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Block 7 PID Exam 5 > Data Management > Flashcards

Data Management Flashcards

1
Q

Practice priorities - what is important

A 
Quality
Pt satisfaction
Accuracy
Provider satisfaction
Workflow efficiencies
Office flow
Staff
Follow up
\$\$$
Reporting capabilities 
Compliance
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2
Q

Practice management systems (PMS) =

A

A category of software that deals with the day to day operations of a clinical practice

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3
Q

Electronic medical record =

A

A digital version of the traditional paper based medical record for an individual
The EMR represents a medical record within a single facility

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4
Q

Integration of EHR and PMS - Generally consists of several functions or modules including

A

Registration
Scheduling
Insurance verification
Code scrubbing

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5
Q

Integration of EHR and PMS - they are typically integrated into

A

a single system

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6
Q

Make staff more efficient in

A 
Registration
Insurance verification
Copay collection
Medication reconciliation
Pre auth tracking
Scheduling
Benefit limitations
Claims and dropping bills
Appt reminders
Wait lists
Forms
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7
Q

Make staff more efficient in scheduling - how

A

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

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8
Q

What is the most valuable asset?

A

Provider time!

Every minute counts - system set up is key

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9
Q

Making providers more efficient - problems with paper charts

A

Searching for paper
Lost charts
Transferring charts btw practice locations

PMS and EMR eliminate these challenges

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10
Q

PMS and EMR provide tools to make providers more efficient including what

A 
Coding guidance
Intuitive templates
Data and Information
Evidence based medicine
Hand offs and follow DM
Delegated authority
Supervising provider
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11
Q

PMS and EMR provide tools to make providers more efficient - Data vs. Information

A

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

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12
Q

PMS and EMR provide tools to make providers more efficient - Hand offs and follow decision making

A

If they are seeing another provider - there can be a process for how the information gets to them

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13
Q

Making the practice more efficient - how

A

Resource allocation and scheduling
Communications
Fulfilling requests for information

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14
Q

Making the practice more efficient - Resource allocation and scheduling

A

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

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15
Q

Making the practice more efficient - Communications

A

Referral letters
Provider authorizations
Incoming documentation

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16
Q

Making the practice more efficient - Fulfilling requests for info

A

How easily does the system allow you to get that information if someone wants a copy of the record

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17
Q

Enhancing quality through

A

EBM
Alerts and Alarms (unfilled orders, pt not coming in, schedule follow ups)
Integrated pt ed documents

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18
Q

Communication

A

Intradepartmental

Patient portal

19
Q

Intradepartmental communication

A

Pt cases between providers and staff

20
Q

Pt portal communication

A 
Communication with pt via secure means - from pt to provider
Ability to: 
- update info
- make payment
- request/schedule appt
21
Q

Pt satisfaction

A

Pt are getting used to providers being on comp

Set up of the space can be key

22
Q

Pt satisfaction - making the pt feel like you spent more time with them

A

SIT down with them

23
Q

Insurance and billing - front end

A 
Insurance verification
Benefits verification
Prior auth management
Sliding fee schedule and discounts
Collect at time of service! Captured audience!
24
Q

Insurance and billing - middle

A

Documentation
Diagnosis codes
Tx/Procedure code capture

25
Q

Insurance and billing - end

A

Claim creation
Custom rules (like maybe claim will not drop without certain codes)
Scrubber (probability of insurance denial)
Denials management
Payment posting

26
Q

Insurance and billing - other

A

Billing non health insurance

  • employers
  • law firms
  • auto or homeowner policies
27
Q

Payment collection

A

Insurance

Pt responsibility

28
Q

Payment collection - pt responsibility

A

When does amount transfer to pt
Payment reminders
Options for collecting (online, over phone)
Ease of transferring an account to collections

29
Q

Compliance

A

Audits - ease of conducting

30
Q

Compliance - managing and tracking

A

Consent to call
Notice of privacy practices
Assignment of benefits
ABN

31
Q

Security

A 
Track access
Monitor use
Limit access
Setting up user rights and permissions
Setting expiration dates for user accounts
Managing paper - tracking amendments
32
Q

Quality/P4P

A 
Quality reporting codes 
Claims rules (based on quality measures)
Dashboards/Monitoring
Improvement activities 
Reporting options - EHR reporting, registry reporting, claims based reporting
33
Q

Population health and programming

A

Call campaigns
- via email, phone, portal, text
Target patients based on demographics, last visit, clinical info

34
Q

Marketing

A

Pt reported referral source tracking - how did you hear about us (see if your marketing is paying off)
Tracking/Managing provider referrals

35
Q

Interfaces and info exchange

A

Sending and receiving documents between providers

36
Q

Vendor services

A 
Document management
Payment posting
Denials
Credentialing
Appt scheduling
Registration and front end revenue cycle
37
Q

Decision support

A

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

38
Q

Peripherals/Integrated partners

A 
Collections
Digital check in- co pay collection
Orders mngmnt and med refill request
Voice recognition
Chronic care mngmnt
Telehealth
Satisfaction surveys
Clinical decision support
39
Q

Selection considerations

A

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

40
Q

Selection considerations - pros to partnering

A

Two heads better than one
Cost sharing for build and implementation of costs
More users, greater leverage with vendor
Shared resources, experience, collaboration

41
Q

Selection considerations - cons to partnering

A

Collaboration takes time and effort
Lots of comm is needed
Requires compromise
Dep on organization, could lose ind and decision making

42
Q

Costs

A

Costs and mdoels - purchasing licenses, % of collections model
Implementation costs - hire project mnger, dec production
Archive system

43
Q

Conversion/Build

A

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

44
Q

Conversion/Build - What players should be involved

A

Should it be driven by IT dept?
Who should manage the project?
- Experienced project manager, Business leaders (like financial or operations mngmt)

Block 7 PID Exam 5 (4 decks)

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