appreciate student answers while ensuring incorrect answers are addressed. Overall, the document stresses that questioning is an art that takes practice to develop effective lessons centered around student participation.
The document discusses the social forces that influence curriculum planning and development. It identifies several levels of social forces - national, national agencies, and stakeholders. At the national level, forces include social diversity, religion, culture, economics, politics, technology, environment, and child psychology. National agencies that influence the curriculum include the Department of Education, Commission on Higher Education, and state universities. Key stakeholders are teachers, students, parents, community, and private organizations. The curriculum is also influenced by laws like the Governance of Basic Education Act. Social science concepts like social, political, economic, technological, environmental, and child development factors shape curriculum goals and learning experiences.
Topic: What is guidance ?
Student Name: Ume Farwa
Class: M.Ed.
Project Name: “Young Teachers' Professional Development (TPD)"
"Project Founder: Prof. Dr. Amjad Ali Arain
Faculty of Education, University of Sindh, Pakistan
This document discusses the counseling service as a component of a school's guidance program. It outlines four aspects that must be considered in administering counseling services: development, components, relationships, and evaluation. Regarding development, the document details 10 functions for establishing an effective counseling program, including studying the environment, defining problems, establishing parameters, designing a counseling model, testing the program prototype, pilot testing, introducing, operating, evaluating, and eliminating the system if needed. It also discusses considerations for counseling program components like personnel, physical setting, time utilization, and professional orientation.
The school purposes in curriculum developmentMica Navarro
This document discusses different levels and types of educational objectives. It defines objectives as specific, measurable targets that advance a school towards its goals. Objectives are categorized into three domains: cognitive, affective, and psychomotor. The cognitive domain involves thought processes like knowledge, comprehension, and evaluation. The affective domain relates to values, attitudes, and appreciation. The psychomotor domain refers to physical skills. Educational objectives must be specific, observable, and able to verify achievement within a given timeframe and conditions.
Educational guidance & counseling study material for mid term b.ed. 6th (e.g....13023901-016
Various individuals like teachers, advisors, deans, parents, and professionals provide guidance and counseling through methods such as interviews, letters, phones, media, and computers. The document defines guidance, counseling, and discusses their purposes including helping students with educational, psychological, and sociological issues. It outlines the characteristics and differences between guidance and counseling. The roles of counselors and guidance personnel in providing services to students are also described.
ORAL DEFENSE ON DIFFERENTIATED INSTRUCTIONWENDELL TARAYA
This document summarizes a study on differentiating instruction for an 8th grade social studies class in the Philippines. The study found that students who received differentiated instruction performed significantly better on post-tests compared to students who received conventional teaching. Specifically, most students receiving differentiated instruction achieved outstanding scores, while students receiving conventional teaching mostly achieved very satisfactory scores. The study also identified the least learned competencies to help teachers develop an enhanced instructional plan to address students' diverse needs and learning preferences.
This document provides a review for the LET (Licensure Examination for Teachers) exam covering General Education topics in English and Filipino. It includes 30 multiple choice questions in English and 14 questions in Filipino covering topics like literature, grammar, vocabulary and comprehension. The questions are designed to help exam takers prepare for the LET by testing their knowledge of key concepts in both subjects.
The document discusses educational leadership and identifies three types: the educational statesman, teacher, and administrator. The educational statesman persuades others through rational arguments, while a teacher leads through expertise in pedagogy. An administrator provides democratic leadership and guides the school toward common educational goals by coordinating teachers, students, and parents. Key responsibilities of educational leaders are to develop curriculum, represent the school externally, support educators, and establish organizational structures that facilitate strategic planning.
TEACHING IS A CHANCE TO GET INVOLVED IN THE FUTURE – A SERVICE – AND IS THE NOBLEST OF ALL PROFESSIONS. HENCE I AM PROUD TO SAY THAT I AM A TEACHER.
A TEACHER SHOULD FOCUS ON WHAT THE STUDENTS CAN DO AND NOT ON WHAT THEY CANNOT.
