Review Figure 10.1 on p. 239 and the section "Billing Workflow" on pp. 238 to 239 of your textbook Health Information and Technology Management.
Write a 150- to 350-word response to the following:
• Discuss at least two components described in the "Billing Workflow" section in Ch. 10 of Health Information and Technology Management.
• How do these components affect health care reimbursement?
EDI Reference Guide
Imagine you are the office manager at a small doctor's office. As the office manager, you are in charge of educating new hires.
Write a 700- to 1,050-word reference guide describing electronic data interchange (EDI).
Include the following in your summary:
• Define EDI.
• Explain how using EDI facilitates electronic transactions.
• Explain how HIPAA has changed how health care information is transmitted in EDI.
• Describe the relationship between Electronic Health Records, reimbursement, HIPAA, and EDI transactions.
Cite a minimum of two outside sources. For additional information on how to properly cite your sources check out the Reference and Citation Generator resource in the Center for Writing Excellence.
Format your paper according to APA guidelines.
1. Watch and summarize the "Patient Confidentiality and HIPAA" video located in this week's Electronic Reserve Readings.
2. Review and summarize the "Assuring Privacy in Electronic Health Information Exchange" presentation from the Department of Health and Human Services.
3. Week 5 Overview Reflection
Week 5 Electronic Reading
1. Daniel, G. W., Ewen, E., Willey, V. J., Reese, C. L., Shirazi, F., & Malone, D. C. (2010). Efficiency and economic benefits of a payer-based electronic health record in an emergency department. Academic Emergency Medicine, 17(8), 824-833.
2. Goedert, J. (2010). EDI issues move up the priority list. Health Data Management, 18(2), 46-50.
3. Mir, S. S. (2011). HIPAA privacy rule: Maintaining the confidentiality of medical records. Journal of Health Care Compliance, 13(2), 5-14.
4. Cinema House Films Inc., 2006: Patient Confidentiality and HIPAA (3:51). [Video File]. Films On Demand.
5. .Nevco Educational Video Inc, 2012: The Case for HIPAA Risk Assessments (38:05). [Video File]. Films On Demand.
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Weekly Overview
Week Five
Overview
Week Five will introduce you to Electronic Data Interchange (EDI) and the Health Insurance Portability and Accountability Act of 1996 (HIPAA). EDI is used in health care to standardize electronic transactions so that electronic information being sent from one computer system to another will be the same. EDI is comprised of eight transactions, each of which are mandated by HIPAA.
HIPAA was enacted by Congress in 1996 to address the security and privacy of patient health information. HIPAA protects a patient's health information from unauthorized use while allowing patients to still receive the care that they need. Regardless of what area of health care you work in, you will use HIPAA. While dealing with patient information of any kind, you will be regulated by HIPAA on how to properly handle the information to ensure that it is kept private and safe.
What you will cover
1. Secure health care transactions and billing
a. Describe how electronic data interchange transactions work.
1) They are mandated by HIPAA
2) They standardize electronic transactions so that all information systems can send and receive the same electronic transactions
b. Describe the billing workflow.
1) Verifying insurance eligibility
2) Billing third party plans
3) Use of codes and patient registration
4) Claims
5) Payment and patient accounts
6) Coordination of benefit claims (COB)
7) Copays and EOB
c. Identify HIPAA privacy requirements.
1) A patient's identification can only be shared with authorized health care providers
2) A patient's identification and health information must be kept out of public view
3) Must receive patient's consent when patient information must be shared with others
4) Annual HIPAA training and education
5) Mobile storage devices that pose a risk and management of data contained therein:
a) Thumb drives
b) Memory cards
c) Tablets and phones
6) Minimization of risks
a) Security Officer: A position within the health care organization that is required by HIPAA. Responsible for development, implementation, and adherence to these policies and procedures. Responsible for tracking and handling security breaches and incidents.
d. Discuss the relationship between EHR, reimbursement, HIPPA, and EDI transactions.
1) How has HIPAA changed how health care information is stored and accessed within the EHR?
2) How has HIPAA changed how information is transmitted through EDI?
3) Describe how EDI facilitates electronic transactions.
4) What are the effects of HIPAA on EDI?
1. Read and summarize the HIPAA for Professionals page from the U.S. Department of Health and Human Services website.
2.Read and Summarizethe HITECH Act Enforcement Interim Final Rule page from the U.S. Department of Health and Human Services website.
3.Review and summarizethe Privacy and Security section in the healthIT.gov website.