1. Discuss the relationship between patient accounts, data flow and charge capture.
a. Patient accounts are unique to each patient who is serviced by the facility. The account holds information such as the patient demographics, any insurance information, and patient’s medical records. Data flow is to make necessary information is accessible to necessary employees to complete treatment. Charge capture is how information is accumulated and put into a patient account. All three of these processes are valuable to patient care. Separately, these three components have processes within themselves, however, they come together to create a complete process that begins when the patient signs into the facility until the accounts receivable has been resolved.
Case 1 -- You work in a busy multi-specialty clinic with a high patient volume. The physicians enter the type of code that will yield the greatest reimbursement. You suspect the codes are not accurate.
Analyzing Workflow for a Health IT Implementation by Lydia Washington, is a short shifted scenario published January 1, 2008 The inability to integrate electronic health records (EHRs) into clinician workflow is a well-documented barrier to implementing EHR systems. To address this problem, organizations must analyze their workflow processes before implementing an EHR system. Optimal workflow requires having the right information at the right time so that the individual performing a step or task can advance the process toward completion. To achieve optimal workflow, organizations must take a step back and analyze the flow of work.
Health Care workers are constantly faced with legal and ethical issues every day during the course of their work. It is important that the health care workers have a clear understanding of these legal and ethical issues that they will face (1). In the case study analysed key legal and ethical issues arise during the initial decision-making of the incident, when the second ambulance crew arrived, throughout the treatment and during the transfer of patient to the hospital. The ethical issues in this case can be described as what the paramedic believes is the right thing to do for the patient and the legal issues control what the law describes that the paramedic should do in this situation (2, 3). It is therefore important that paramedics also
The cost of Medical equipment plays a significant role in the delivery of health care. The clinical engineering at Victoria Hospital is an important branch of the hospital team management that are working to strategies ways to improve quality of service and lower cost repairs of equipments. The team members from Biomedical and maintenance engineering’s roles are to ensure utilization of quality equipments such as endoscope and minimize length of repair time. All these issues are a major influence in the hospital’s project cost. For example, Victory hospital, which is located in Canada, is in the process of evaluating different options to decrease cost of its endoscope repair. This equipment is use in the endoscopy department for gastroenterological and surgical procedures. In 1993, 2,500 cases where approximately performed and extensive maintenance of the equipment where needed before and after each of those cases. Despite the appropriate care of the scope, repair requirement where still needed. The total cost of repair that year was $60,000 and the repair services where done by an original equipment manufacturers in Ontario.
– Health care providers who transmit health information in electronic form for certain standard transactions.
The federal government has taken a stance to standardized care by creating incentive programs that are mandated under the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009. This act encourages healthcare providers and healthcare institutions to adopt Meaningful use in order to receive incentives from Medicare and Medicaid. Meaningful use is the adoption of a certified health record system that acquires or obtains specified objectives about a patient. The objectives or measures are considered gold standard practices with the EHR system. Examples of the measures include data entry of vital signs, demographics, allergies, entering medical orders, providing patients with electronic copies of their records, and many more pertinent information regarding the patient (Friedman et al, 2013, p.1560).
The biller normally gathers all data concerning the bill including claims transmission, payment posting, charge entry, insurance follow-up and patient follow-up.
In the medical billing and coding process there are several steps. In the medical billing process physicians prepare and sign documentation of the patients visit. The next step is to post the medical codes and transactions of the patients visit in the practice management program and to prepare claims. The process used to generate claims must comply with the rules imposed by federal and state laws as well as with payer requirements. Claims that are correct help to reduce the chance of an investigation of the practice for fraud and also the risk of liability if an investigation does occur (Valerius, Bayes, Newby & Seggern, 2008). Most physicians depend on their personnel to process their medical bills without looking at the bills before they’re submitted for payment. Some physicians who don’t review the medical billing procedures may not receive the payment they deserve (Adams, Norman, & Burroughs, 2002).
