Lesson 18 - Technology and Health Care

* clean claim form

A claim form without errors

* Direct deposit

A method by which a payer can have money placed into a provider's account

scanner

A scanner is a device that you may not be as familiar with. The scanner reads a document, much like a fax machine, and sends the image to the computer. Once in the computer, the image can be sent to other computers. The scanner can be used to read hard copies of patient records and charts. These can then be stored on the computer as part of the patient's electronic medical file. The scanner used to be quite expensive but is now widely available. It is often sold as part of an all-in-one machine, which combines a copier, fax machine, scanner and printer in one unit.

* modem

Allows you to submit claims electronically via computer

remote services

As you know, medical assistants, medical claims and billing specialists, medical coding specialists and medical transcriptionists depend on one another in their jobs. The roles of each specialist are like links in a chain. All are equally important and all are dependent on the others to succeed. Because the specialists' roles are intertwined, medical professionals have benefited from technology that remotely connects them no matter where they are. In fact, some medical transcriptionists and medical coders work from home, but are connected to the physician's office or to other medical professionals via the computer. After breakfast, Jack heads downstairs to his home office to begin his day at 9:00 a.m. Jack logs onto the shared drive that all the transcriptionists in his company have access to. The shared drive has folders for the transcription service's clients—various clinics and doctors' offices in the area. The physicians in many of the offices and clinics carry a digital hand-held device so they can dictate their information directly into it. These sound files are then loaded onto the shared drive and saved into the corresponding clinic or doctor's office folders. Jack opens up one of the sound files that he needs to transcribe. He uses a special program that is connected to the patients' electronic health records (EHRs). After Jack is finished typing it, he saves it to the patient's chart on the computer and moves the sound file into a folder for the finished reports. Once the transcribed report is saved in the patient's chart, it goes back to the physician for a signature. The physician opens up the report and signs it electronically. Then Jack is ready to start another report! Jack appreciates this technology because he doesn't have to type all of the physician's notes. Most of the time, Jack only has to transcribe portions of the report. He also appreciates the time the technology saves. Jack no longer drives around town to pick up tapes from all the different doctors' office and clinics. Jack doesn't have to drop off reports. Instead, everything is done electronically. If an office uses paper charts rather than electronic health records, Jack and his transcription company use the sound files to transcribe, but then the office prints a copy of the report for the patient's paper chart. Now let's meet Melanie, who is an independent medical coder. Melanie is one of many remote coders in her company who work online in distant locations. The company finds work for them to code. Melanie likes the flexibility of her job in that she can decide when and how much she wants to work. Melanie wakes up around 5:00 a.m. to get a few hours of work in before her two young children wake up. She brews a pot of coffee, pours a cup and sits down at her computer. Melanie checks her e-mail, which contains plenty of work for her day. She starts with a superbill indicating a patient came in for a broken finger, as well as transcription documenting how the x-ray was performed and the radiologist's reading of the x-ray. Melanie applies the correct codes for the diagnosis and the procedure and then sends these codes to the medical claims and billing specialist at the physician's office, who sends the codes to the insurance company.

* coding and billing

Assigns codes and creates insurance claims

* web-based claim submission

Claim submitted via a carrier's Web site

* Clearinghouse

Company that facilitates the processing of claims

computer hardware

Computer hardware includes the physical pieces of equipment that sit on your desk. These pieces are part of a team of components that work together, allowing the computer to perform necessary functions. Let's look first at the "brain" of the computer. The central processing unit, or CPU, houses all of the computer's circuitry. Memory size and computing speed determine the CPU's power. How fast can you add 243 + 360? Five seconds? Ten? This is the speed of your brain's processor. The processor of a computer works the same way—it is the brain inside the computer. The processor takes the input it is given and uses software instructions to manipulate the data. The faster the processor, the faster the computer works. But speed means nothing if the computer can't retain the information.

