ROLE OF HRM & TPM

7/31/2019 ROLE OF HRM & TPM

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ROLE OF HUMANRESOURCES INHOSPITAL


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INTRODUCTION

A hospital is a microcosmic community thatoperates like a small city, presenting the sameissues with a stronger dynamic due to the humaninteraction factor.

With functions that cover everything from

performance management to safety, HumanResources Management plays a vital role in thehealth care workplace in ensuring the delivery ofhealth care services and facilitating optimalpatient outcomes.

In any health care setting, the Human Resourcedepartment fills a variety of personnel needs thatboth employers and employees encounter.

The role of this department is to manage allaspects of operations that are personnel related.


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FUNCTIONS

Examples of Specific Human Resources Management

Functions Include:

- Hiring

- Physician and Nurse Recruitment

- Employee Orientation

- Personnel Management- Benefits & Compensation Management

- Counseling

- Claims Handling

- Training and Performance Monitoring

- Professional Development Programs- State and Federal Regulations Education

- Work place Safety and Sanitation

- Labor Mediation

- Administration Employee Meetings

- Staff Morale & Retention


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Personnel Management

The personnel department hires andfires employees and locates

temporary workers when needed.

Management handles all the financialand time related aspects of an

employees work life.

Human resource management makesdecisions about the personal health,

progress and welfare of workers.


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Training & Performance

Monitoring

A primary task performed by human resources isquality control.

Employees can be trained to perform at optimal

levels by utilizing their primary skills.

Human Resources specialists develop tests tomonitor skill levels that can be administered

during the hiring process or later in the term of

employment.

Additionally, Human Resources Managers workclosely with both clinical and non-clinical

department managers in order to develop

relevant professional development programs and

provide useful continuing education opportunitiesfor em lo ees.


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Meetings between Staff,

Employees & Administration Human Resource Management maintains the lines

of communication at all levels to better manage

business personnel.

Regular meetings are an efficient way to discuss

issues and needs. Personal interaction opens dialogue for

suggestions and grievances between

administration, staff and employees.

Meetings build trust and confidence in a companyand assure that quality control is in place

effectively.

Communication is a core tenet in group dynamic

principles.


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Human Resource Management

is Vital in Health Care Effective human resources

management plays a crucial role in the

success of health care systems.

Proper management of humanresources is vital in the recruitment and

retention of clinical and non-clinical

staff, maintaining staff morale,providing opportunities for professional

development, and in the ability of a

health care organization to deliver

quality health care services and


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ROLE OF THIRD-PARTYADMINISTRATOR (TPA)IN HOSPITAL


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INTRODUCTION

TPA is Third Party Administrator which connects theinsurer & the insured.

Their basic role is to function as an intermediary

between the insurer and the insured. The core

services of a TPA is to ensure better services topolicyholders.

TPAs concept were introduced by the IRDA

(Insurance Regulatory and Development Authority )in

the year 2001.

The concept of TPA was been introduced by IRDA for

the benefit of both the insured and the insurer. While

the insured is benefited by quicker & better service,

insurers are benefited by reduction in their

administrative costs, fraudulent claims and


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DEFINITION

A Third Party Administrator (TPA) isan organization that processes

insurance claims or certain aspects of

employee benefit plans for a separateentity. This can be viewed as

outsourcing the administration of the

claims processing.


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ROLE IN HEALTH CARE

Third party administrators are prominentplayers in the managed care industryand have the expertise and capability toadminister all or a portion of the claims

process. They are normally contracted by a health

insurer or self-insuring companies to

administer services, including claimsadministration, premium collection, noenrollment and other administrativeactivities.


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Contd..

A hospital or provider organizationdesiring to set up its own health plan

will often outsource certain

responsibilities to a TPA. For example, an employer may

choose to help finance the healthcare

costs of its employees by contractingwith a TPA to administer many

aspects of a self-funded health care

plan


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SERVICESThe services provided by TPA are as follows:

ID Card: TPA provides ID cards to all theirpolicyholders in order to validate their identity atthe time of admission.

The TPAs undertakes Pre-authorizationbefore a surgical procedure to ease claimprocessing.

Cashless Hospitalization: Each policyholderis provided with a list of empanelled hospitals

where in he/she can avail cashlesshospitalization.

Claim Management: On behalf of theinsurance companies TPA administers and

settles claims for hospitals and policyholders.


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FUNCTIONS

The specialized functions of the TPA include: The TPA keeps and maintains all the records of

medical insurance policies of an insurer.

The TPA issues identity cards to all thepolicyholders. The policy holders will have toshow the identity cards to the hospital authoritiesbefore availing any services from the hospital.

In case of a claim, policyholders will have toinform the TPA on a 24 hr toll- free line providedby them.

After informing the TPA, the policyholder will bedirected to a hospital where the TPA has a tiedup arrangement. However, policyholders havethe option to be admitted at another hospital oftheir choice in which case, payment will be on

reimbursement basis.


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FUNCTIONS contd..

TPA pays for the treatment; they issue anauthorization letter to the hospital for theadmission of the policyholder in thehospital.

At the point of discharge, all the bills willbe sent to the TPA while they are trackingthe case of the insured at the hospital.

TPA makes the payment to the hospital.

TPA sends all the documents necessaryfor consideration of claims, along with thebills to the insurance company.

The insurance company then reimbursesthe TPA.


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CONCLUSION

Third party administrators areprominent players in the managed

care industry and have the expertise

and capability to administer all or aportion of the claims process.

ROLE OF HRM & TPM

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