The electronic health record system is intended to go beyond the data collected in a provider’s office and will entail a more comprehensive patient history. The EHRs will allow the patient's health records to move with them to other specialists, hospitals and health care providers. The system will enhance free choice of clinicians hence foster coordination with private and public community-based programs for children, infants, adolescents, and adults. It will also include a scope of services which will include preventive, behavioral, emergency, inpatient, acute and chronic illnesses and home health care (Middleton, 2015). The system will support an insurance coverage that ensures patients get access to affordable and comprehensive quality care.
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A regular, uniform mode of communication for all parties involved in health care including insurance payers, providers, government agencies and clearinghouses will be established as stipulated in the administrative simplification. All electronic transactions will be performed as a type of Electronic Data Interchange Approved by the Accredited Standards Committee X12(ASC X12) (Reich, 2014). The use of National Provider Identifier will be mandatory to provide an efficient universal shorthand for identifying a vital part of the healthcare process. An internal audit will be carried out to help recognize and prevent potential problems in events of external audits. An in-depth edit will be carried out for both presubmission claims and claims that have been adjudicated. The audit process will shed light on non-compliant aspects and provide resolutions to eliminate areas of non-compliance (Reich, 2014). The process will entail a healthcare provider submitting and doing a follow-up process on claims with the health insurance companies in order to receive payment for any services rendered to patients covered such as treatments. After the doctor has treated the patient, a diagnosis and procedure codes will be signed hence assist the insurance company to determine the coverage and medical necessity of the services provided. …show more content…
The medical personnel includes physicians, nurses, surgeons, dental hygienists, health aides, medical transcriptionists and home health aides (Reich, 2014). The EHR helps in organizing and improving every moment of care, they keep providers productive and focused on patients by surfacing the most relevant data to help providers make informed decisions. It also ensures that the provider is not overwhelmed by data entry tasks hence providing effective services. Knowledge gained from the EHR system helps in guiding providers to improve their performance. Providers are coached based benchmarking from across the network to improve use, efficiency, and ROI. It also helps the performance teams to embed program requirements into the workflow to inform care decisions and automate quality measure satisfaction (Kocher, 2012). The introduction of ACOs programs into an existing Medicaid managed care needs to assign responsibilities between ACOs and MCOs. EHR fosters successful delineation of responsibilities between the different healthcare providers which hence supports ACOs and MCOs in complementing
A regular, uniform mode of communication for all parties involved in health care including insurance payers, providers, government agencies and clearinghouses will be established as stipulated in the administrative simplification. All electronic transactions will be performed as a type of Electronic Data Interchange Approved by the Accredited Standards Committee X12(ASC X12) (Reich, 2014). The use of National Provider Identifier will be mandatory to provide an efficient universal shorthand for identifying a vital part of the healthcare process. An internal audit will be carried out to help recognize and prevent potential problems in events of external audits. An in-depth edit will be carried out for both presubmission claims and claims that have been adjudicated. The audit process will shed light on non-compliant aspects and provide resolutions to eliminate areas of non-compliance (Reich, 2014). The process will entail a healthcare provider submitting and doing a follow-up process on claims with the health insurance companies in order to receive payment for any services rendered to patients covered such as treatments. After the doctor has treated the patient, a diagnosis and procedure codes will be signed hence assist the insurance company to determine the coverage and medical necessity of the services provided. …show more content…
The medical personnel includes physicians, nurses, surgeons, dental hygienists, health aides, medical transcriptionists and home health aides (Reich, 2014). The EHR helps in organizing and improving every moment of care, they keep providers productive and focused on patients by surfacing the most relevant data to help providers make informed decisions. It also ensures that the provider is not overwhelmed by data entry tasks hence providing effective services. Knowledge gained from the EHR system helps in guiding providers to improve their performance. Providers are coached based benchmarking from across the network to improve use, efficiency, and ROI. It also helps the performance teams to embed program requirements into the workflow to inform care decisions and automate quality measure satisfaction (Kocher, 2012). The introduction of ACOs programs into an existing Medicaid managed care needs to assign responsibilities between ACOs and MCOs. EHR fosters successful delineation of responsibilities between the different healthcare providers which hence supports ACOs and MCOs in complementing