Computers in the Medical Office

1. Computers inthe Medical Office Chapter 2: Information Technology and HIPAA

2. Information Technologyin the Medical Office • Medical practices are using information technology to accomplish many administrative tasks • Three major areas affected by technology are • Electronic medical records • Electronic prescribing • Practice management

3. Electronic Medical Records • An electronic medical records (EMR) contains clinical information about a patient, such as: • Physicians’ notes • Test results • Surgical reports • X-rays

4. Electronic Medical Records • Benefits of EMR systems include: • Immediate access to health information • Everything located in one place • More than one person can access at a time • Access to latest research for clinical decision-making • Automated alerts and reminders

5. Electronic Medical Records • Benefits of EMR systems include: • Secure and fast communication among physicians and staff • Patient education and support • Administrative and reporting tools • Reduction in medical errors

6. Electronic Medical Records • Obstacles to EMR implementation: • Startup costs • Learning curve • Confidentiality and security

7. Electronic Prescribing • The use of computers or hand-held devices to create and transmit prescriptions to pharmacies in a secure manner • Reduces medication errors • Eliminates problem of illegible prescriptions • Provides physician with information about effectiveness, interactions, and standard dosage

8. Practice Management Programs • Used to complete administrative tasks, such as: • Scheduling • Recording patient information • Creating and transmitting claims • Billing patients • Creating financial reports • Collecting on overdue accounts

9. Practice Management Programs • Used to complete administrative tasks, such as: • Scheduling appointments • Recording patient information • Creating and transmitting claims • Billing patients • Creating financial reports • Collecting on overdue accounts

10. Practice Management ProgramsAppointments • Computerized scheduling makes it easy to locate, schedule, and change patient appointments • Electronic insurance claims result in fewer errors, faster payment • Clearinghouses check claims for errors before transmitting to third-party payers

11. Practice Management ProgramsClaims and Billing • Some medical practices use clearinghouses to prepare electronic claims in HIPAA standard format • A clearinghouse receives claims from a physician practice, checks claims for accuracy and completeness, and transmits the claims to insurance carriers in HIPAA format

12. Practice Management ProgramsClaims and Billing • Some medical practices hire billing services to prepare claims • When clearinghouses or billing services are used, HIPAA requires the practice have a contract with the outside service • The service company must meet and follow all HIPAA rules

13. Practice Management ProgramsReimbursement • Patients who make payments at the time of an office visit are given a walkout statement • Payments from insurance plans are entered in the medical billing program

14. Practice Management ProgramsElectronic Medical Records • Some PMPs are able to exchange data with EMRs • Saves time and money, no re-entering of data

15. Advantages of Computer Usein Medical Offices • Information can be accessed by more than one person at a time • Information is easy to find • Less storage space is required • Increased efficiency • Fewer errors

16. HIPAA and ElectronicExchange of Information • Health Insurance Portability and Accountability Act of 1996 (HIPAA) intended to: • Ensure portability of health insurance when employees change jobs • Increase accountability and decrease fraud and abuse in health care

17. HIPAA and ElectronicExchange of Information • Health Insurance Portability and Accountability Act of 1996 (HIPAA) intended to: • Improve the efficiency of health care transactions and mandate standards • Ensure the security and privacy of health information

18. HIPAA Electronic Transactionand Code Sets Standards • Electronic Data Interchange (EDI) is the electronic transmission of data from one computer to another • In the past, many different EDI systems were used, which created the need for many software programs to translate the data from one format to another

19. HIPAA Electronic Transactionand Code Sets Standards • Regulations that specify a standardized format for health care transactions • X12-837P Health Care Claim for professional claims • Regulations that require the use of specific code sets, such as CPT-4 for procedures and ICD for diagnoses.

20. HIPAA Electronic Transactionand Code Sets Standards • National Provider Identifier (NPI) • Unique ten-digit number assigned to each health care provider • Effective May 23, 2007, all but small health care plans must use NPI; small plans have one additional year to comply

21. HIPAA Privacy Rule • Protects individually identifiable health information • Protected Health Information (PHI) • Notice of Privacy Practices

22. HIPAA Security Rule • Storing and transmitting patient health care information on the computer raises significant security concerns • Administrative, technical, and physical safeguards required to prevent unauthorized access to protected health care information