Data Management Flashcards
Practice priorities - what is important
Quality Pt satisfaction Accuracy Provider satisfaction Workflow efficiencies Office flow Staff Follow up \$\$$ Reporting capabilities Compliance
Practice management systems (PMS) =
A category of software that deals with the day to day operations of a clinical practice
Electronic medical record =
A digital version of the traditional paper based medical record for an individual
The EMR represents a medical record within a single facility
Integration of EHR and PMS - Generally consists of several functions or modules including
Registration
Scheduling
Insurance verification
Code scrubbing
Integration of EHR and PMS - they are typically integrated into
a single system
Make staff more efficient in
Registration Insurance verification Copay collection Medication reconciliation Pre auth tracking Scheduling Benefit limitations Claims and dropping bills Appt reminders Wait lists Forms
Make staff more efficient in scheduling - how
Ticklers
Provider can put into the system when they want to see the pt again and then the front desk or system can go ahead and schedule them with that info
What is the most valuable asset?
Provider time!
Every minute counts - system set up is key
Making providers more efficient - problems with paper charts
Searching for paper
Lost charts
Transferring charts btw practice locations
PMS and EMR eliminate these challenges
PMS and EMR provide tools to make providers more efficient including what
Coding guidance Intuitive templates Data and Information Evidence based medicine Hand offs and follow DM Delegated authority Supervising provider
PMS and EMR provide tools to make providers more efficient - Data vs. Information
Data - something you enter into system and can run trends on it
Information - scanned in piece of paper for ex - not a lot of room for analysis
PMS and EMR provide tools to make providers more efficient - Hand offs and follow decision making
If they are seeing another provider - there can be a process for how the information gets to them
Making the practice more efficient - how
Resource allocation and scheduling
Communications
Fulfilling requests for information
Making the practice more efficient - Resource allocation and scheduling
Making data driven decisions by tracking resource utilization
Allows you to schedule room (or resources)
Can look at data too to know if you need new equipment
Making the practice more efficient - Communications
Referral letters
Provider authorizations
Incoming documentation
Making the practice more efficient - Fulfilling requests for info
How easily does the system allow you to get that information if someone wants a copy of the record
Enhancing quality through
EBM
Alerts and Alarms (unfilled orders, pt not coming in, schedule follow ups)
Integrated pt ed documents
Communication
Intradepartmental
Patient portal
Intradepartmental communication
Pt cases between providers and staff
Pt portal communication
Communication with pt via secure means - from pt to provider Ability to: - update info - make payment - request/schedule appt
Pt satisfaction
Pt are getting used to providers being on comp
Set up of the space can be key
Pt satisfaction - making the pt feel like you spent more time with them
SIT down with them
Insurance and billing - front end
Insurance verification Benefits verification Prior auth management Sliding fee schedule and discounts Collect at time of service! Captured audience!
Insurance and billing - middle
Documentation
Diagnosis codes
Tx/Procedure code capture
Insurance and billing - end
Claim creation
Custom rules (like maybe claim will not drop without certain codes)
Scrubber (probability of insurance denial)
Denials management
Payment posting
Insurance and billing - other
Billing non health insurance
- employers
- law firms
- auto or homeowner policies
Payment collection
Insurance
Pt responsibility
Payment collection - pt responsibility
When does amount transfer to pt
Payment reminders
Options for collecting (online, over phone)
Ease of transferring an account to collections
Compliance
Audits - ease of conducting
Compliance - managing and tracking
Consent to call
Notice of privacy practices
Assignment of benefits
ABN
Security
Track access Monitor use Limit access Setting up user rights and permissions Setting expiration dates for user accounts Managing paper - tracking amendments
Quality/P4P
Quality reporting codes Claims rules (based on quality measures) Dashboards/Monitoring Improvement activities Reporting options - EHR reporting, registry reporting, claims based reporting
Population health and programming
Call campaigns
- via email, phone, portal, text
Target patients based on demographics, last visit, clinical info
Marketing
Pt reported referral source tracking - how did you hear about us (see if your marketing is paying off)
Tracking/Managing provider referrals
Interfaces and info exchange
Sending and receiving documents between providers
Vendor services
Document management Payment posting Denials Credentialing Appt scheduling Registration and front end revenue cycle
Decision support
Clinical decision support - dx based guidelines
User guides
User training
Release/update info and training
User communities
Sentinel metrics dashboard
Provider and practice performance reviews
Peripherals/Integrated partners
Collections Digital check in- co pay collection Orders mngmnt and med refill request Voice recognition Chronic care mngmnt Telehealth Satisfaction surveys Clinical decision support
Selection considerations
Cloud vs Onsite server vs. Partner with another org
Process - who is involved
Decision criteria - the system that is the least worst
Site visits
Conversion to new system
Selection considerations - pros to partnering
Two heads better than one
Cost sharing for build and implementation of costs
More users, greater leverage with vendor
Shared resources, experience, collaboration
Selection considerations - cons to partnering
Collaboration takes time and effort
Lots of comm is needed
Requires compromise
Dep on organization, could lose ind and decision making
Costs
Costs and mdoels - purchasing licenses, % of collections model
Implementation costs - hire project mnger, dec production
Archive system
Conversion/Build
Timeline
Planning - training, reduced schedule at and after go live
Archive - paper records (IA need to for 7 years, minors until age of majority plus 7 yrs)
Forms - coding
Conversion/Build - What players should be involved
Should it be driven by IT dept?
Who should manage the project?
- Experienced project manager, Business leaders (like financial or operations mngmt)
