Prepare now for electronic regulations
Prepare now for electronic regulations
AHIMA suggests steps to pave the way
If you're waiting for the government to adopt standards for the exchange of electronic health information before you adapt your information system, you may be wasting valuable time.
Congress, through the Health Insurance Portability and Accountability Act (HIPAA) of 1996, mandated that the U.S. Department of Health and Human Services adopt standards for the exchange of electronic health information. The effort was made to spur administrative simplification and to protect patient privacy.
"The road to administrative simplification will be anything but simple," predicts Sandra R. Fuller, MA, RRA, vice president for practice leadership for the American Health Information Management Association (AHIMA) in Chicago.
Fuller says that health care organizations should get a head start on implementation. To help with the process, she has developed a list of interim steps that organizations can take even before the final regulations are published. The steps, which are divided into categories, include the following:
General
· Assign responsibility for tracking the progress of regulations as they develop.
· Prepare to review and comment on the proposed regulations once published.
· Continue to inform key internal stakeholders about HIPAA and its impact on information systems and processes.
· Seek current information on the industry's approach to HIPAA compliance.
· Develop resources, such as publications, seminars, Web sites, and professional networking, to facilitate development of an approach to complying with HIPAA requirements.
· Plan internal educational programs to describe HIPAA requirements to those responsible for implementing them.
Standardization of code sets
· Monitor payer compliance with official coding guidelines.
· Perform regular coding quality control studies.
· Provide feedback on documentation issues that impact the quality of coded data.
· Routinely train coding staff on current coding practice.
· Provide access to resources available on coding guidelines and best practices.
· Efficiently update the codes in October for ICD-9-CM and in January for CPT-4 for both transaction and analysis systems.
Health care identifiers
· Assess the quality of the master patient index (MPI).
· Perform required clean-up of the MPI.
· Institute procedures to maintain the integrity of the MPI.
· Train staff on the importance of data quality in an MPI.
· Make necessary data quality improvements in registration systems.
· Create an enterprise MPI, as appropriate.
· Eliminate duplications in the enterprise MPI, as appropriate.
· Assign responsibility for the maintenance of MPI data integrity.
· Perform routine data integrity checks on the provider database.
· Develop effective procedures to maintain provider tables.
· Integrate or interface provider tables to necessary systems.
· Monitor data quality for unique provider identification numbers (UPINs) on billing documents.
· Provides easy access to UPIN tables.
· Maintain current complete payer tables.
· Perform data quality checks on payer data entry.
· Develop feedback loops from the billing process to data collection processes regarding payer data.
Claims transactions
· Maintain effective communication regarding claims processing with all affected parties.
· Perform routine maintenance on the charge master.
· Utilize electronic claims processing and electronic data interchange.
· Explore feasibility of converting to electronic claims processing or outsourcing function.
· Have comprehensive documentation of claims processing.
· Routinely monitor remittance information against claims data.
· Have an effective process for handling rejected claims.
· Aggregate and analyze data about rejected claims to improve claims processing.
· Become familiar with transaction standards and standard setting organizations.
Information security
· Ensure that organizational structures exist to develop and implement an information security program.
· Ensure that policies exist to control access to and the release of identifiable patient health information.
· Assign users of electronic health information unique access codes.
· Restrict users' access to only the information they need to do their jobs.
· If necessary, amend medical staff bylaws or rules and regulations to delineate physicians' responsibilities for protecting health information confidentiality.
· Ensure that employee handbooks outline each and employee's responsibility for protecting health information confidentiality.
· Train everyone with access to health information about confidentiality and their responsibilities
· Include confidentiality and information security provisions in all outsourcing contracts.
· Limit and record system and network managers and programmers access to patient information.
· Monitor access to information and develop corrective action plans for violation of organization policy.
· Perform risk assessments in an effort to continually improve systems security.
· Use informational resources, such as books, publications, and seminars to maintain cutting-edge knowledge of information security issues and industry response.
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