Chapter 11: Southtown Medical Center

I.

Problem Statement
Southtown Medical Center Management CFO David Cash identified
Administrative Error as the root cause of the numerous billing reworks and
resubmitting charges to the insurance company. This led in wasting of time for
duplicating works and decreasing the quality of services.

II.
A.
B.
C.
D.
III.

Areas of Consideration
Human Resource
Process and Procedure
Service Planning and Control
System
Alternative Course of Action
A. Human Resource
1)
2)
3)
4)

Evaluate work performance

Hire/Assign the right person for the job
Proper identification of job description
Orientation, Training and Seminars

B. Process and Procedure

1) Redefine billing process
C. Service Planning and Control
1)
D. System
1) Quality check and control for encoding
2) Make the administration aware of the correction on sloppy documents.
IV.

Recommendation
Southtown Medical Center Management is highly recommended to have a
proper and clear delegation of duties and responsibilities. They should also

implement orientation, trainings and seminars for the employees specifically

the nurses. They are also to hire a coding specialist to identify errors in the
system and find solutions especially in the reimbursement through correct
application of coding rules. These recommendations will help in reducing
billing errors.
V.

Action Plan

Activity
Orientation on
Coding Rules

Persons Involved
Workers/ Nurses

Upgrade Computer
Codes
Redefine billing
process

Computer
Technician/Analyst
Management

Time Frame
1 week on every
update of the
system
1 day

Outcome
Correct coding
process

1 day

Quality service

Quality checks

Fishbone Diagram

Human Resource

Service
Planning/Control

Insufficient
training and
knowledge of
nurses
Delegation of work

Breakdown in the system

Lack of quality checks in the

computer system process

Incorrect input of codes

Hiring of coding
specialist

Duplicate billing

Up-coding

Down-coding

Process/Procedure

Sloppy Documentation

System

Erroneous
Bills