Custom «Electronic Health Records Claim Support Warrent » Essay Paper Sample
Electronic health records have many functions that are associated with them. These records are not just used to record information about the care given to patients, but also record legal and financial information and also they can be used in quality improvement and research purposes. HER are longitudinal electronic record of the health information of a patient that is generated through encounters in the setting of care delivery. This information may include progress notes, patient demographics, medications, medical history of the past, important signs, immunizations, radiology reports, and laboratory data. They also support directly or indirectly other activities that are related to health care such as supporting decisions that are evidence based, outcomes reporting and quality management. This therefore shows that Electronic Health Records are very important in the medical practice of today, especially when dealing with claims and that is why it should be seriously supported (Hoyt p. 28).
Health care providers are working in a market that is constantly becoming competitive and full of concerns of reducing the many medical errors, cash flow improvements, and compliance to regulation and public policy developments. All this must be done while maintaining high quality care services to patients. Claim volumes on the other hand are on the rise due to the increasing sale of health insurance policies. Such a situations calls for systems that are efficient, high quality technology and business process that will help health providers who wish to stay ahead of the crowd to raise their bar. This does not mean merely meeting the above challenges but coming up as leaders in the health profession who can change business processes and operations successfully to suit the changing trends. This is why EHRs come in handy to counter the challenges.
Although some people argue that use Electronic Health Records may bring about new risks of malpractice liability, its advantages outweigh the disadvantages by far. Some of the concerns raised by the skeptics include data destruction or loss, corrections that are inappropriate to medical records, inaccurate data entry, and also unauthorized access to information. But these concerns are not new because they also exist with medical paper records. These areas that seem to pose potential risks can be addressed if hospitals adopt procedures and policies that are compatible and feasible with the Electronic Health Records system functionalities. E.H.R systems can provide clear records of corrections made in accordance with the policy of the respective facility. It addresses the security, integrity, accessibility, and privacy of crucial health information through policies and procedures that accommodate the Accountability Act and Insurance Portability's security and privacy regulations. This system has built-in safeguards that flag down errors in data entry and therefore prevent to a large extent, the chances of data loss (Amatayakul and Lazarus 45).
When large volumes of data about a patient are needed, E.H.R systems make it available to the clinicians. Questions are still asked as to whether physicians have a duty legally to access past medical records of patients. But historically this issue has been adjudicated on a case-by-case basis, something that requires the opinion of an expert witness's testimony in regards to whether the required standard of care necessitated the physician's action. As this system is slowly integrated into the regional networks that are already established, standards of accepted practice will no doubt evolve with it. There are many mistakes that can be made in the course of a physician's work. For example there may be an override of an electronic alert on a specific medication by a doctor, or a medical practitioner might pick on a course of action that is not stipulated in the clinical guidelines that are provided. Without clear records this can prove disastrous to the medical practitioner. E.H.R see to it that this does not happen by generating up to date documentary evidence that shields the practitioner's actions in peer review proceedings or even in a malpractice case. Detailed information about a patient's care may not be available if paper records are used, or it may be difficult locating the information, this is easily accessed if E.H.R records are used. This in turn can help plaintiff attorneys make discoveres that are extensive by requesting for electronic information that is relevant in medical malpractice litigation. EHRs that are well integrated have the capability a path that is electronically traceable about the transition of a patient in a facility. Although this in reality may pose security and privacy risks, particularly, increase in the flow of electronic information raises a major concern touching on the confidentiality and privacy of health information. It is feared that the information that was once stored in locked cabinets on paper, if stored on multiple computer servers of organizations that are remotely connected may create an environment in which healthcare data exchange may be prone to human error and security vulnerabilities (Nagelkerk p184).
Despite these concerns the move towards the use of EHRs should go on. The recent bills that address the high cost of adopting EHRs and implementing them to the practices of physicians, is a positive move. More legislation should now look at the established prohibitions on the relationship of physicians and hospitals. Where this practice has not picked up, plans should be made to provide for the creation of confidentiality, interoperability, and security standards that will aid in a smooth transition to record keeping that is electronic based. Those who argue that EHRs pose more liability risks should look at the enormous effort being put in towards this initiative. These local and State efforts that are directed towards putting in place an interconnected system of healthcare just serve to reflect the nation's enthusiasm of this project. It is encouraging to see that nearly more than half of the States have given out executive orders or have mandated the use of EHRs through legislation
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Studies carried out show that physicians employing the use of EHRs pay fewer malpractice claims. What this simply shows is that Electronic Health Records do not just improve the quality of care, it is an additional support showing what physicians and clinicians who have or have used Electronic Health Records feel and believe. It strongly strengthens the fact that this system actually helps them provide to their patients healthcare that is of high quality and safe. This is a very positive move as this view by physicians will definitely tip the scale in favor of the implementation of the Electronic Health Records. The liability carriers of malpractice could also greatly lower the malpractice premiums for physicians using EHRs. This of course will also see the rise in willingness in federal and private payers in their allocation of funds towards helping physicians buy EHRs. Those who are worried that their information may be lost if EHRs are employed should know that there are provisions put in place for EHR Anti-kickback exceptions that in a way loosens the legal restrictions allowing use of EHR-related software and training services without causing any violations the laws of federal abuse and fraud. Specifically, this provision protects any arrangement that involves the use of EHR technology by health plans or health providers who submit or make payment requests to a federal health care program to entities or individuals engaged in healthcare delivery. This also inhibits donors from shifting costs to the federal programs of healthcare. This if correctly implemented then there is no doubt that it will encourage more adoption of Electronic Health Records and at the same time insulate providers of healthcare from prosecution (Fieschi, Coiera, & Li p1300).