* word processing

Creates documents

database management

Databases are like a very long grocery list. Each item on the list—milk, eggs, lettuce—is an individual record. The database management program can look at each record, or item, compare it to the other records in the database, and arrange it according to the user's instructions. The record does not have to be one word. It can be a phrase, like "16 oz. can of cream of mushroom soup," or it can be a patient's home address. Within a record are fields. Fields are the individual pieces of the record. The patient's street address is a field, her city is a field, her state is a field and her ZIP code is a field. Each bit of information that you want to be able to sort has to be in its own field. This is how the program sorts the records. You tell it which field to search, and what to look for, and it will pull up the records containing the criteria in that particular field. Because of the speed at which a database program can find and sort large amounts of information, it saves a tremendous amount of time. Databases are used as address books, calendars and telephone directories. As we mentioned previously, databases can hold huge amounts of data and can access all of this information quickly by using the search feature. The search function reads the user's instructions for what field to search, and for what word to search, and finds every record with that word in that field in a matter of seconds. For instance, you may need to contact every patient who needs to schedule his annual prostate exam. You can search the database for all male patients between the ages of 30 and 70, and the computer will give you all the records that fit that criteria. You can then print out the list. You can even merge the database records with your word processing program and print out a postcard to each patient! Obviously, the database must be kept current, or it loses its effectiveness. New information should be entered into the database on a regular basis to keep the most up-to-date information. Records regarding patients who are no longer treated by the practice can be marked appropriately so the computer knows that the file is no longer active. When used properly, a computer's database management program can organize and retrieve information in a way unmatched by other methods of storing data.

electronic transactions save money

Every instance where electronic transactions reduce the time spent processing transactions can, of course, be translated into cost savings for your office and your patients. For instance, the estimated per-claim savings of processing claims electronically instead of manually is: $1.49 per claim for physicians $1 per claim for health plans $.86 per claim for hospitals $.83 per claim for others Filing claims electronically can also save valuable time. It takes days for paper claims to be delivered through the mail system, not to mention that there is no proof when you send a claim that it was received. Once the claim is delivered, the insurance company must digitize the information for its system and then process the claim. Finally, the insurance company mails an EOB and the reimbursement. In contrast, submitting a claim electronically is comparable to picking up the telephone and calling the insurance company. The claim is received instantly, already digitized. Processing can begin immediately. With electronic filing, you have proof of timely filing and can check the status of claims with just a few keystrokes on your computer. The reimbursement can be completed even more quickly with direct deposit. Direct deposit is a process through which money is electronically deposited into a bank account. To pay a claim, the insurance company authorizes its bank to transfer funds into the physician's bank account. This is all done electronically, via computers, with no actual cash or checks changing hands. The new world of electronic claims presents many opportunities for medical professionals. Software helps eliminate errors, track claims and other medical records and improves the speed of submission and reimbursement of claims. Electronic claims can make life in the medical office easier.

* Operating system

In charge of the routine functions of the computer

* payers

Insurance companies

clearinghouses

It all starts when a medical claims and billing specialist takes the encounter forms from the previous day and enters their data in to the computer. Once all the codes and charges are entered, the claims are batched together and divided into groups. One group consists of claims that must be sent to the insurance companies; the other consists of bills that must be sent to patients. Let's look at the claims that need to be sent to the insurance company first. Billers who work in a physician's office or hospital file claims to many different insurance companies or payers. Most of them want to receive their claims electronically. There are several options for filing claims electronically. The provider can either contract with a clearinghouse—a company that facilitates the processing of claims information in to standardized formats, then submits the claims to the appropriate insurance companies—or file directly to the insurance companies, which is called a carrier-direct submission. The claim information can also be directly entered in to the insurance carrier's Web site as a Web-based claim submission. If the provider uses a clearinghouse, the biller will prepare claims with medical billing software. Then, the program will convert the data the biller entered in to files on the computer. The software exports the files into a format that the clearinghouse can receive. The provider's software must be compatible with the clearinghouse. Once the claims are exported into the system, the software sorts them according to payers. Most clearinghouses have the ability to check for errors. If a claim has an error, the clearinghouse will send a report with the needed correction. The biller can then make the correction and resubmit the claim. A claim without errors is called clean. The clearinghouse then forwards the clean claims to the appropriate payers for processing. If there are claims that cannot be sent electronically, the biller can either print and send a paper claim or the clearinghouse can send the paper claim on the provider's behalf. The clearinghouse downloads reports indicating how many claims it received and when the claims were forwarded to the payers. Insurance carriers will report to the clearinghouse when they receive the claims. These reports are important for timely filing and insurance claim follow-up. After the insurance company receives the claim from the clearinghouse, it processes and pays (or rejects) that claim. Sometimes insurance companies notify the provider of a rejected claim on payment vouchers they send to providers. Other times, payers notify the provider of rejected claims through the electronic reports that are transmitted to the clearinghouse.