This document discusses instructional planning and management of instruction. It emphasizes that a teacher's instructional competence is important for controlling misbehavior and maximizing learning opportunities. When instruction is characterized by a high degree of competence, the chances of controlling negative influences and deterring behaviors that hinder learning are greater. The document outlines several principles for effective instruction, including understanding student needs, using positive teaching approaches, and facilitating student achievement. It also describes the instructional planning process, which involves diagnosing student needs, setting objectives, preparing lessons, guiding learning activities, and evaluating student performance. Teachers are encouraged to carefully plan units and lesson plans to provide organization and direction for both teachers and students.
The document discusses checklists and rating scales used for performance evaluation. It defines checklists as lists that check for the presence or absence of traits, and rating scales as tools that assess levels of performance. Checklists are useful for objective evaluations but only assess limited aspects, while rating scales provide flexibility in judging performance qualitatively through descriptive or numerical scales. Both tools have advantages like structure and adaptability, but also limitations such as subjectivity.
The document discusses different aspects of curriculum including definitions, designs, and models. It defines curriculum as the planned learning experiences and intended outcomes designed by schools. Three common curriculum designs are discussed - subject-centered focusing on content, learner-centered centered on learners, and problem-centered organizing around problems. Four curriculum development models are summarized - Tyler's model originating in 1949 uses objectives, Taba's grassroots model engages teachers, Saylor, Alexander, and Lewis's model specifies goals before design, and Oliva's deductive model allows faculty input.
Patient access areas are facing increasing challenges due to new clinical information requirements from payers before authorizing costly diagnostic tests. Payers are requiring more detailed documentation such as prior treatment attempts, test objectives, and rationale for choosing specific tests over less expensive alternatives. They are also performing more peer-to-peer reviews and suggesting lower-cost or preferred facilities. This has increased the workload and number of rescheduled appointments for patient access staff. To address these changes, some hospitals are capturing more clinical data from providers, providing scheduling with authorization timelines, and screening for necessary waivers at registration. Educating provider offices on payer needs through "lunch and learns" and ensuring patient access staff have access to full patient charts can help
A Detailed Guide On Prior Authorization Process In RCM.pptxRichard Smith
In no small measure, the difficulty of providing patients with the proper care at the appropriate time has skyrocketed up the graph, and the conflict between cost-conscious insurance companies, patients, and their doctors won’t go away any time soon. Sounds like a dilemma? We all can agree to the stemmed fact that finding innovative ways to improve care delivery has been a goal for many healthcare executives as the healthcare landscape continues to get more complex.
A Detailed Guide On Prior Authorization Process In RCM.pdfRichard Smith
In no small measure, the difficulty of providing patients with the proper care at the appropriate time has skyrocketed up the graph, and the conflict between cost-conscious insurance companies, patients, and their doctors won’t go away any time soon. Sounds like a dilemma? We all can agree to the stemmed fact that finding innovative ways to improve care delivery has been a goal for many healthcare executives as the healthcare landscape continues to get more complex.
Health Insurance & Prior authorization Requirements: Its Impact and Recommend...mosmedicalreview
Insurers use prior-authorization to ensure medical necessity. Medical peer review can be initiated when a prior authorization request or a claim is denied.
This document provides information to help individuals become better healthcare consumers. It discusses healthcare consumerism and the importance of understanding one's health insurance plan rules and networks. It also provides tips for saving money such as using generic drugs, shopping costs of medical services, and auditing medical bills for errors. The overall message is that empowering individuals with healthcare knowledge can help reduce their out-of-pocket expenses.
We believe in innovations and learning new technologies to meet the ever changing market dynamics. We perform as trusted partners to our clients in their endeavor to find the right operating model to leverage the offshore-based Process Outsourcing advantage with a promise to deliver the best in industry service at competitive terms.
Strategies To Improve Authorization For Revenue Cycle Management.pdfCosentus
Healthcare is a very important sector for the world. While it takes care of patient health, there are numerous aspects involved to run a healthcare organization or provider. One of the important aspects is finance, which helps the healthcare organization get the right remuneration and help it function smoothly so that it is able to provide the best healthcare services to the patients. One of the important parts of the finance aspect of a healthcare organization is revenue cycle management. For more visit pdf
How to improve the Claims Adjudication Process?DataGenix
Most use traditional claims management systems that aren't only inappropriate as well as an expensive option for managing complex multi-source data but also complicate the communication between the payers and providers. That's why Claims Adjudication Software is gaining so much consideration.
