1. Management and Decision Support Systems12
Management and Decision Support Systems

2. Pretest (True/False)
Integrated systems require HL7 to exchange information with other healthcare systems.
The ADT system registers patients before they are treated or scheduled for treatment.
In a general ledger that uses a double-entry bookkeeping system, expenses are amounts that are owed, but not yet paid.

3. Pretest (True/False) (continued)
Accounts payable systems control the outflow of money from a healthcare facility for all expenses except payroll.
Rent, insurance, and utilities are all examples of direct costs a department must pay.

4. Interfaced or Integrated?
Interfaced systems
Consist of separate software and databases linked into computer network
Exchange information with other healthcare systems using HL7 or proprietary transaction standard
Software may be from same or different vendor

5. Interfaced or Integrated? (continued)
Integrated systems
Share common database
Data records read and updated without need for HL7
Same vendor also supplies software programs such as registration and billing to work together seamlessly

6. Administrative Systems
Include financial, human resource, scheduling, and quality management systems
Include hospital registration system (ADT system) and billing system (A/R system)
Two systems on either end of patient care
Provide secondary data that may be used for various purposes

7. Eight Financial Systems
Financial information systems
Track income, expenses, assets, liabilities
General ledger
Overall accounting system used to produce financial statements and monitor organization’s overall financial health
Accounts receivable
Money owed to the business

8. Eight Financial Systems (continued)
Purchasing
Used to order supplies and services
Accounts payable
Manages payments for facility purchases, recurring expenses (rent, utilities) and nonrecurring expenses (maintenance, repairs)

9. Eight Financial Systems (continued)
Inventory and materials management
Works with purchasing, deducting from quantity on hand supplies used and adding to quantity on hand supplies received
Payroll
Administration of employee payroll information and payment of wages, employer taxes, benefits

10. Eight Financial Systems (continued)
Budgeting
Used to predict annual expected income and expenses
Cost accounting
Used to attribute direct and indirect costs to various departments

11. HR Management System Functions
Employee evaluations
Training
Education and continuing education
Employee health

12. Patient Scheduling Systems
Outpatient Scheduling
Allows for examination and treatment of patients
Predicts labor and resource needs
Involves making appointments for length of time appropriate to reason for appointment
Relies on schedule templates

13. Figure 12-5 Appointment schedule screen
Figure Appointment schedule screen. (© 2009 Sage Software Healthcare, Inc. All rights reserved.)

14. Patient Scheduling Systems (continued)
Inpatient scheduling
Includes processing doctors’ orders for tests or services, coordinating with respective department, arranging for assistant to transport patient within hospital
Requires schedule coordinator who handles several different departments

15. Staff Scheduling Systems
Employee scheduling systems used to determine which employees are working when
Human resources tracks and manages vacation schedules, employee sick days, holidays

16. Staff Scheduling Systems (continued)
Provider scheduling includes blocking doctors’ appointment schedule when doctors are not in the office and arranging for another doctor to “cover” patients; maintains on-call schedule
Surgery scheduling includes preop, surgery, and postop, plus cleaning of operating room

17. Facility and Equipment Maintenance Systems
Many administrative systems maintain facilities and equipment, including:
Systems to track requests for repairs and upgrades to building, rooms, departments
Systems to control heat, air, energy usage
Systems for fire control, security, employee tracking, and timekeeping

18. Facility and Equipment Maintenance Systems (continued)
Repair orders for systems that require outside service are tracked and reported to purchasing and accounts payable

19. Facility and Equipment Maintenance Systems (continued)
Biomedical, surgical, radiological, laboratory, and other medical equipment must be serviced and tested regularly
Joint Commission, CAP, other regulatory agencies require facilities to keep testing maintenance records

20. Quality Management (QM)
Covers many areas related to hospital operation and patient care provided to patients
Produces data and reports used for risk analysis and decision support that allow facilities to evaluate appropriateness and effectiveness of medical care

21. Quality Management (QM) (continued)
Tracks and maintains data entered by QM department
Uses and analyzes data abstracted from patient health records and other departmental systems

22. QM Data Includes Case management and utilization management
Tracks certification, authorization, concurrent review of the case, avoidable days, denials, appeals
Infection control
Tracks and reports communicable diseases, hospital-acquired infections, diagnoses that must be reported to CDC

23. QM Data Includes (continued)
Incident tracking
Tracks both patient and nonpatient incidents
Patient relations
handles patient complaints to improve care and patient satisfaction, reduce risk

24. Figure 12-8 MIDAS risk management screen records a patient fall
Figure MIDAS risk management screen records a patient fall. (Courtesy of MidasPlus, Inc.)

25. QM Data Includes (continued)
Risk management
Minimizes loss by reducing risk through preventive policies and measures
Peer review
Involves patient, employee, or audit that calls attention to issue relevant to patient care; other providers review to determine appropriateness, make recommendations

26. QM Data Includes (continued)
Comparative performance measure systems
Compares performance measures to those of other similar facilities
May use NHQM and CMI information available from Medicare, or download data from vendors

27. Risk Assessment Versus Risk Management
Risk assessment involves analyzing processes and measuring statistical data to identify preventable losses and minimizing their occurrences
Example: assessing computer security to minimize security risks to EPHI data

28. Risk Assessment Versus Risk Management (continued)
Risk management provides organizations with information needed to improve performance and processes and provide safer environment for employees, patients, volunteers, visitors
Basic functions: risk identification, risk analysis, loss prevention/reduction, claims management

29. CMS RAC Program
Identifies improper payments made on healthcare claims provided for Medicare beneficiaries and obtaining repayment to Medicare

30. CMS RAC Program (continued)
Affects healthcare providers including hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers, and any provider/supplier that bills Medicare Parts A and B
Reviews handled by private companies with financial incentives to identify and recoup overpayments

31. RAC Risk Management Strategy
Establish committee to handle RAC issues
Create procedure to track RAC requests and ensure they’re handled within permitted timelines
Conduct internal assessment to ensure submitted claims meet Medicare rules

32. RAC Risk Management Strategy (continued)
Prepare and provision HIM department to comply with RAC requests
Create policies and procedures for deciding which RAC denials to appeal

33. Role of HIM Department
Ensure claims are as accurate as possible when first submitted
Ensure requests from recovery audit contractor are handled efficiently, effectively, and according to existing procedures and policies