Medical Manager Unit 9 ICBS 170

Medical Manager Electronic Data Interchange (EDI)  Ability to request, receive, transfer and integrate information electronically.  ATM machines  Debit purchases  Instant, on-line connectivity to the world outside your office  Uses in a medical office include:

Medical Manager Patient referral Preauthorization Eligibility Credit card approval Check approval Claim status checking Electronic mail Pharmacy and clinical data transmission Immediate medical data

Medical Manager Electronic Media Claim (EMC)  Paperless claims  Submit electronic claims directly to a variety of dissimilar insurance carriers Electronic Remittance Advice (ERA)  Information received from insurance companies about claims that have been adjudicated and paid to post payments and adjustments to patients accounts automatically.

Medical Manager Eligibility  Ability for PCP to receive his or her patient roster electronically instead of on paper is very valuable to the day-to-day operation of a practice  Ability to send and receive messages even faster than a fax machine

Medical Manager Internet  Worldwide network of computers  Provides a method for unsecured communications throughout the world Intranet  Private secure EDI networks that work like the internet  Within a private closed network in which only network participants can view the information

Medical Manager HIPPA  1996 Congress passed legislation called the Health Insurance Portability and Accountability Act (HIPPA).  Intended to : improve portability and continuity of health care delivery Promote use of medical savings accounts Improve access to long term care Simplify administration of health insurance  Four distinct components

Medical Manager Transactions and Code Sets Standardized formats Requires specific transaction standards to be used Code sets are subject to standards  Diagnoses codes  Procedure codes Uniform Identifiers National provider Identifier  Doctors, nurses and other healthcare providers Employer identifier  FEIN (federal employer identification number)  Used to identify employer sponsored health insurance National Health Plan Identifier  Assigned to each insurance plan

Medical Manager Security Protection of an individual’s health information Medical data transmitted over a public network ( ) be encrypted so that it could not be intercepted and read Privacy Designed to protect a patient’s identifiable health information from unauthorized disclosure Office privacy policies  Informs patients of their rights and how their information can be used

Medical Manager Consent Patient gives consent to the use of his or her protected health information by the practice for purposes of treatment, payment and operation of health care practice Signing a consent form or signing an acknowledgment that they have received a copy of the office’s privacy policy Authorization Information to be given to someone other than the office staff and for purposes other than treatment, payment or office operations Authorization form must be signed by patient or an official request is made by an authorized government agency New authorization is signed each time there is a different purpose or the need for the patient’s information to be shared