25 Appeal Letters and Using PPACA For Today's AppealsTammy Tipton
The document discusses strategies for appealing health insurance claim denials using the Patient Protection and Affordable Care Act (PPACA). It outlines 8 steps for appealing medical necessity denials and provides templates for 25 types of appeals, focusing on obtaining full disclosure from insurers and citing legal and compliance issues. The presenter recommends negotiating stronger provider terms in managed care contracts and pursuing external review when necessary.
Georgia-based medical groups can effectively manage denial claims by identifying the root causes, prioritizing high-impact areas, and improving processes. They should analyze denial data to determine where errors most commonly occur, such as registration, eligibility verification, authorization, and claims submission. Groups can reduce denials by 10% by enhancing registration accuracy, eligibility verification training, pre-authorization checks, and customizing claims edits to payer requirements. Outsourcing denial management to experts can not only provide insights but implement tools and services to eliminate future denials.
This document discusses improving the customer experience in healthcare. It outlines the key stakeholders in healthcare delivery (patients, providers, payors) and describes two common types of patient journeys (routine/preventative care and acute/emergency care). These journeys involve coordination between many different groups. The document examines areas like task routing, resource management, facilities management, revenue cycle management, and compliance that are important to consider when improving the customer experience across the healthcare system.
Automating Prior Authorization for a Surgical GroupSolemanOne
Prior authorization is a crucial process in the healthcare industry, particularly for surgical procedures. It involves obtaining approval from insurance companies before performing certain treatments or surgeries.
5 Eligibility and Benefits Verification Challenges that Most Medical Practice...Billingparadise1
Practices can use either real-time computerized eligibility checks or manual checks to verify a patient's eligibility verification.
In order to ensure that patients are eligible for the services they are seeking, medical practices have a few options for validation. One way to verify eligibility is through the use of computerized real-time eligibility checks. This method utilizes electronic systems to instantly check a patient's insurance coverage and benefits, providing the practice with immediate confirmation of the patient's eligibility.
How a Real-Time Automated Decision-Support Tool Can Cure the Prior Authorizat...Cognizant
A collaboration between Cognizant, the New England Healthcare Exchange Network and Informatics In Context is demonstrating how a real-time prior authorization (PA) system for medical and administrative processes saves time and money.
How to Fix Rejections to Improve Revenue Cycle Management in Healthcare.pdftevixMD
Maximize revenue and streamline your practice's financial workflow with tevixMD. Improve your revenue cycle management and get paid faster. Try it now.
This document summarizes a case study on reengineering processes at Nethrajyoth International Hospital in southern India. [1] The hospital aimed to increase services for poor patients without increasing fees for other patients, but faced constraints on resources and staff. [2] The old process involved patients moving between departments with long wait times. Reengineering focused on eliminating wait times using a centralized IT system. [3] The reengineered system links 60 terminals to schedule appointments, registration, payments, and hand patients between departments, cutting perceived wait times for a better patient experience.
The document discusses the importance of the patient registration process in revenue cycle management. It outlines the key information that should be collected during registration, including patient demographics, insurance details, and provider information. An accurate and complete patient registration is critical to set the foundation for proper billing and claims submission.
Similar to White Paper: How Can we Improve the Prior Authorization Process Today? (20)
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TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardso...rightmanforbloodline
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
TEST BANK For Accounting Information Systems, 3rd Edition by Vernon Richardson, Verified Chapters 1 - 18, Complete Newest Version
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White Paper: How Can we Improve the Prior Authorization Process Today?
1. Prior authorization is among the most
cumbersome processes confronting payers,
providers and, ultimately, patients. Rife with
inefficiencies, prior authorization wastes
resources, delays services and worse. At
TransUnion, we think it’s time for a change.
In this paper we’ll discuss prior authorization
inefficiencies from both the payer and provider
perspectives; analyze the impact of the prior
authorization process on patients; review some
of the most recent initiatives undertaken to
streamline the prior authorization process;
and propose a solution that’s available today to
remove significant inefficiency from the process.
But before we begin, let’s take a look at the prior
authorization process as it stands today—from the
payer, provider and patient perspectives .
How can we improve the prior
authorization process today?
Why prior authorization costs everyone dearly—and how to fix it
“Nearly 90% of surveyed physicians reported
that prior authorization sometimes, often
or always delays access to care.”1
- “Health Care Coalition Calls for Prior Authorization Reform.”
