2 The Use of Health Information Technology in Physician Practices

Learning Outcomes When you finish this chapter, you will be able to: 2.1Describe the functions of practice management programs. 2.2Identify the core functions of an electronic health record system. 2.3Discuss the advantages of electronic health records. 2.4Describe the impact of health information technology on documentation and coding. 2.5Discuss how the HIPAA Privacy Rule and Security Rule protect patient health information. 2.6Explain how the measures put in place by the HITECH Act strengthen HIPAA privacy and security requirements. 2-2

Key Terms administrative safeguards audit/edit report audit trail autoposting breach clearinghouse CMS-1500 (08/05) computer-assisted coding electronic data interchange (EDI) 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) 2-4 personal health records (PHRs) physical safeguards protected health information (PHI) technical safeguards walkout statement workflow X Health Care Claim (837P)

2.1 Functions of Practice Management Programs (Continued) 2-6 Most offices use a practice management program (PMP) to complete routine office tasks, including: – 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 Management Programs (Continued) 2-7 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 Management Programs (Continued) 2-8 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 2-9 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

2.2 Functions of Electronic Health Record Programs (Continued) 2-10 Electronic health records (EHRs) may include information from multiple EMRs and have eight core functions: 1.Health information and data elements 2.Results management 3.Order management 4.Decision support 5.Electronic communication and connectivity 6.Patient support 7.Administrative support 8.Population reporting and management

2.3 Advantages of Electronic Health Records 2-11 Advantages of EHRs include: – Increased patient safety – Improved quality of care – Greater efficiency

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 Documentation and Coding 2-13 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 Documentation and Coding (Continued) 2-14 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