chapter one primesuite’s practice management and electronic health record software

chapter one

PrimeSUITE’s Practice

Management and

Electronic Health

Record Software

© 2015 McGraw-Hill Education. All rights reserved.

Learning Outcomes

• When you finish this chapter, you will be able to:1.1 Describe practice management

applications.

1.2 List the advantages and disadvantages of

an electronic health record.

1.3 Describe EHR applications.

1-2


Learning Outcomes (cont)

• When you finish this chapter, you will be able to:

1.4 Chart the flow of information from

registration through processing of the claim.

1.5 Use the help feature in PrimeSUITE.

1-3


Key Terms

• Application• Care provider• Clearinghouse• Clinical information• Current Procedural

Terminology (CPT)• Demographic

information• Electronic claims

submission

1-4

• Electronic Health Record (EHR)

• Electronic Medical Record (EMR)

• Encounter form (Superbill)

• International Classification of Diseases-10th revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS)


Key Terms (cont)

• Interoperability• Master Patient

(Person) Index• Point of care• Practice Management• Speech recognition

1-5


1.1 Practice Management Applications

• Practice Management (PM) Software Computer programs that carry out

administrative functions or operations

• Electronic Health (Medical) Record (EHR/EMR) Includes the clinical documentation of patient

care

1-6


Applications found in PM Software

• Enter patients into a patient or master list• Schedule appointments• Assign ICD-10-CM diagnosis and CPT

Procedure Codes• Complete a billing claim form• Send insurance claims to carriers

1-7


1.2 Why Adopt EHR Applications ?

Conversion to an EHR has been slow because of:

– Security concerns (loss, theft, tampering)– High cost of implementation– Time involved for providers in learning how to

implement, maintain, and use an electronic system

– Loss of productivity by administrative and direct patient care staff during the learning phase

1-8


Why Adopt EHR Applications (cont)

(slow conversion continued)

– Sharing of information with other providers from a privacy viewpoint

– Ability to communicate with other computer systems (interoperability)

1-9


Why Adopt EHR Applications ? (cont)

• Advantages:– With today’s technology and proper policies,

security need not be a concern.– Initial costs are high, but savings in supplies,

space, staff, etc., plus the positive impact on patient care, all increase return on investment.

– There is a high learning curve, but once learned, the benefits outweigh the disadvantages.

1-10


Why Adopt EHR Applications ? (cont)

• Advantages (cont):– Interoperability allows for sharing of

information.– It is much easier to assure regulatory

compliance.– Collection and use of incredible amounts of

clinical data for use in medical research and epidemiology is made possible.

1-11


1.3 EHR Applications

• Clinical documentation of the visit• Ability to ePrescribe medications• Exchange of clinical information between

providers• Ability to access clinical trials, evidence-

based medicine, and research• Mobile EHR applications• Point of care dictation of the progress notes,

possibly using speech recognition technology

1-12


1.4 Flow of Information from Registration through Claim Processing

• An appointment is made.• Patient is “checked in” or registered.• Patient waits to be seen by the provider.• The patient is called back to an exam room.• Patient vital signs are taken, and questions

are asked about why they are being seen and about their medical history.

• Patient examination is completed.• A plan of care is provided.

1-13


Flow of Information from Registration through Claim Processing (cont)

• Patient check-out and billing procedures begin:– Create/file follow up on insurance claims

• Claims processing edits• Claims status/clearinghouse reports• Claims maintenance

– Receive insurance Explanation of Benefits (EOB); post payments• Insurance transactions

– View accounts/generate statements

1-14


Flow of Information from Registration through Claim Processing (cont)

• If diagnostic procedures such as x-rays or laboratory tests were ordered, clinical documentation steps may be repeated:– Receive results from lab/hospital

• Document import results – Authenticate results/execute follow-up

instructions• Track orders

– Notify patients of results• Document follow-up

1-15


1.5 Use of the Help Feature

“Help” functions are standard in most software applications. PrimeSUITE is no different.

PrimeSUITE “Help” can be accessed through any screen.

1-16


Use of the Help Feature (cont)

• When you click on “Help,” access to the entire user’s guide is available.– It can be searched by topic.– It can be searched by the index or glossary.

• The important thing about “Help” is that it is there for just that, to help you learn PrimeSUITE and to assist you when you are unsure of the steps you need to complete.

1-17


Summary

• Practice management applications– Master Patient Index/Patient List– Scheduling appointments– Assign ICD-9-CM and CPT codes– Complete billing claim form– Send insurance claims to carriers

• Advantages and disadvantages of an electronic health record

1-18


Summary (cont)

• EHR Applications include:– Clinical documentation– Electronic prescribing– Exchange of clinical information– Research evidence-based medicine,

pharmaceutical research, clinical and financial benchmarking studies

– Speech recognition

1-19


Summary (cont)

• Flow of information from registration through processing of the claim– Appointment scheduling– Front desk check-in– Patient taken to examining room– Provider meets with the patient– Patient checked out– Business office/billing completed– Follow-up on test results

• The “Help” feature in PrimeSUITE

1-20

chapter one primesuite’s practice management and electronic health record software

Documents

mcgrawhill education

cmpcs slide

cont advantages cont

learning outcomes cont

direct patient care

flow of information

learning phase

high learning curve