American Medical Association.
in national operational
savings opportunity exists
for providers if electronic
transactions and
workflows were adopted.2
$323
million
2. NUMBER OF PRIOR
AUTHORIZATIONS
COMPLETED
per week per
physician.3
PHYSICIANS,
NURSES, AND
CLERICAL STAFF
TIME SPENT
ON PRIOR
AUTHORIZATION
ACTIVITIES.3
PERCENTAGE OF
PHYSICIANS WHO
DESCRIBE prior
authorization
burden as high
or extremely
high.3
PERCENTAGE
OF PHYSICIANS
WHO HAVE
STAFF WORKING
EXCLUSIVELY
ON PRIOR
AUTHORIZATIONS.3
Prior authorization
today
What is prior authorization? Simply put, an
authorization (also called “pre-authorization,”
“precertification,” or “service review”) occurs
when a healthcare provider (provider) is required
to attain permission from a health insurance
company (payer) before administering a specific
treatment, procedure or test to a patient.
Typically, prior authorization is required to
determine if services are medically necessary
under the insurance plan rules. The rules
typically look at the cost, utilization and efficacy
of the suggested procedures.
The goal? To limit unnecessary expenditure
on the part of the payer, as well as minimize
ineffective or over utilized services rendered by
the provider. For example, in many situations an
X-ray may cost less yet may be just as effective
as a more expensive CT scan.
Today, the process comprises a primarily
manual exchange of documents (most of which
vary by payer, plan and even patient) between
a payer and a provider. However, strides have
been made to streamline the process through
automation.
Figure 1. Prior authorization today
75%
of Physicians
64%
of Physicians
16.4hr
per Week
37
per Week
3. THE PROVIDER’S POINT OF
VIEW: TOO MUCH MANUAL
WORK
For healthcare providers, the prior authorization
process can be both time-consuming and
frustrating. As it stands today, prior authorization
is a predominantly manual task for providers.
Whether it’s by manually reviewing options
online through different payer proprietary
portals or calling payers only to wait on hold
for an inordinate amount of time, both can be
cumbersome and vary across payers.
Generally, the process involves gathering the
requisite information (which varies by payer and
even treatment type or disease state), faxing or
mailing that information to the payer, and then
calling to follow up every few days.
In concept, the process concludes when the
provider is given an authorization number, but
even that isn’t necessarily final.
That authorization number is a payer requirement
for payment to be made to the provider that
performed the procedure. In other words, a
physician can order the procedure, but if the
authorization is not present or things changed
clinically (which happens often), it is the hospital or
other facility that doesn’t get paid. In essence, the
hospital will have done the procedure for free.
Here’s the process from the provider’s point of view:
Determining when
prior authorization (PA)
is required
As procedures are ordered, providers determine
when, in fact, prior authorization is required for a
particular treatment, procedure or test.
Registration staff members refer to their own
prior authorization processes (developed in-
house, often kept in spreadsheets, binders and/
or sticky notes) to check if prior authorization is
required. But payers define the prior authorization
requirements, which vary by plan and are liable to
change, often without warning.
“The folks that do this in a
hospital have a really tough
job. They keep track of all
the requirements and really
own the process. They have
mounds of paper, sticky notes
and grids with procedure
codes and phone numbers
as their ‘fort’ to defend their
reimbursement.”
– Jonathan Wiik,
Principal Consultant at
TransUnion Healthcare.
4. Determining if a PA request has
already been submitted
Typically, before submitting a PA request, hospital
staff check with the payer (and/or doctor) to
determine whether a prior authorization request
has already been initiated. This occurs through
various methods, such as contacting the physician
responsible for initiating the request, calling a
payer representative or logging into the payer
portal.
Submitting
a PA request
Once a provider determines that prior
authorization is in fact necessary, they begin the
process of looking up the payer’s requirements,
securing the appropriate clinical documentation
(also referred to as “clinical indicators”) and
sending that information to the payer. Again, this
process is typically manual, which means it is
most often completed through legacy technology
such as phone, fax and snail mail.
Obtaining
PA approval
Once all the necessary documentation has been
submitted, providers wait—sometimes days—to
get a meaningful response from the payer. Often,
payers contact providers for more information,
such as additional clinical documentation.
