EBK CASE STUDIES IN HEALTH INFORMATION
3rd Edition
ISBN: 9781337514538
Author: Mccuen
Publisher: VST
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- The difference between a remittance advice (RA) and an explanation of benefits (EOB) is: The RA goes to the provider only and includes payment information. The EOB goes to the provider. The RA is sent to the patient and includes payment information. The EOB contains payment information.arrow_forwardWhich Health Insurance Portability and Accountability Act (HIPAA) requirements specify how health care information is stored and accessed in the electronic health record (EHR)? (Select all that apply.) Paper back-up of all EHR information as safeguards Administrative safeguards Technical safeguards Designates a set number of employees with access to EHRarrow_forwardWith the use of Electronic Health Records most healthcare facilities and offices no longer submit a paper claim form instead of the fields in the EHR translate in the background to an electronic format of the CMS 1500 (physician claim) or a UB04 (hospital claim) form. However, it is still essential that you understand how to complete a claim form properly. In reviewing the different Blocks on the CMS 1500 form, choose a section of Blocks (as discussed in the unit) and in your own words: List the Block Numbers (i.e., Blocks 1-8), Describe what information goes into the Blocks Discuss any formatting requirements for the Blocks and what happens to a claim if the formatting is incorrect. In the second document above, CMS discusses Incomplete or Invalid Submissions. Explain how the Part A/Part B Medicare Administrative Contractors (MAC) handles these types of claims. CMS also discusses the difference between a “clean claim” and “other-than-clean claims.” Explain in your own words the…arrow_forward
- You were just hired as the office manager of a 6 physician office. As part of my responsibilities, one of the physicians asked you to investigate the possibility of an electronic health record (EHR) system. He is interested in this but the other physicians are reluctant to change to the system. They had heard that the federal government was going to mandate this and wanted to be proactive. The physician asked you to prepare an explanation to all of the physicians regarding the issues of implementing an EHR system. Research a website that provides support for your position on electronic health records and provide a summary of the website and the URL. Write a brief summary of the issues surrounding the use of electronic health records.arrow_forwardWhen time is used as a key component in billing an E/M service, the provider must document face-to-face time with the patient and how much time was spent counseling the patient with the family.arrow_forwardYou are the director of health information services at a tertiary-care hospital. You and the director of emergency room services are jointly responsible for reporting instances of COVID-19 to the appropriate state authority. You have just completed an audit of your institution’s reporting mechanism and discovered that the reporting requirements are not consistently met. The audit could not definitively establish whether the reporting never occurred or occurred but was not documented in the patient’s health record. Discuss what legal issues are present and what approaches you should take to resolve this problem.arrow_forward
- This question deals with Health Information Management professionals Identify the types or categories of revenue and expenses that would be required in a release of information function within a hospital or clinic. What assumptions are necessary before starting?arrow_forward"The health care agency owns the data in it's computer system and is therefore free to do whatever it chooses with that data." Is this accurate? What issues does this statement raise?arrow_forwardplease discuss two possible reasons that the implementation of a health intervention program might fail (you can use any program you wish, all I ask is that you make certain that it is a health education programarrow_forward
- Here is the image of a medical visit for patients. Our team is looking for improvement in both patient and physician satisfaction. As shown in the image below, 1.patients currently arrive at the medical office and complete an information form. 2. Some patients have appointments, but others are walk-ins. 3. An office assistant places the completed forms in a folder with the patient’s chart while answering the phone, assisting other patients, and dealing with paperwork. 4. The provider pulls the chart, provides the medical service, fills out forms for prescriptions and services provided, and returns it to the front desk. 5. The billing department enters the fee ticket, hopefully without errors, into a claim form to be mailed to the insurance company. 6. The insurance company receives the claim form and checks to see if it was sent to the correct company, if the form was completed correctly by the provider, and if the procedure was covered. If any of the above criteria are not met, the…arrow_forwardExplain the process used to manage the Master Patient Index (MPI) in 1-2 pages. Why is it important and how are the corrections with duplicate medical record numbers made. Include in your report what process is used for health information exchange and patient matching.arrow_forwardYour organization has experienced an unusual increase in injuries, accidents, and illness (mostly nosocomial infections). The senior department directors believe that many of these issues could have been prevented. In addition, new federal mandates and IT projects are further challenging morale and some patients have spoken to the local media. The clinical teams are willing to assist, however their time is limited as they must devote efforts to patient care. As you work to redesign the risk management program the COO wants you to develop a system to evaluate enterprise and financial risk. The reason for this is that there are two models that are inconsistent and he wants to "work on the same page" as your team. This is an initiative to streamline operations and reduce confusion. You are not expected to be an expert, however the goal is to submit a proposal that you and your CFO can work on together to evolve into a policy that assists each department. In addition, you want a strong…arrow_forward
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