Download 3.02 Understand health informatics Name____________________

3.02 Understand health informatics
Name____________________
Handout
KEY
Date ____________________
Directions: Record notes and class discussion in your own words. Compare the ICD9-CM and CPT codes as you view the PowerPoint presentation.
Health Informatics
Management Duties
Health
Informatics 1-Design and develop information
systems needed for medical records
and insurance
2-Develop policies and procedures for
handling medical information to ensure
patient privacy and security
3-Stay within budget
4-Train users
Technical Duties
1-Design and develop information
systems that operate between
healthcare facilities
2-Integrate all medical records and
insurance requirements into one
user-friendly system
3-Develop information systems that
adhere to policies and procedures
for handling information to ensure
patient privacy and security
Health 1. Analyze information
Informatics 2. Abstract and code patient information
Professionals 3. Communicate information
4. Document information
5. Manage health information systems
Analyze patient -Determine health information required
information -Collect required information
-Evaluate the information
-Report and distribute information within legal guidelines
ICD-9-CM Coding
CPT Coding
Abstract and
code patient
information
1-Collect
information to
record charges and
reimbursements
2-Use appropriate
medical terminology
3-Apply information
for regulatory and
legal purposes
http://icd9cm.chrisendres.com/
http://www.findacode.com/search/search.php
3.02 Understand health informatics II
Handout
Name___________________
Date ____________________
Directions: Record notes and class discussion in your own words.
Document
information
Career Responsibilities
-Complete insurance forms
-Communicate information
-Use technology
-Schedule appointments
-Complete medical records forms
-Maintain accounting records
Communicate -File records
information
-Use technology
-Schedule appointments
-Complete medical records
-Maintain accounting records
Manage -Combine the information systems
health used within a healthcare agency
information
systems -Enable timely and accurate flow
of information
-Organize information within
guidelines
-Participate in the design of
operational systems
-Evaluate operational systems
Class Discussion
3.02 Medical Abbreviations
Handout
a
ac
ad lib
ax
BR
BS
BSE
CBC
cl liq
DNR
DOA
DOB
Dx, dx
ED
FUO
gtt
NPO
N/V, N&V
p
P
OOB
pc
po
R
R/O
ROM
Rx
SOB
Sx
T, temp
TPR
UA, U/A
WNL
Name ___________________
Class ___________________
before
before meals
as desired
axillary
bedrest
blood sugar
breast self-exam
complete blood count
clear liquids
do not resuscitate
dead on arrival
date of birth
diagnosis
emergency department
fever of unknown origin
drop
nothing by mouth
nausea and vomiting
after
pulse
out of bed
after meals
by mouth
respiration
rule out
range of motion
treatment
shortness of breath
symptom
temperature
temperature, pulse, respiration
urinalysis
within normal limits
3.02 Medical Insurance Key Terms
Handout
Key Term
abstracting
Definition
collecting information from a
medical record
claims attachment medical report attached to the
claim form substantiating a
medical condition
coding
assignment of a code to the
patient’s diagnoses, procedures
for the purpose of
reimbursement
ICD-9-CM
International Classification of
Diseases, 9th Revision, Clinical
Modification – coding system
used to report diagnoses and
reasons for encounters, such as
an annual physical examination,
on outpatient and physician
office claims
CPTa
Current Procedural Terminology
– coding system published by
the American Medical
Association that is used to
report procedures and services
performed during outpatient and
physician office encounters
Name___________________
Date ___________________
Student Notes
3.02 Medical Insurance Key Terms
Center for Medicare and
CMS
Medicaid Services –
administrative agency within the
federal Department of Health
and Human Services;
responsible for the operation of
Medicare and Medicaid
explanation of
benefits (EOB)
report detailing the results of
processing a claim (Ex: payer
reimburses provider $80 on a
submitted charge of $100)
health insurance
claim form (CMS1500)
documentation submitted to a
third-party payer or government
program requesting
reimbursement for healthcare
services provided
medical necessity
linking every procedure or
service code reported on the
claim to an ICD-9-CM condition
code that justifies the necessity
for performing that procedure or
service
preauthorization
prior approval for treatment by
specialists and documentation
of post-treatment reports
remittance advice
notice sent by the insurance
company that contains payment
information about a claim
page 2
3.02 Filing Records
Handout
Name _______________
Date ________________
Alphabetic Filing
 All personal names are transposed so that the last name is the primary indexing
unit, first name second and middle name or initial is the third unit.
 April Smith
Smith, April
 Jesse W. Brown
Brown, Jesse W.
 If filing identical names, use the city and street names to place in alphabetical
sequence
 Don S. Clay, Asheboro, N. C.
Clay, Don S. Asheboro
 Don S. Clay, Raleigh , N. C.
Clay, Don S. Raleigh
 Names with prefixes are filed disregarding punctuation and spacing within the
surname
 Rena de la Santos
de la Santos, Rena
 Amee La Croix
La Crois, Amee
 David M. McArthur
McArthur, David M.
 Abbreviated names are files as though the names were spelled out.
 Chas. Malley
Malley, Charles
 Charles L. Malley
Malley, Charles L.