In this case, clinical staff reach out to the
doctor and/or patient to secure the necessary
documentation. In the interest of their patients,
providers often follow up with payers to check on
the status of their prior authorization requests.
This can involve even more paperwork and,
eventually, more waiting.
Managing denials
and appeals
Each payer has a time-consuming and labor-
intensive process for appealing a denial. Typically,
the provider’s first step involves investigating
whether the payer’s rules were followed and that
proper documentation occurred. If this was the
case, the provider reaches out to the payer to
schedule an informal peer-to-peer discussion.
If that discussion fails, the doctor is generally
required to submit a letter that explains why they
feel the treatment is in fact medically necessary.
These letters often include any additional clinical
documentation the doctor deems pertinent to the
appeal.
Payers then often enlist the expertise of an
outside physician to review the case and make
a final determination. If the payer upholds the
denial, patients can then request review by the
insurance board for their state.
1
2
3
4
Up to
9hours
per week
Staff members’ time
spent on hold on the
phone per week waiting
for payer responses.4
5. THE PAYER’S POINT OF VIEW:
AN IMPORTANTWAYTO
CONTROL COSTS
Payers understand that the prior authorization
process can be burdensome for providers.
According to “Pains of prior authorization
create pressure for reform,” from AMA
Wire:
“Prior authorization ‘is a huge pain point
for us and our providers,’ said Liz Hartley-
Sommers, a registered nurse and clinical
data exchange manager at Blue Cross
Blue Shield Louisiana (BCBSLA).
“The issue also affects patients, she said,
‘because those people are having to wait
for prior authorizations to be completed
in order to get treatment.”5
That said, payers, like providers, face a
particularly difficult challenge when it comes to
prior authorization, as they need to both allow
physicians to practice medicine with minimal
disruption and curb health plan costs to keep
premiums at an affordable rate.
To that end, there must be some level of utilization
control. Prior authorizations help ensure that
providers follow evidence-based practices and
keep costs—as well as outcomes—in mind as tests
are ordered.
Once a prior
authorization request
comes in, the payer’s
process begins:
1. First the request is loaded into their system
2. Next, the review team evaluates the request
based on a standardized set of rules
3. Lastly, depending on whether a patient meets
or does not meet the standards of medical
necessity defined by the plan, the request is
either approved or denied
However, decisions are generally far from
straightforward. A payer’s review team is often
required to evaluate unique clinical circumstances
of the provider care team and patient—concerns
that exist outside of the purview of the
standardized rule sets.
Documentation can also be presented in an
incomplete and inconsistent manner, making
streamlined decisions difficult. Therefore, with
the introduction of variability and subjectivity, a
decision can be rather hard to come by.
321
6. ?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
THE PATIENT’S POINT OF VIEW:
CONFUSION, DELAY, WORRY
The patient’s part in this process is simply to
wait. As previously discussed, prior authorization
is usually required for only the most costly
procedures, which also tend to be the most
critical.
Therefore, any delay in the prior authorization
process directly affects the patient experience,
and possibly her or his health. This is never the
intention, but can be an unfortunate outcome
of a saturation of plan utilization rules like prior
authorizations.
“Utilization management programs,
such as prior authorization and step
therapy, can create significant barriers
for patients by delaying the start or
continuation of necessary treatment
and negatively affecting patient health
outcomes,”6
- “Prior Authorization and
Utilization Management Reform Principles.”
American Medical Association
Beyond the wait, patients occasionally have to
contact payers themselves. Although not ideal
and used as a last resort, this usually occurs when
a provider knows that a particular procedure
typically requires PA and knows the answer will be
“no.”
In this situation, the provider advises the patient
to reach out to the payer as an advocate to see
if there is anything the payer can do. (In some
cases, a provider will supply the patient with a pre-
drafted letter to send to the payer.) Effectively,
this places a majority of the prior authorization
burden on the patient’s shoulders.
Additionally, patients must sometimes supply
medical documentation that their provider lacks,
which most often occurs when a patient has
switched providers or has had a procedure done
at an outside facility. For patients, this can involve
calling a previous provider to request medical
documentation, or taking lots of time to search
through various files to find the appropriate
medical necessity evidence.
