INFORMATION TECHNOLOGY for the Health Professions CHAPTER Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Fourth Edition An Introduction to the Administrative Applications of Computers: Practice Management, Scheduling, and Accounting 3

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Medical Informatics Clinical applications  Direct patient care Special-purpose applications  Education, pharmacy Administrative  Office and materials management, scheduling, accounting, and financial applications

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Medical Informatics Telemedicine  Delivery of health care through telecommunications

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Administrative Applications: Practice Management Software Practice Management Software:  Designed to computerize administrative functions in a health care environment  Allows organization of patient data, case data, and provider data  Enables electronic scheduling, electronic progress notes, creation of lists of codes for diagnosis, treatment, and insurance

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Administrative Applications of Computer Technology in the Medical Office Administrative applications include:  Office management tasks  Scheduling  Accounting Administrative tasks in a medical office include:  Coding and billing  Insurance  Payment

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Practice Management Software Allows bucket billing (billing one insurer after another until the patient is billed) Organization of information in relational databases  Each type of information is organized in its own table and can be accessed easily  Tables can be linked

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Figure 3.1 MediSoft electronic appointment book. Source: Courtesy of MediSoft.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Figure 3.2 MediSoft new appointment entry screen. Source: Courtesy of MediSoft.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Figure 3.3 Patient transaction entry (MediSoft 14). Source: Courtesy of MediSoft.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Bucket Billing or Balance Billing Balance billing is unique to the health care environment  A claim is filed with the primary insurer Response and check are received  A claim is filed with secondary insurer Response and check are received  Only after claims have been filed with all insurers, and responses received, is the patient billed

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Database An organized collection of data created and maintained using database management software (DBMS)

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Database A file contains related information on an entity. A file can have many tables, each containing related information. Tables can be linked by a common field. Tables are made up of records.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Database A record contains information on one item in the table.  Records are made up of fields. A field is a piece of information in a record.  A key field uniquely identifies a record.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Coding and Grouping Systems CPT: procedure codes ICD: disease codes MEDCIN: codes for symptoms, history, exams, tests, diagnosis, and treatment SNOMED: provides a common language LOINC: laboratory and clinical codes NDC: drug

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill CMS-1500 CMS-1500 is the most commonly used claim form.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Figure 3.4 CMS-1500 Form.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Accounting Transactions: charges, payments, and adjustments Case: condition that brings a patient to the doctor's office

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Scheduling Making appointments in today's medical office involves using an electronic appointment book resembling the one on the next slide.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Figure 3.1 MediSoft electronic appointment book. Source: Courtesy of MediSoft.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Insurance Types of medical insurance  Indemnity (fee-for-service) plans  Health maintenance organizations  Preferred provider organizations

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Insurance Types of medical insurance  Government insurance Medicare, Medicaid, CHAMPVA, TRICARE, CHAMPUS, Workers' Compensation  Government insurance is administered by the Centers for Medicare and Medicaid Services

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Claim Request for payment from an insurer Can be submitted:  Electronically through a clearinghouse  On paper

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Figure 3.5 UB-04 Form. Source: Independence Blue Cross/Blue Shield.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Figure 3.5 (continued) UB-04 Form. Source: Independence Blue Cross/Blue Shield.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Figure 3.5 (continued) UB-04 Form. Source: Independence Blue Cross/Blue Shield.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Figure 3.5 (continued) UB-04 Form. Source: Independence Blue Cross/Blue Shield.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Response to Claims An ERA (electronic remittance advice) accompanies a response to an electronic claim. An EOB (explanation of benefits) explains why certain services were covered and others not.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Bucket Billing Bucket billing allows the medical office to accommodate two or three insurers, who must be billed in a timely fashion before the patient is billed. Relational databases allow information input in one part of the program to be linked to information in another part of the program.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Bucket Billing Reports can be generated with the information provided in the relational database.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Accounts Receivable Accounts receivable—any invoices or payments from the patient or the insurance carriers to the practice

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Superbill (Encounter Form) List of diagnoses and procedures common to a practice

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Figure 3.6 The Superbill or Encounter Form lists procedures and tests common to the practice.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Patient Protection and Affordable Care Act (2010) On March 23, 2010, the Patient Protection and Affordable Care Act was signed into law by President Obama. The law expands health insurance coverage to 32 million more people by requiring them to buy health insurance.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Patient Protection and Affordable Care Act (2010) It also expands Medicaid coverage, and reforms current insurance practices. U.S. citizens and legal residents would be required to buy “minimal essential coverage.”

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Patient Protection and Affordable Care Act (2010) Out of the estimated 25 million people who would be required to buy insurance, about 19 million could be eligible for subsidies.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Patient Protection and Affordable Care Act (2010) Anyone with an income below 4 times the federal poverty level ($22,000 for a family of 4, $10,800 for an individual; 4 times the federal poverty level: $88,000 for a family of 4, $44,000 for an individual) would be eligible for some sort of subsidy.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Patient Protection and Affordable Care Act (2010) Anyone with an income below 3–4x the poverty level would not have to pay more than 10% of their income for health insurance.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Patient Protection and Affordable Care Act (2010) The bill closes the donut hole in drug coverage for those over 65, with a $250 rebate in In 2011, people in the “hole” could purchase brand name drugs at a 50% discount. By 2014, states must expand Medicaid to cover childless adults.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Patient Protection and Affordable Care Act (2010) The bill reforms some of the practices of the private insurance industry:  Children cannot be denied coverage because of preexisting conditions.  No one can be denied coverage for preexisting conditions starting in  Children can stay on their parents' insurance plans until age 26.

Information Technology for the Health Professions, Fourth Edition Lillian Burke Barbara Weill Reports Procedure day sheet Payment day sheet Patient day sheet Practice analysis report Patient aging report