coding and billing software

Medical coding refers to assigning standardized, unique numbers to every possible diagnosis and treatment that can occur. As you can imagine, the coding manuals contain a lot of numbers! As a patient receives care, the physician usually uses a checklist for common diagnoses and procedures, or dictates notes that detail the diagnosis and prescribed treatment. After the notes have been transcribed, the medical coder converts the diagnoses and procedures (the treatment given) into codes to be submitted to the patient's insurance company. Coding ensures that the doctor is paid for the services she performs and that the patient is charged fairly and impartially. Software is available that checks the coder's work for inaccuracies, and can also suggest procedure code options for a particular diagnosis code. The medical billing process consists of taking the codes and entering them in the appropriate places on an insurance claim form. Fortunately, the universal insurance claim form CMS-1500 has become fairly standard, but there are still several agencies, mostly governmental, that require a different format. There are several requirements that the physician's medical biller must fulfill before the bill can be submitted for payment. The procedure codes must "match" or be appropriate for the diagnosis code that is given, and other information must be submitted before the insurance company will pay the bill. The process is fairly complicated, and computers have become almost a necessity when it comes to fulfilling each insurance provider's requirements when submitting a bill. Medical bills, known as claims when they are sent to an insurance company, are rarely on paper. Most are sent as electronic files over the Internet. To create an insurance claim, all of the appropriate codes and patient information are entered into the computer. The billing software then determines the amount of the claim by using the codes. Each code has a standardized cost associated with it. The program then adds all of the services together and creates the claim on the appropriate claim form. At this point, the program can also create a billing statement for the patient. The patient's statement reflects the amount due based on what the doctor expects to receive from the patient's insurance company, and the amount the patient is responsible for based on his particular insurance plan. Each plan has terms that specify how much the patient pays and how much the insurance provider pays for medical care. The billing software also accounts for the particular insurance plan's payment terms.

* Paper claims

Non-electronic claim forms

* per-claim charge

One type of fee that a clearinghouse charges to submit claims

* database management

Organizes lists of information

* scheduling

Organizes patient and staff appointments

cable and satellite connections

Some medical offices use modems, while others access the Internet through cables, satellite connections or through a wireless connection to another computer. Cable and satellite Internet are similar to cable television and satellite television subscription services used in many homes. They can be faster at processing the information than a modem and telephone line arrangement. Many offices are using a mixture of the options available. A computer can connect to the Internet via telephone lines and a modem. Other computers can then connect to the main computer wirelessly and also have access to the Internet.

telephone lines

Telephone lines are in fact considered computer hardware when used in connection with a computer modem. The modem (short for modulator-demodulator) is like a translator for the computer that allows it to connect with the Internet. Information leaves the computer as a digital signal; however, telephone lines can only accept information as an analog signal. The modem converts the digital data to analog data so that it can be transmitted. When information is being sent to the computer, the modem turns the analog data into digital data so that the computer can process it. So, with information leaving and returning to the computer along them, telephone lines can be considered input and output devices! The modem itself can be inside the computer or set up as an attachment at a later time.

connectivity

The Internet can be described as: "A network of such [computers], connected to one another by wide-band communication lines" which provided "the functions of present-day libraries together with anticipated advances in information storage and retrieval and [other] symbiotic functions."—J.C.R. Licklider5 It's hard to believe that this description was written in 1960, thirty years before the Internet became common knowledge. A fundamental pioneer in the call for a global network, J.C.R. Licklider, articulated the idea in his January 1960 paper, "Man-Computer Symbiosis." This definition still applies today. Worded a little differently, the Internet is a vast worldwide network of interconnected computer systems. Initially, universities used it to share research information, but in 1979, CompuServe became the first service to offer electronic mail (e-mail) capabilities and technical support to personal computer users.6 The Internet has now grown into a media that markets goods, provides information to the public and sells products online. As a medical assistant, you can use the Internet to keep abreast of changes in your profession or to research patients' questions. E-mail is an electronic method of communicating. Via the Internet, you are able to send and receive messages from other Internet users. E-mail is a very efficient and effective way to communicate with physicians and insurance carriers.

