HIM 445 Milestone One Process Improvement
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Feb 20, 2024
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Milestone One: Process Improvement Alexis Sanchez Southern New Hampshire University HIM 445: Professional Practical Experience Sandra Masten
February 11, 2024
1.
Improvement Areas
Elation (EMR) should incorporate more mandatory fields, particularly the social
security number data entry point and scanning medical cards or patient IDs. Both
components facilitate patient verification. The social security number can function as
an additional patient identifier when creating new profiles for claim billing, and the
digital uploads of insurance cards or IDs support eligibility searches.
In cases where insurance cards are scanned into the Elation profile, a user cannot
properly view the image because it lacks a zoom-in feature. This aspect prevents a
biller (or other team member) from verifying the insurance information and any other
details from scanned images. A solution for issues 1 and 2 is to customize the EMR
and improve these features so a user can maximize application use.
MedOffice (billing software) has two separate accounts, one for each practitioner, so
there is no connection between patient profiles. This aspect can cause a user to create
new patient accounts with incorrect or missing information (insurance, date, or birth,
etc.) based on Elation data input. Since Elation has separate accounts per provider,
there are instances where on-site users input incorrect information, leading billing
personnel to create a new profile with incorrect patient data, resulting in denied
claims or insurance eligibility rejects. A possible resolution is to have a single
MedOffice interface and amalgamate patient profiles with the idea of using a drop-
down menu to select the appropriate provider.
MedOffice does not recognize when a user is creating a duplicate patient profile
(identical name spelling, date of birth, or social security), leading to users picking
either profile to bill claims. The result is an incomplete ledger of claims based on a
single patient. I suggest customizing the MedOffice patient profile template and
adding the date of birth, first and last name, and social security number as patient
identifiers. Also, I recommend adding (if possible) a system alert triggered when
three patient identifiers match when creating a new profile.
2.
Best Option The final proposal will focus on achieving a single MedOffice interface where patient
profiles undergo amalgamation. Changing this aspect adds efficiency to the billing process and
limits the search for insurance information or patient data. This feature will also cater to business
expansion. As the company caters to more providers, staff can bypass creating new patient
records and manually transferring data points across accounts if there is a shared patient base.
This options focus is entering new provider information only once, versus entering hundreds of
patient data. The most critical necessity in creating a single MedOffice interface is staff time as
the application does not appear to have a profile merging feature (MedOffice, 2024). The process
can involve gathering a total list of patients per provider, matching patient identifiers, and
updating relevant notes and ICD-10 codes. Additionally, the administrator must create a new
physician record so the software prompts users to select an appropriate provider from a drop-
down menu when inputting claims.
3.
Received by Stakeholders I believe the proposal would encounter initial rejection because of the time required to
complete the task. The merging process will primarily employ a copy-and-paste method, where
the user must duplicate each field in an existing chart and transfer the data into a final record,
which will be time-consuming. Another factor to consider is the current position of the company.
The business recently assumed a new provider and billed claims for previous encounters
stretching into the beginning of 2023. This acquisition created a backlog of billing and a time
restraint for filing since insurance will not pay claims over a year old. Though the process is
complete, the possibility of taking a step back to merge all the new patient profiles poses a factor
in proposal rejection. Also, as staff are remote, there is the issue of miscommunicating where
employees are in their merging process, resulting in delayed claim input.
4.
Results of Proposed Changes A short-term result after merging patient profiles might include a change to the workflow.
A recently added step in claim billing is checking Medicare eligibility to update part C
information and switch existing insurance where necessary. This process occurs at the EMR
level as providers add patient encounters. Creating a single interface with merged patient profiles
and physician accounts should eliminate the need to check eligibility person by person every
time a new encounter is charted. Record amalgamation in MedOffice ensures validating each
insurance entry and will occur less frequently versus initiating the process as the EMR undergoes
daily updates. The short-term result should reduce the step count necessary when billing claims
and increase productivity. In the long-term perspective, a possible result is reducing rejected claims. There are too
many places to search, verify, and correct patient insurance information following a claim
rejection, i.e. two MedOffice and two Elation accounts, with the possibility of increasing the
number of data entry points as the company assumes more providers. A single user interface in
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MedOffice ensures fewer data entry points to authenticate insurance information, leading to a
better likelihood of processing claims with accurate and active member IDs. The company
should also see an increase in claims made per staff member. Increased work productivity with
fewer claim rejections suggests a quicker turnaround in receiving reimbursement.
5.
Inspired by EHR Go Assignments
The Structured and Unstructured Data and Introduction to Chart Deficiencies EHR Go
assignments highlighted the relationship between system framework and usability. The
Structured and Unstructured Data worksheet included elements like understanding how including
variations of structured data entry points enables an EHR to carry out drug-drug interaction
checks or allows a user to generate a patient list with specific conditions. The Introduction to
Chart Deficiencies EHR Go assignment focused on identifying missing and present aspects in a
patient chart. The take-away experience inspired the idea that the EHR is a tool intended to add
efficiency and productivity to user workflow. An application lacking in features diminishes the
user experience, resulting in workarounds and unnecessary additional steps to achieve a task.
With this concept, I began to look at the applications I work with to assess improvement areas
within the EMR and billing software to identify improvement areas that can increase
productivity and the user experience.
Reference MedOffice. (2024). Amazing medical practice management software. Retrieved February 7, 2024, from https://medoffice.net/