7. PRIOR AUTHORIZATION’S
FINANCIAL IMPACT ON PAYERS
AND PROVIDERS
Primarily manual by nature, the PA process poses
a serious burden on payers and providers, and,
ultimately, puts patients at risk. But what are its
financial impacts?
According to the 2016 CAQH Index, the provider’s
average cost for prior authorization transactions
in 2015 were:
• $7.50 for per manual transaction
• But only $1.89 per electronic transaction5
As you can see, the manual nature of the PA
process can be quite costly, yet the drive toward
automation has been slow:
The Council forAffordable Healthcare
(CAQH) 2016 survey indicated that over a
third (35%) of authorization tasks remain
manual, using phone, fax or email to
precertify procedures. This is ten times
the rate of eligibility transactions, which
have only manual checks in three percent
(3%) of the cases. Adoption of electronic
prior authorizations has lagged far behind
other transactions.2
Obviously, automation is key, yet its full potential
has yet to be realized.
Next, let’s take a look at the current automation
initiatives underway in the PA process.
Goal:
Standardize transactions to automate a large part of the
prior authorization process
How itworks:
A series of three provider-initiated transactions
→→ 278x217: Request authorization from payers
→→ 278x215: Inquire on the status of an
authorization request
→→ 278x216: Notify payers when a person has been
admitted to a hospital or shares authorization/
referral information between providers and/or
payers
Roadblock:
Lower payer adoption because 1) 278x215 and 278x216
transactions are not HIPAA mandated, so payers are
reluctant to invest in them, and 2) while the 278x217
transaction is HIPAA mandated, without mandated
operating rules, payers implement it inconsistently
Goal: Simplify prior authorization processes by letting
providers input relevant data in order to receive a more
real-time response. Replaces a phone call or fax process
How itworks:
→→ Check if a procedure requires an authorization
→→ Obtain the status and retrieve the authorization
number of a previously submitted authorization
→→ Request an authorization for a procedure if one
is needed and not on file
Roadblock: Providers have to visit different
websites to check authorization for each payer
Figure 2. Current industry approaches to prior authorization
$7.50per manual
transaction
$1.89per electronic
transaction5
vs
ASCX12 278
TRANSACTIONS
AUTHORIZATION
PORTAL
8. THE ACAAND PRIOR
AUTHORIZATION
In an attempt to meet the need for a more
streamlined prior authorization process, the
Patient Protection and Affordable Care Act (ACA)
of 2010 included Section 1104, which introduced
healthcare operating rules to standardize and
automate cumbersome healthcare processes. The
ACA defines “operating rules” as “the necessary
business rules and guidelines for the electronic
exchange of information that are not defined by a
standard or its implementation specifications.”
Basically, operating rules addressed gaps in
standards, helped refine and standardize the
infrastructure that supports electronic data
exchange, and recognized interdependencies
among transactions.
CAQH CORE writes the operating rules, basing
them on a range of standards, for example,
ASCx12. HHS/CMS mandates compliance
with transactions/versions/operating rules
via regulations including compliance dates,
enforcement penalties, and so on.
The most important feature of these operating
rules is that they are vendor agnostic (or
standardized), which simplifies the prior
authorization process for everyone involved.
Regarding providers, the ACA (and particularly
the HIPAA HITECH Act) has arguably increased
the prior authorization burden. Providers are now
made to electronically report certain metrics
regarding health records or be penalized.
Additionally, adoption of the transaction is
painfully slow. For example, only 1% of surveyed
payers provide a 278 response, according to a
survey by Healthcare Administrative Technology
Association (HATA).7
Goal: Gather prior authorization information in less
time than manually searching for the same information,
without the provider having to log into multiple payer
websites
How itworks:
→→ Automated scanning of a payer’s website for
prior authorization information
→→ Commonly used to determine if a prior
authorization request has been initiated and
obtain the authorization number
Roadblock: Difficulty managing credentials and
tracking and maintaining screen scraping robots to
remain in sync with payer website changes
Goal: Help providers automate the prior authorization
process
How itworks:
→→ Identify and prepopulate payer forms with
patient’s demographic information
→→ Provide phone and fax numbers for specific prior
authorization services
→→ Monitor the prior authorization status
→→ Direct staff to a payer’s website, guide them
through the process and take screen captures to
support appeals of denied claims
Roadblock: Helps automate manual work, but it’s
not true automation
SCREEN
SCRAPING
WEB-BASED
WORKFLOW TOOLS
9. RECOMMENDATIONS: STEPS
PROVIDERS CAN TAKE NOW
TO IMPROVE THEIR PRIOR
AUTHORIZATION PROCESS
Unfortunately, the efforts made to streamline the
prior authorization process have been woefully
inadequate. Here’s what providers can do today.