computer memory

The amount of information a computer can hold depends on how much memory it has. There are three different types of memory: RAM (random access memory), ROM (read-only memory) and data storage memory. Random Access Memory - RAM is the memory that the computer uses to process what you are telling it to do at that particular moment. When you turn the computer off, the RAM empties itself. When you use the computer again, the RAM doesn't remember what you've done during previous uses. Read-only memory - ROM, on the other hand, holds the information that runs the computer. It stores the information that has been installed by the manufacturer to tell the computer what to do with all the attached hardware. This information is in permanent memory even when the computer is off. Because of the important data stored in ROM, its contents can't be altered. RAM and ROM sizes need to be large enough to operate the complicated medical software used in the healthcare industry. RAM and ROM are chips which are attached to memory cards. These memory cards are attached to a circuit board called the motherboard. The motherboard acts as a relay center for the computer. It sends messages from the software to the hardware and then back again. The motherboard helps all the computer parts communicate with each other so the computer will work properly. Data storage memory - Data storage memory is just that—the hardware devices that allow you to save large amounts of information that can be accessed when needed. It takes the place of rooms full of file cabinets, cabinets full of files, files full of papers and papers full of typewritten data. The days of intricate and eccentric filing methods are over. No longer can one person dominate the way that an office navigates its storage and filing needs. The computer is set up to store and manage information in a logical and user friendly format, which is an easy system to learn and maintain. The filing and storage software chosen by a particular office may differ from that of another office, but the purpose remains the same. Different computers using different software programs use the same hardware to save information. Computers come with a hard drive and usually, a CD-RW or DVD±RW drive already installed. The hard drive is the main storage device, and is installed inside the computer. The hard drive stores all of the software applications that the user can access. Different programs used to be loaded into the computer each time they were needed. Now that they are stored in the computer on the hard drive, the programs are easier to use. The hard drive needs to have ample space available for storage purposes. The CD-RW and DVD±RW drives are portable storage methods. Both are optical drives, but their formats are different. The CD or DVD drive records data from the computer onto a compact disk (CD), or a digital video/versatile disk (DVD). Either disk can then be taken to another computer with a compatible drive, and the disk can be read and saved by that computer. An older form of device is called a floppy drive. Floppy drives are portable storage devices as well, but use different storage media. The most common of these is the 3.5" drive, which holds about 1.4 megabytes (MB) of data. There are also Zip drives®, Jaz drives®, flash drives and tape drives, which we will discuss in a moment. Each uses a different storage media, and holds varying amounts of information. Computer manufacturers are offering fewer models with floppy disk drives, as more customers increasingly prefer the CD-RW or DVD±RW drive. The DVD can hold substantially more data than any other type of portable storage drive—4.7 gigabytes (GB) or more. The CD can hold about 700 MB, and is used by most software companies, so you have to have a CD drive to load the software. There are now CD/DVD±RW drives, which can read and write to both CDs and DVDs. All of these devices can be added to the computer as an attachment, or peripheral device. Adding extra components can increase the data storage capabilities of a computer with limited storage space.

* Digitizing

The process of entering data into a computer record

* Carrier-direct submission

When a provider files a claim directly to the insurance company

peripheral hardware

When all of the inside hardware is working together, other pieces can be plugged into the computer to enhance its capabilities. You are probably already familiar with some of these devices, such as the monitor, keyboard, mouse and printer. These devices connect to the motherboard through different types of ports on the back of the CPU. These forms of computer hardware have become increasingly user oriented. Monitors can have antiglare screens that protect against eyestrain and keyboards have been designed to combat carpal tunnel syndrome. Printers have become more reliable and easier to use, and your mouse may even be wireless.

scheduling software

When office staff scheduled appointments without the aid of a computer, they often handwrote multiple copies of the office's patient schedule. The front desk needed a copy, the doctor wanted a copy and his nurse wanted a copy. They probably used a pencil to make preliminary appointments and then copied the list in pen, or with a typewriter, for permanent record keeping. Scheduling software is easy to navigate and keep organized. Patient information can be entered as needed or retrieved from the computer's database. A database is a software program that can hold and organize a large amount of information.

operating system software

When you turn on a computer, a screen pops up and you begin your tasks. At that moment, you are interacting with the computer's operating system. The operating system is in charge of the routine functions of the computer. There are different types of operating system software, produced by competing companies. Microsoft® and Apple® make the two most popular operating systems.2 Microsoft's Windows® operating system is used in most medical offices. There are lively debates about which operating system performs best, but they are both able to achieve the goals of a medical practice. These systems are so popular because of their user-friendly designs. They are both arranged to process and display information in a way that feels natural to the user—they think the way you do. After you turn on the computer and it has finished its startup process, you will see a screen called the desktop. The desktop is a screen with graphic icons representing often-used software programs, files, folders and hardware managers, arranged in rows to make them easy to find. To access the information or program, you simply double-click on the icon and it opens the program or file that you requested. At the bottom of the screen is a toolbar that tells you what programs are running and what files are open on the computer. You'll notice a start button on the left corner of the toolbar. The start button gives you access to all of the rest of the computer's contents—you don't want everything on your desktop or you won't be able to find anything! This is the place to go to find a program that does not appear on the desktop. While you type data into the computer, you must save it frequently to avoid losing the information due to a power outage or other disruption. When you click on save, you have the option to save the new information on the hard drive, a disk, or another storage device, such as a flash drive. Do you recall Mr. Johnson, who was patiently waiting for his medical records? All of his records are divided into computer files that are located in a computer folder. Like a folder in an actual file cabinet that holds lots of different reports, notes, and charts, a computer folder organizes all of Mr. Johnson's files so you can access all of the information you have—billing information, medical charts, health history, even insurance information—on Mr. Johnson in one location. Usually a folder is retrieved by opening the program that you plan to use the folder in, and then clicking on the folder name from a list. Another list appears, showing all of the files that are held inside of the folder. These files can be opened, edited, moved, printed or deleted. Be sure to choose the correct action for the desired result. You don't want to select delete if what you really wanted to do was print! To help Mr. Johnson get his records, you simply open his folder and print out each file onto paper. You know that the same information has been backed up on microfilm, but you find it quicker and easier to just print the files from the computer.

