Over the last few decades, modern use of standardized terminologies has addressed safety, quality and cost problems in most health care facilities. This report will find out how EpiCare Electronic Health Records (EHRs) are used to identify and prevent fraudulent medical billing practices.
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Electronic Health Records
These reports provide a network-based interface for storing and reviewing data between healthcare organizations. The main purposes of EHRs include: improving the quality and convenience of care, enhancing patient participation, boosting the accuracy of diagnoses, and reorganizing billing requirements of the health maintenance system. Its capacity of storing data ensures good governance of patient’s information by making available real-time and updated information for both clinicians and patients.
EpiCare EHRs are supplied by Epic, a private company dealing with healthcare IT solutions by providing software solutions. The software was created to define effective adoption of electronic health records with the intention of supporting patient care related functions such as registration, clinical appointments, laboratory data and billing information for insurers. It conforms to an automated documentation and reporting system accessible to numerous venues in the healthcare organization. The software serves big and medium medical organizations and hospitals. Almost half of the system users are specialized clinicians and caregivers in social services.
Functions of EpiCare
EpiCare has clinical structures such as the ambulatory function that combines management and documentation of patient data into a swift system capable of adjusting to the user’s preferences. For example, CareConnect is an electronic health record system providing physicians with registration, planning and billing services. The scheme applies epic health EHR software to improve the quality of care by streamlining health care facilities’ workflow and improving fiscal performance. Most significantly, all health care providers including insurers are able to access health records from different places (“MultiCare Health System” par 2-3).
Through the resolute professional billing, epic systems get rid of inaccurate claims by allowing paperless collection processes and streamlined data entry. The billing system easily traces revenue across all health care systems. It also configures claims to satisfy insurers and payers through a single card to simplify follow-up. As a result, fresh and accurate financial claims are created – leading to timely and exact payments. The system works by analyzing information from clinical systems submitting all claims. Comprehensive financial reporting creates an avenue, through which insurers can detect, anticipate and prosecute fraud cases without delays. Coyne, the principal executive officer of ISO believes “Software applications can track daily activity, to-do lists, time, mileage, and expenses” (par. 16). This process provides special investigating units with information to eliminate any natural processes that could contribute to fraud before they happen.
Technical requirements of EHRs
In order to ensure data of patients is protected and stored effectively, EHR systems keep data in a structured format to allow retrieval and transfer of the patient’s information. Thus, providers are entitled to use EHR systems that can aid patient care, and continuous stream information. The Office of the National Coordinator (ONC) of Health IT sets requirements that regulate and assess the EHR technologies in order to attain meaningful use. The principal goal of ‘meaningful use’ is to advance the increase of digitized health records and improve health care (Blumenthal 2).
For technologies to achieve the meaningful function, they must be operational and useful. This facilitates health providers to record complete and accurate healthcare information, access and use recorded data for diagnosis, and share information more easily (Ciampa and Revels 11). The systems should adopt simplified solutions and be able to protect the secrecy and security of interoperability. This ensures public confidence is maintained and health information is safe from identity thieves.
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EHRs should be able to use hardware and software to manage and manipulate both data and information. They are required to have spyware tracking software, which is used to monitor user behaviors, and thus collect stolen and fraudulent information (Ciampa and Revels 227). Medical interfaces enable efficiency in sharing data between organizations. The interoperability of the technology among insurance providers and healthcare is significant in enhancing management of fraudulent activities. This characteristic offers a plan, through which both patients and insurers are able to validate entered data. Thus, the model enables the acceptance of validated pay and not ‘pay and chase’ as was the case earlier. Its interoperability also increases information access to numerous venues in the health care system.
Consequences of EHRs to Healthcare
Health care fraud takes place when individuals or institutions provide forged healthcare information with the intention of gaining unauthorized profits. Most actions are characterized by falsified, distorted and misrepresented billing information leading to defraud of the Medicare/ Medicaid system and other private insurance institutions. The seriousness of falsified medical records becomes significant when improper treatment arising from misrepresented medical history places them at a health risk. In spite of this, the health care industry has applied the economic consumption of advanced technologies in the prevention, identification and prosecution of fraudulent medical billing practices across providers and facilities.
Hospital Information Systems boost the interchange of data between healthcare systems and roles by combining modern care delivery models and financial compensation. In order to improve the efficiency of digitized health records and better health maintenance, EHR technologies must attain meaningful use. This facilitates health providers to enter complete and accurate care and financial information, access and use recorded data for diagnosis, and share information more easily. In addition, healthcare facilities receive incentives from Medicare and Medicaid to adopt the use of EHRs and adopt health programs.
Ciampa, Mark, and Mark Revels. Introduction to Healthcare Information Technology. Boston, MA: Cengage Learning, 2012. Print.
Coyne, Frank. n.d. ” Technology Advancements to Fight Insurance Fraud”. n.d. Web.
Blumenthal, David. 2014. “Patients & Families.” PDF File. Web.
“MultiCare Health System”. 2007. Web.