Concerns still remain that access to Electronic Health Records by physicians in different hospital could in a way implicate the Anti-referral and Anti-kickback laws. Others have foreseen that there may be disagreements in the interpretation of some of the requirements, but this is to be anticipated and of course appropriate measures have been taken. Appropriate security measures and legislative safeguards have been put in place to protect a patient's confidentiality in regard to his or her medical record. Another area that EHRs play a very vital role is in faster processing of claims. Processing of claims electronically especially in regard to disability claims requires a faster and efficient system like E.H.R. This system enables electronic health records to be sent through a network of patient care that is linked to many medical facilities in the various US States. This makees it possible to patients having claims, especially those with disabilities to have their data accessed in just in hours or minutes form any medical facility near them unlike the current system in accessing of records can take weeks or even months because paper records must be located, copied and then mailed to the respective facility. On top of speeding up the processing of claims, the system can also perform intelligent analysis on the health record of patients and alert the respective facility on any information that may be significant. EHRs are also very important when a patient's complete information is needed. For instance a claim applicant may be required to list his or her physician on the claim. This becomes a problem in situations where some patients forget which doctor saw them during their hospital stays. The use of EHRs enables the person in charge to access all the health information of a patient that is recorded in the network of patient care (iHealthBeat p.1).
EHRs are also very vital in the billing process, a process that physicians use to process client's claims. The processing of claims by insurance companies involve a number of steps, first information is entered into the medical billing software program. This information comes from a super bill which is just all the information about a patient during his or her hospital visits. This super bill contains unique treatment and diagnosis codes which are used by insurance companies to determine the legitimacy of a claim. This information together with the billing software are used to submit the claim to a medical billing clearing house where the claim is ascertained and then send to the payer. If the claim is rejected or accepted, then a notification will be send to the clearing house which then updates the claim provider on its status and necessary steps to be taken. As it has emerged, all these processes are carried out online; one can imagine the inconveniences that will be experienced if paper records are used. That is why EHRs are an important component in the medical practice especially in regard to claims, to the extent that each facility should strive to have them in place. EHRs software that is integrated with practice management system has great potential of making insurance claim processing easier. EHRs enables one to effectively manage the processing of claims, meet the demands of his or her clients, deal with the pressing regulatory concerns thereby staying competitive (Amatayakul & Lazarus p79).
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Electronic records enable insurance companies to minimize administrative burdens allowing the staff members dealing with claims to only focus on the servicing of the claims. It reduces or completely eliminates paperwork giving claim specialists a quicker access to the needed information hence facilitating claim resolutions to be made on time for the insured. With EHRs the payers of health insurance are able to have state-of-the-art electronic claim management capabilities that ensure that there is cashless treatment of their clients therefore no hustling for payments. They increase the rate and efficiency with which handling of claims is done, facilitate file sharing among providers of healthcare, clients, claim staff, and brokers, and also improves the quality of data and the security of documents. Implementing EHRs will no doubt bring about a commitment to optimization of the claims handling experience of insurance companies for the good of their clients (idhasoft p 1).
This article has shown that there are far more benefits of using Electronic Health Records than there are the disadvantages. Some of the benefits have been partially mentioned but the issue of claims has been dealt with in detail. Well kept records reduce the risk of losing vital information and make its location in times of need very easier and faster. EHRs help a lot in the billing process when physicians are faced with the task of processing the claims of their clients. This minimizes administrative burdens in insurance companies thereby enabling resolutions of claims to be made faster to the client's satisfaction. EHRs bring about a wholesome compliant solution that allows for web-based management and processing of claims and electronic records of medical care. They bring about efficiency but at a lower cost than the traditional paper filing methods. This is the service that all health facility should work towards.
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