 Professional titles and degrees are placed at the end of the name and enclosed
in parentheses.
 Organizations and Businesses in order they are written
American, Red, Cross
 Exception: If Owner's name is name of business, then follow name rules
The T.S. Eliot Company is filed as Eliot, T., S., Company
 Hyphenated names are considered as one unit
 After indexing, follow strict alphabetical order, use as many letters as needed to
file
 Nothing comes before something
 Numbers in a name are indexed as though they were spelled out
Numeric Filing
 Cross indexing (referencing) is required
 Patient names are indexed as for alpha filing
 Agency numbering usually runs in order, and a record is kept of which numbers
have been assigned.
 When patient comes to agency, alpha cross index is checked to locate patient's
file number
 Numbers go in order from small to large
 If zero falls before other numbers, the zero is disregarded when filing
Many systems use the same terminal (last) digit for certain shelves or drawers - if so check the last digit and then put all the same last digits together
3.02 Telephone Etiquette Handout
Answering the phone
1. Speak clearly.
2. Use your normal tone of voice.
3. Use proper language.
4. Address the caller by his/her title (Good morning Mr. Doe.)
5. Listen to the caller and what they have to say. Repeat information if you are taking a
message to verify accuracy.
6. Be patient and helpful.
7. Always ask politely if you need to put someone on hold.
8. Always focus on the call. Try not to get distracted by others.
9. Do not eat or drink when talking on the phone.
Placing a call
1. Always identify yourself.
a. Name
b. Company name
c. Phone number
2. Always be aware of confidential information.
3. Always be aware of people around you. Be discreet.
4. Avoid leaving long messages. Keep it brief.
3.02 Scheduling Appointments
Teacher Resource
Correct scheduling of appointments is essential for good public relations. Computerized
systems specific to agency will be learned on the job.
Appointment Procedures
 Vary from office to office
 Computer Scheduling
 Computer automatically locates next available appointment
 Provides a record of appointments already scheduled
 Prints out copies of daily schedule
 Appointment book
 Time blocked in 15-minute intervals
 First…block out lunch, meetings, etc. with a large X
 Appointment time depends on purpose of appointment and would be determined by
the agency
 Some agencies use buffer period
When a patient calls…
1. Find out reason for call
2. Try to schedule convenient appointment for patient
3. Try to give choices
4. Be sure you have the required information before closing the call
5. Spell names correctly (ask if you don't know)
6. Write the patient's phone number in the appointment ledger
7. Repeat the date, time and important appointment details
8. Thank the caller and say good-bye
9. Double-check appointment book to assure correct time was blocked off
If the patient calls to cancel…
1. Ask if he/she would like to reschedule
2. Erase/delete appointment and reschedule
3. Do not ask why they are canceling
Scheduling issues…
1. In many agencies, patients who don't show up are billed
2. "No show" noted on patient's chart
3. If an emergency occurs and the health care provider is called away, sometimes all
appointments must be canceled
4. Sometimes, offices will make time for patients with emergencies to be seen
3.02 Maintain accounting records
Teacher Resource
What is the purpose of financial records? Used to record and analyze the financial
performance of a business.
What are financial statements? Reports that sum up the financial performance of a
business.
Asset records name the buildings and equipment owned by the business, original and
current value, and the amount owed if money was borrowed to purchase the assets.
Depreciation records identify the amount assets have decreased in value due to their
age and use.
Inventory records identify the type and number of products on hand for sale/use.
Records of accounts identify all purchases and sales made using credit. An accounts
payable record identifies the companies from which credit purchases were made and
the amount purchased, paid, and owed. An accounts receivable record identifies
customers that made purchases using credit and the status of each account.
Cash records list all cash received and spent by the business.
Payroll records contain information on all employees of the company, their
compensation, and benefits.
Tax records show all taxes collected, owed and paid. As a part of payroll, employers
must withhold a certain percentage of employees’ salaries and wages for federal
income tax. The company also makes payments for Social Security and Medicare and,
in some cases, for unemployment compensation.
3.02 Sample Budget
Teacher Resource
South Hills Healthcare, P. A.
123 American Boulevard,
Anytown, North Carolina 99999
Budget
Actual
Difference
$4,575,761.00
$3,303,137.00
$1,272,624.00
$2,355,182.00
$17,473.00
$64,768.00
$2,358,346.00
$27,272.00
$67,195.00
Pathology
Food Supplies
Domestic Services
Fuel, Light, Power,
and Water
$6,716.00
$57,866.00
$49,766.00
$67,245.00
$8,716.00
$53,828.00
$50,969.00
$89,235.00
Insurance
Motor Vehicle
Expenses
$68,849.00
$28,114.00
$68,849.00
$26,235.00
Repairs and
Maintenance
$38,334.00
$30,103.00
Maintenance
Contracts
$34,023.00
$34,023.00
$1,632.00
$211,746.00
$1,632.00
$167,339.00
$733.00
$1,733.00
$3,002,447.00
$2,985,475.00
Total Income
Expenses
Employee Salaries
Drug supplies
Medical and Surgical
Supplies
Patient Transport
Other Administrative
Expenses
Bad Debts
Total Expenses
Net Income
$16,795.00
$16,972.00