word processing

Word processing programs allow you to create documents on the computer much like you would using a typewriter. On a computer, though, changes to the text and the addition of graphics are much, much easier. Typewriters require a lot of manual adjustments and corrections. When using a word processing program, spelling and grammar can be checked and corrected instantly. Whole documents can be formatted and aligned just by clicking a few buttons. These programs are widely used in the medical office. An icon on the computer's desktop represents the word processing program. It can also be located using the computer's menu of programs by using the Start button. Usually the program automatically takes you to a blank document, surrounded by toolbars and help tools displayed on the screen. You then start typing and formatting your new document, save it and print it. Many times you will open an existing document, make a few changes to the document you want, and then save and print it. This is called a template. Every time the document format is needed, the template acts as a shortcut—you just fill in different information in the same document each time. When starting with a blank screen, certain default settings, such as text size, font style and margins are automatically set. Word processing programs allow the user to change these settings to fit her specific needs. An administrative letter is formatted much differently than an interoffice memo. Word processing programs make formatting and styling documents much simpler tasks. Whole sections of text can be moved after they have already been typed by using the cut and paste functions of the program. Graphics can be scanned in and appropriately placed. What used to take hours using a typewriter, scissors and glue can now be done in a fraction of the time.

backup of information

a copy of all the information on the computer's hard drive. Backups are best kept away from the source computer, in a cool and dry place. A fireproof safe is a good place to store the backup media. Backup storage employs different types of media than when you are merely transferring data or storing a small amount of information. Magnetic tape is a thin ribbon of plastic tape coated with iron oxide that can record data, just like the tape used in audio and video cassettes. It is an economical way to store large amounts of information, but the backup process is very slow. Many businesses that use magnetic tape run their backup programs overnight. A flash drive can hold several gigabytes of data, yet is about the size of a tube of lipstick. It plugs into a Universal System Bus (USB) port, which makes it very user-friendly. Most computers are now sold with USB ports on the front of the CPU, or even on the monitor. Zip drive and Jaz drive disks are flat and square like a 3.5" disk, but are thicker and hold more information—anywhere from 100 to 2,000 MB of data.

computer network

a group of computers that are set up to communicate with each other and can access the same files and resources. Each computer has a certain amount of memory and disk space. These terms refer to the amount of information that can be stored and processed by that computer. Memory is measured in gigabytes and megabytes.

direct deposit

a process through which money is electronically deposited into a bank account. To pay a claim, the insurance company authorizes its bank to transfer funds into the physician's bank account. This is all done electronically, via computers, with no actual cash or checks changing hands.

byte

a unit of measure of computer memory or disk storage space equal to that needed to store a single character.

* A _____ _____ is a group of computers that communicate with each other and can access the same files.

computer network

electronic claims

digitized insurance claims transmitted from a computer using a modem to the insurance company or a clearinghouse. What does digitized mean? Well, when data is entered into a computer record, you are digitizing the information. You can digitize data from a healthcare form simply by using software and entering the required information.

* _____ is the physical components that work together to make a computer run.

hardware

gigabyte

is 1,024 megabytes.

megabyte

is 1,048,576 bytes

* A computer's _____ is measured in megabytes and gigabytes.

memory

* Hardware such as a printer, mouse and keyboard are considered _____ hardware.

peripheral

software

refers to applications, loaded into the computer, that give directions to the hardware. Without the software, the hardware doesn't know what to do!

hardware

refers to the physical components that work together to keep a computer functioning.

* _____ is applications loaded into the computer that tell it what to do.

software

spreadsheet software

uses columns and rows to organize information. A spreadsheet can also perform mathematical equations, make comparisons and sort data. Spreadsheets are a good way to illustrate large amounts of information for easy reference.