Sandy Bowen and Andi Dunn: “Creating Policies and Procedures that Help You Work”

First in a series of four “Ask the Expert” sessions with policy and procedure writers Sandy Bowen and Andi Dunn. Sandy and Andi are business writers who assist healthcare and other organizations develop written communications for regulatory compliance, process efficiency, business continuity, and continuous improvement. Read full bios.

As anyone who has implemented new HIT knows—whether it is an EMR, patient portal, or PACS–the costs to the practice go far beyond the software, hardware, and upgrades purchased. New HIT can disrupt office workflows and roles, requiring you to redefine relationships among your staff and with your patients.

One way to manage the change and gain the practice efficiencies and health outcomes desired from HIT is to develop and maintain a set of policies and procedures. Policies and procedures guide your staff to make decisions and perform tasks in a standardized way. In addition to the familiar HIPAA privacy and security documentation, your HIT adoption will benefit from policies and procedures for front-office staff, operations and management, EMR training, and even patients.

In this series, we first look at what policies and procedures are and how to decide which ones we need. In installments two and three, we consider how to create and implement policies and procedures that are really useful and effective. In the fourth installment, we discuss a system for updating policies and procedures so they remain useful and can serve as an effective tool for continuous improvement.

Part I: Policies and Procedures in a Medical Setting
Written policies and procedures (P&Ps) provide a structure for an organization to deliver services, comply with regulations, manage the revenue stream, and continue to grow and improve. To comply with HIPPA, for example, medical practices create privacy and security policies and procedures. Billing clerks may also have procedures for verifying the ICD-9 code selection when submitting claims to specific payers. Medical protocols are policies and procedures for care delivery. From patient registration to Meaningful Use reporting, the policies and procedures that you accumulate in your practice should adequately address your needs.

What are Policies and Procedures?
Policies and procedures are an organization’s formal communications about why and how work is performed. However, policies and procedures are not the same. Policies serve as guidelines for decision-making and judgment by setting out the goals, purposes, rules, or authorized resources for operations and care delivery. Procedures describe the standardized methods or best practices for carrying out the policies.

For example, a particular medical practice has a goal of reducing the frequency of its claim rejections by Medicare and other third-party payers. After analyzing why claims are being rejected, the provider determines that a significant number of rejections are due to incorrect selection of ICD-9 codes when claims are submitted to the payers.

The provider decides to create a written policy and set of procedures for ICD-9 coding to help reduce the rate of rejections. Click here to obtain the white paper.