The revenue cycle is a flowchart that explains where a patient goes after registration. Registration in charge of registering the patient, and making sure the patients have signed their in-patient consent forms. After all the information is recorded into EPIC, you will then move on to scanning. In scanning, the employee is responsible for scanning in the history and physical document, the informed consent form, monitoring strips, and EKG’s. After all the documents are scanned into OnBase, you will then move onto indexing. In indexing, the employee indexes all the documents that were scanned into the patient’s chart. Once all the documents are indexed into patients charts in EPIC, the coders will code the patients’ charts. Coding will check
“An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users.” (healthit.gov) The EHR mandate was created “to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.” ("Providers & Professionals | HealthIT.gov", n.d., p. 1) The process has proved to be quite challenging for providers. As an incentive, the government began issuing payments to those providers who “meaningfully use certified electronic health record (EHR) technology.” (hhs.gov) There are three stages that providers must progress through in order to receive theses financial incentives. Stage one is the initial stage and is met with the creation and implementation of the HER in the business. Stage two “increases health information exchange between providers.” ("United States Department of Health and Human Services | HHS.gov", n.d., p. 1) Stage three will be the continuation and expansion of the “meaningful use objectives.” ("United States Department of Health and Human Services | HHS.gov", n.d., p. 1) The hospital, where I work, initiated the HER mandate many years ago. In this paper, I will discuss the progression and the challenges that my hospital encountered while implementing the EHR mandate.
There are several factors that contribute to the complexity of the revenue cycle. Frequent changes in contracts with payers, legislative mandates, and managed care are just a few examples of reasons why revenue cycle in the healthcare industry is so complex. Furthermore, the problems that arise in the steps of the revenue cycle further complicate the whole process. For example, going through the steps of the revenue cycle efficiently is extremely difficult when it is managed by poorly trained personnel. Furthermore, if a healthcare provider does not have the proper information system to track patient records and billing, receiving reimbursement can become difficult. In addition, one of the main factors that delay payments is denial from the insurance companies. The reason for Denial includes incorrect coding, the certain sequence of care and medical necessity or even delay in submitting claims. Lastly, inefficient patient correspondence can not only hinder the process of revenue cycle but also result in many patient complaints (Wolper, 2004).
reimbursement determinations. As a result, the camaraderie among physicians has developed into a more aggressive approach to impede competition (Shi & Singh, 2012). Little information is shared with patients in regards to procedures or disease control. The subjects are forced to rely on the internet for enlightenment on the scope of their illnesses (Shi & Singh, 2012). Furthermore, the U.S. health care system fails to provide adequate knowledge on billing strategies for operations and other medical practices. The cost in a free system is based on supply and demand and is known in advance of hospital admission (Shi & Singh, 2012). The need for new technology is another characteristic that is of interest when considering the health care system. Technology is often v...
I had the opportunity to meet with Dee Laguerra for a few hours and learned so much about the Medical records side of our facility and its impact on healthcare organization. As Director of Health Information Management (HIM) she is responsible for many aspects of managing the medical record; which is a legal document. I did not realize how complex this department is and how vital this department is to the legal and financial position of the organization. Dee’s position as director is the responsibility for the collection, organizing, scanning, and completions of the medical records in a timely matter after the patient is discharged. The reason for the timeliness of scanning the medical records is for the preparation for the coders to review all the charts to code for insurance billing. The time requirement for th...
Health information management involves the practice of maintaining and taking care of health records in hospitals, health insurance companies and other health institutions, by the use of electronic means (McWay 176). Storage of medical information is carried out by health information management and HIT professionals using information systems that suit the needs of these institutions. This paper answers four major questions concerning health information systems.
When reviewing the collection of data on patients it is important to first off have respect for all the sensitivity of the information you are reviewing and keeping this information private, you have access to full medical history by holding the responsibility as patient personnel. The importance of billing and collections is to review and confirm the data and documentation matches the claim and what was billed, personnel can also identify missing components or billing opportunities that were missed for additional reimbursement. Customer service is imperative because you need to interact with customers in regards to accounts, information verification, or balances owed. Exceptional customer service ensures that you value the customer and are willing to work with them and help,