Transcript 2 - Walla Walla Community College

2
The Use of Health
Information
Technology in
Physician Practices
Learning Outcomes
When you finish this chapter, you will be able to:
2.1
2.2
Describe the functions of practice management programs.
Identify the core functions of an electronic health
record system.
2.3
Discuss the advantages of electronic health records.
2.4
Describe the impact of health information technology on
documentation and coding.
2.5
Discuss how the HIPAA Privacy Rule and Security Rule protect
patient health information.
2.6
Explain how the measures put in place by the HITECH Act
strengthen HIPAA privacy and security requirements.
2-2
Key Terms
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administrative safeguards
audit/edit report
audit trail
autoposting
breach
clearinghouse
CMS-1500 (08/05)
computer-assisted coding
electronic data interchange
(EDI)
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2-3
electronic funds transfer (EFT)
electronic medical records (EMRs)
electronic prescribing
evidence-based medicine
health information technology (HIT)
HIPAA (Health Information
Portability and Accountability Act of
1996)
Key Terms (Continued)
• HIPAA Electronic
Transaction and Codes Sets
standards
• HIPAA Privacy Rule
• HIPAA Security Rule
• HITECH (Health Information
Technology for Electronic
and Clinical Health Act)
• National Provider Identifier
(NPI)
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personal health records (PHRs)
physical safeguards
protected health information (PHI)
technical safeguards
walkout statement
workflow
X12-837 Health Care Claim (837P)
2-4
2.1 Functions of Practice Management2-6
Programs (Continued)
• Most offices use a practice management program
(PMP) to complete routine office tasks, including:
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Patient scheduling
Recording patient information
Creating and transmitting electronic claims
Receiving electronic payments
Billing patients
Creating financial reports
Collecting on overdue accounts
2.1 Functions of Practice Management2-7
Programs (Continued)
• A clearinghouse is a company that collects
electronic insurance claims from medical
practices and forwards the claims to the
appropriate health plans
• An audit/edit report is sent from the
clearinghouse to the practice, after the basic
edit is complete
2.1 Functions of Practice Management2-8
Programs (Continued)
• Reimbursement
– A walkout statement lists the procedures
performed, the charges for the procedures, and
the amount paid by the patient
– Autoposting is an automated process for entering
information on a remittance advice (RA) into a
computer
2.2 Functions of Electronic
Health Record Programs
• Electronic medical records (EMRs) are
computerized records of one physician’s
encounters with a patient over time
• Personal health records (PHRs) are private,
secure electronic files that are created,
maintained, and owned by the patient
• Electronic prescribing is the use of computers and
handheld devices to transmit prescriptions to
pharmacies in digital format
2-9
2.2 Functions of Electronic Health
Record Programs (Continued)
• Electronic health records (EHRs) may include
information from multiple EMRs and have eight
core functions:
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Health information and data elements
Results management
Order management
Decision support
Electronic communication and connectivity
Patient support
Administrative support
Population reporting and management
2-10
2.3 Advantages of Electronic
Health Records
• Advantages of EHRs include:
– Increased patient safety
– Improved quality of care
– Greater efficiency
2-11
2.3 Advantages of Electronic
Health Records (Continued)
2-12
• Evidence-based medicine refers to medical
care that uses the latest and most accurate
clinical research in making decisions about the
care of patients
• The Health Information Technology for
Economic and Clinical Health Act (HITECH) is
intended to promote the use of EHRs in
physician practices and hospitals through the
use of financial incentives
2.4 The Impact of HIT on Documentation2-13
and Coding
• A Workflow is a set of activities designed to
produce a specific outcome
• The process of assigning preliminary diagnosis
and procedure codes with a computer is
known as computer-assisted coding
2.4 The Impact of HIT on Documentation2-14
and Coding (Continued)
• Impact of HIT on Documentation and Coding
– Every service must be documented in order to
receive reimbursement
– Incomplete or incorrect documentation may result
in claim denials or even a federal investigation
– All codes should be reviewed to ensure accuracy