1. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Chapter 3 An Introduction to Medical Informatics and the Administrative Applications of Computers

2. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Medical Informatics  Clinical applications—direct patient care  Special-purpose applications— education, pharmacy  Administrative—office and materials management, scheduling, accounting and financial applications  Telemedicine—delivery of health care through telecommunications

3. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Administrative Applications: Earliest Applications  Programs designed to computerize administrative functions in a health-care environment  Allow organization of patient data, case data, and provider data  Enable electronic scheduling, electronic progress notes, creation of lists of codes for diagnosis, treatment, and insurance

4. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Administrative Applications Earliest Applications (cont)  Allow bucket billing (billing one insurer after another until the patient is billed)  Organize information in a relational database Each type of information is organized in its own table Tables can be linked

5. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Database  An organized collection of data created and maintained by a system called database management system (DBMS)

6. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Database (cont)  A file contains related information on an entity  A file can have many tables, each containing related information  Tables can be linked by a common field  Tables are made up of records

7. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Database (cont)  A record contains information on one item in the table Records are made up of fields  A field is a piece of information in a record A key field uniquely identifies a record

8. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Coding and Grouping Systems  CPT holds procedure codes  ICD holds disease codes  MEDCIN codes symptoms, history, exams, tests, diagnosis, and treatment  SNOMED provides a common language  LOINC standardizes laboratory and clinical codes  NDC codes drugs

9. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. CMS-1500  CMS-1500 is the most commonly used claim form

10. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Accounting  Transactions: charges, payments, and adjustments  Case: condition that brings a patient to the doctor’s office

11. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Insurance  Types of medical insurance Indemnity (fee-for-service) plans Health maintenance organizations Preferred provider organizations Government insurance: Medicare, Medicaid, CHAMPVA, TRICARE, CHAMPUS, Workers’ Compensation Government insurance is administered by the Centers for Medicare and Medicaid Services www.cms.hhs.gov/forms www.cms.hhs.gov/forms

12. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Claim  Request for payment from an insurer  Can be submitted: Electronically through a clearinghouse On paper

13. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Response to Claims  An ERA (electronic remittance advice) accompanies a response to an electronic claim  An EOB (explanation of benefits) is a response to a paper claim

14. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Balance or Bucket Billing  Balance billing is unique to the health care environment A claim is filed with the primary insurer  Response and check are received A claim is filed with the secondary insurer  Response and check are received Only after claims have been filed with all insurers, and responses received, is the patient billed

15. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Accounts Receivable  Accounts receivable—any invoices or payments

16. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Superbill (Encounter Form)  List of diagnoses and procedures common to a practice

17. Information Technology for the Health Professions, Third Edition Lillian Burke and Barbara Weill Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Reports  Procedure day sheet  Payment day sheet  Patient day sheet  Practice analysis report  Patient aging report