© 2009 by The McGraw-Hill Companies, Inc. All rights reserved. McGraw-Hill Career Education Computers in the Medical Office Chapter 2: Information Technology and HIPAA

2-2 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Information Technology in the Medical Office  Medical practices are using information technology to accomplish many administrative tasks  Three major areas affected by technology are  Electronic medical records  Electronic prescribing  Practice management

2-3 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Electronic Medical Records  An electronic medical records (EMR) contains clinical information about a patient, such as:  Physicians’ notes  Test results  Surgical reports  X-rays

2-4 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Electronic Medical Records  Benefits of EMR systems include:  Immediate access to health information  Everything located in one place  More than one person can access at a time  Access to latest research for clinical decision-making  Automated alerts and reminders

2-5 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Electronic Medical Records  Benefits of EMR systems include:  Secure and fast communication among physicians and staff  Patient education and support  Administrative and reporting tools  Reduction in medical errors

2-6 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Electronic Medical Records  Obstacles to EMR implementation:  Startup costs  Learning curve  Confidentiality and security

2-7 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Electronic Prescribing  The use of computers or hand-held devices to create and transmit prescriptions to pharmacies in a secure manner  Reduces medication errors  Eliminates problem of illegible prescriptions  Provides physician with information about effectiveness, interactions, and standard dosage

2-8 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Practice Management Programs  Used to complete administrative tasks, such as:  Scheduling  Recording patient information  Creating and transmitting claims  Billing patients  Creating financial reports  Collecting on overdue accounts

2-9 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Practice Management Programs  Used to complete administrative tasks, such as:  Scheduling appointments  Recording patient information  Creating and transmitting claims  Billing patients  Creating financial reports  Collecting on overdue accounts

2-10 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Practice Management Programs Appointments  Computerized scheduling makes it easy to locate, schedule, and change patient appointments  Electronic insurance claims result in fewer errors, faster payment  Clearinghouses check claims for errors before transmitting to third-party payers

2-11 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Practice Management Programs Claims and Billing  Some medical practices use clearinghouses to prepare electronic claims in HIPAA standard format  A clearinghouse receives claims from a physician practice, checks claims for accuracy and completeness, and transmits the claims to insurance carriers in HIPAA format

2-12 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Practice Management Programs Claims and Billing  Some medical practices hire billing services to prepare claims  When clearinghouses or billing services are used, HIPAA requires the practice have a contract with the outside service  The service company must meet and follow all HIPAA rules

2-13 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Practice Management Programs Reimbursement  Patients who make payments at the time of an office visit are given a walkout statement  Payments from insurance plans are entered in the medical billing program

2-14 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Practice Management Programs Electronic Medical Records  Some PMPs are able to exchange data with EMRs  Saves time and money, no re-entering of data

2-15 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. Advantages of Computer Use in Medical Offices  Information can be accessed by more than one person at a time  Information is easy to find  Less storage space is required  Increased efficiency  Fewer errors

2-16 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. HIPAA and Electronic Exchange of Information  Health Insurance Portability and Accountability Act of 1996 (HIPAA) intended to:  Ensure portability of health insurance when employees change jobs  Increase accountability and decrease fraud and abuse in health care

2-17 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. HIPAA and Electronic Exchange of Information  Health Insurance Portability and Accountability Act of 1996 (HIPAA) intended to:  Improve the efficiency of health care transactions and mandate standards  Ensure the security and privacy of health information

2-18 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. HIPAA Electronic Transaction and Code Sets Standards  Electronic Data Interchange (EDI) is the electronic transmission of data from one computer to another  In the past, many different EDI systems were used, which created the need for many software programs to translate the data from one format to another

2-19 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. HIPAA Electronic Transaction and Code Sets Standards  Regulations that specify a standardized format for health care transactions  X12-837P Health Care Claim for professional claims  Regulations that require the use of specific code sets, such as CPT-4 for procedures and ICD for diagnoses.

2-20 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. HIPAA Electronic Transaction and Code Sets Standards  National Provider Identifier (NPI)  Unique ten-digit number assigned to each health care provider  Effective May 23, 2007, all but small health care plans must use NPI; small plans have one additional year to comply

2-21 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. HIPAA Privacy Rule  Protects individually identifiable health information  Protected Health Information (PHI)  Notice of Privacy Practices

2-22 McGraw-Hill Career Education © 2009 by The McGraw-Hill Companies, Inc. All rights reserved. HIPAA Security Rule  Storing and transmitting patient health care information on the computer raises significant security concerns  Administrative, technical, and physical safeguards required to prevent unauthorized access to protected health care information