Prior authorization rules library
As you know, prior authorization requirements
vary by payer, plan, procedure and service line.
What’s more, payers tend to continually update
their prior authorization requirements, often
without warning. Therefore, a prior authorization
solution that provides access to an online
centralized database that maintains, monitors and
updates prior authorization requirements across
payers will increase staff productivity.
To understand the savings opportunity, picture
the staff time spent calling payers, then waiting
on hold, only to discover that the procedure in
question doesn’t require prior authorization.
In contrast, a constantly updated prior
authorization library helps staff know which
procedures do not require prior authorization—
which lets staff avoid calling about them and
focus only on the procedures that do require it.
ASCX12 278 transactions
ASCX12 278 transactions would be a great
addition to streamlining the prior authorization
process. Unfortunately, not enough payers have
implemented them. But providers can begin
to realize the benefit of automation for the few
payers that have adopted the 278 transactions.
Exception-based workflows
While you can’t automate 100% of the process,
exception-based workflow tools will help to
manage staff workload and reduce inefficiencies.
Through the use of predefined routing decisions,
these tools can create tasks and work lists for
individual and group user roles for any exceptions
that are encountered with the prior authorization
process.
For example, if a procedure exceeds a certain
dollar threshold, exception-based workflows
would automatically task staff to follow up with
payers to validate requirements; or if a procedure
requires a prior authorization, an exception-based
workflow would create a task for staff to request
one from the payer.
10. For more information, visit
www.transunionhealthcare.com
Call 1-888-217-8928 or email hcsolutions@transunion.com.
1
“Health Care Coalition Calls for Prior Authorization Reform.” American Medical Association. January 25, 2017. Accessed March 22, 2017. https://www.ama-assn.org/health-care-coalition-calls-prior-authorization-reform.
2
“2016 CAQH INDEX.” CAQH. Accessed March 22, 2017. http://www.caqh.org/sites/default/files/explorations/index/report/2016-caqh-index-report.pdf.
3
“2016 Prior Authorization Physician Survey.” American Medical Association. 2016. Accessed March 22, 2017. https://www.ama-assn.org/sites/default/files/media-browser/public/government/advocacy/2016-pa-survey-results.pdf
4
“Fixing Healthcare’s Broken Pre-Authorization Screening & Verification Model.” HIT Consultant. June 27, 2016. Accessed March 22, 2017. http://hitconsultant.net/2016/06/27/revenue-cycle-pre-authorization-process/
5
Park, Troy. “Pains of Prior Authorization Create Pressure for Reform.” AMAWire. February 25, 2017. Accessed March 22, 2017. https://wire.ama-assn.org/practice-management/pains-prior-authorization-create-pressure-reform.
6
“Prior Authorization and Utilization Management Reform Principles.” American Medical Association. Accessed March 22, 2017. https://www.ama-assn.org/sites/default/files/media-browser/principles-with-signatory-page-for-slsc.pdf.
7
Morse, Susan. “Relieving the Pain of Prior Authorization Delays.” Healthcare Administrative Technology Association. February 21, 2017. Accessed March 22, 2017. http://m.healthcareitnews.com/news/relieving-pain-prior-authorization-delays.
TRANSUNION’S PRIOR AUTH LIBRARYSM
TransUnion’s Prior Auth Library screens whether an authorization is required for medical procedures
prior to service. Registration staff no longer needs to track these complicated prior authorization
requirements in multiple spreadsheets, binders or sticky notes.
The solution delivers:
A comprehensive
rules library
—with more than 1.5 million payer-
specific prior authorization rules for
more than 16,000 procedure codes
Continually updated prior
authorization rules
—from all major payers, covering
92% of insured lives in the U.S.
Immediate
response
—as to whether an authorization is
required for a specific procedure,
enabling fast decision-making
Seamless
integration
—into TransUnion ClearIQ Patient Payment
Estimation, simplifying patient access workflow
with exception-based work queues