Tag: electronic data interchange

3 Best Practices For Implementing A New EHR, PM System

By Jessica Kojima, vice president of professional services, AdvancedMD.

Jessica Kojima

Medical providers often battle inefficient and piecemeal software configurations that constitute the technological lifelines of their practices. Even if current solutions aren’t integrated to meet their needs, they sometimes feel it is easier to stick with what they’ve got instead of considering the possibility of upheaval.

Staying current—or better yet, striving for innovation—often comes at a price of temporary disruption for providers and staff. But if a new electronic health record (EHR) and practice management (PM) system are implemented with proper planning and stakeholder buy-in, the practice can realize true efficiency without substantial disruption.

Here are three best practices for implementing a new EHR or PM system for medical practices to minimize disruption.

Consider the big picture

Before the EHR/PM implementation process kicks off, the practice should assess the effectiveness of its clinical and administrative workflows. A practice that wants to cram a new EHR or PM into an existing workflow that isn’t working is thinking short-term. It’s important to consider “big picture” goals and aim to improve bad processes and optimize productivity. An effective approach will realize efficiencies across an entire practice versus one function or role. By considering the importance of productivity optimization across the whole operation, a holistic and integrated approach will enable growth and improvement for both patients and staff.

Preparing for payer migration

While considering the practice’s overall goals, the practice must also perform a payer analysis. A new PM system will require new Electronic Data Interchange (EDI) agreement enrollments to electronically submit and receive claims, remittance, eligibility, and claims status, which differ from payer to payer. This is often a forgotten aspect of moving to a new practice management system, and is arguably the most critical change. The practice should have the following items ready well before implementation:

Many payers also require online registrations, voided checks, letters on specific letterhead—to name a few—to process an agreement. This demands timely attention by a designated individual in the practice for a seamless enrollment process. The practice should also set a “go-live” date to start submitting transactions through the new system. Preparing adequately in the weeks ahead of implementation will enable a timely kickoff of the new system.

Focus on people

Instinctively, an EHR and PM implementation might seem to be all about the software technology. Not so: it’s about the people. It’s vital that a medical practice identifies an implementation champion who will be responsible for both supporting and managing the transition. Depending on how aggressive the go-live goal is, the practice may need a practice management and a clinical champion to ensure all of the configuration and training occurs simultaneously. The champion’s role is to listen to every staff member affected by the transition and communicate openly with the team about why the switch is being made and how the leadership will support them. Ideally, everyone agrees on the approach, objectives, and expected outcomes.

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The State of Electronic Healthcare Transactions in Workers’ Compensation

Tina Greene
Tina Greene

Tina Greene, Senior Regulatory Affairs Consultant, Casualty Solutions Group, Regulatory Affairs and Compliance at Mitchell International.

The Administrative Simplification provisions of the Federal Health Insurance Portability and Accountability Act of 1996 (HIPAA, Title II) include requirements that national standards for electronic health care transactions be established. These standards were adopted to improve the efficiency and effectiveness of the nation’s health care system by encouraging the widespread use of electronic data interchange in health care.

In the final rule, it’s recognized that:

“Non-HIPAA entities such as workers’ compensation programs and property and casualty insurance accept electronic healthcare transactions from providers, however, the Congress did not include these programs in the definition of a health plan under section 1171 of the Act.

The statutory definition of a health plan does not specifically include workers’ compensation programs, property and casualty programs, or disability insurance programs, and, consequently, we are not requiring them to comply with the standards. However, to the extent that these programs perform healthcare claims processing activities using an electronic standard, it would benefit these programs and their healthcare providers to use the standard we adopt.”

“Health Insurance Reform: Standards for Electronic Transactions; Announcement of Designated Standard Maintenance Organizations; Final Rule and Notice.” Federal Register 65:160 (17 August 2000) p. 50319.

In an effort to realize the effectiveness of electronic data interchange, some states have adopted regulations requiring electronic healthcare transactions for billing and payment. Early implementers of EDI for workers’ compensation in various states identified issues such as payer ID (claim administrator identification), claim filing indicator code and claim number, and worked with stakeholders to find resolutions. These issues have since been addressed in industry standards.

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