Final answer:
Two essential elements of a clinical review process are the verification of patient information and adherence to ACA regulations, like minimizing administrative costs and transitioning to EMRs. Careful management of health records and coordination by clinical trial coordinators are crucial to this process.
Step-by-step explanation:
When creating a clinical review process for patient paperwork to ensure compliance with insurance regulations and to reduce claim denials, two crucial elements must be included within the review process. The first element is the thorough verification of patient information, which includes confirming the team members involved by name and role, confirming the patient's identity, surgical site, and procedure, and reviewing anticipated critical events. These critical events involve the surgeon discussing steps, operative duration, and blood loss, anesthesia staff reviewing patient-specific concerns, and nursing staff confirming sterility, equipment availability, and other issues. The second element centers around the adherence to regulations introduced by the Affordable Care Act (ACA), which demands that healthcare providers minimize administrative costs and transition to electronic medical records (EMRs) to further reduce administrative expenses and streamline the review process.
Correct management of health records is critical to this process as it addresses concerns around balancing treatment costs, patient quality of life, and privacy risks. Clinical review must involve the coordination of patient schedules, maintaining detailed notes, tracking patients for follow-up studies, and ensuring proper documentation to support trials and results publication as guided by a clinical trial coordinator. Moreover, the clinical review process should accommodate the diverse payment structures such as fee-for-service systems and health maintenance organizations (HMOs) while considering potential adverse selection in insurance markets.