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© 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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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