EHR on Coding and Reimbursement

¶ … EHR on Coding and Reimbursement Systems

What is EHR? - Definition and Background Information

Coding Systems - What is coding and how is it used?

Reimbursement Systems - How is reimbursement addressed in the medical field?

Literature on EHR

Beard: Changes in Reimbursement Systems

Classen: Computerized Provider Order Entry Systems

Scott: EHR and Kaiser Permanente

Romano: EHR and Clinical Decision Support Systems

The future of EHR

What EHR Means for the Future of Health Records

How Health Records Affect Medical Treatment

Coding and the Future of Medicine

Reimbursement Systems and Electronic Records

Summary of Literature Information

Summary of the Future of EHR

The Impact of EHR on Coding and Reimbursement Systems

The medical acronym EHR is short for Electronic Medical Records. These are records that are stored on computers and are accessible online. They are very well-protected, and they cannot be accessed by just anyone. Fortunately, though, they can be accessed quickly and efficiently by medical professionals all over the world. When a person comes into a medical facility, that person's medical record is available electronically. This can be very important - even life and death - when it comes to treating a person for a serious illness or an accident or injury. Medical records used to be only paper, and it was not possible for them to be sent almost instantaneously to another part of the country or the world. With EHR, patients can have more protection against problems such as allergies of which the medical team would not otherwise be aware, and that can give the patients some peace of mind when it comes to whether doctors will be able to treat them efficiently and protect them from further harm.

Now that EHR is becoming more popular and is more widely used, it is beginning to affect coding and reimbursement systems throughout the medical community. Coding addresses the input of medical information to a patient's chart. There are codes for all kinds of medical issues, and that makes the input of information faster and less prone to error. Because of that, individuals who work in the coding department of any hospital or medical facility are significant members of the medical team. They also have a hand in reimbursement from insurance companies, because they must code the patient's condition and procedures correctly in order for the hospital to see that reimbursement. An error in coding means a lack of reimbursement from insurance, but EHR is a better, safer way to ensure that everyone's codes are the same and that each medical problem and procedure is coded correctly for reimbursement and for the patient's protection.

In the reimbursement system study that was done by Beard (1997), it was shown that health care has changed drastically in the last 25 years. The way that patients and insurance companies are billed for services, and the way in which medical facilities charge for services, are both very different now than they were in the past. Because of that, the process is becoming more streamlined and it is easier to manage the system - which results in a better, faster, and less expensive process (Beard, 1997). Future changes to health care reimbursement models can only help the process to become even better than it currently is, allowing for more help for more patients who need medical care. The way that providers order what they need to continue in the medical profession is also a part of handling medical practices electronically (Classen, Avery, & Bates, 2007). Even though it is only used in approximately 15% of hospitals and an even smaller number of clinics, it is one of the marvels that is paving the way for more medical records to be handled and stored online (Classen, Avery, & Bates, 2007).

Companies like Kaiser Permanente are also getting involved with EHR. A recent study that was done in Hawaii showed, however, that doctors were actually slower at treating patients and updating their information when they used electronic recordkeeping (Scott, et al., 2005). In addition, there was some concern as to whether the records would be safe and whether software problems or other electronic slow-downs would keep doctors from getting (and providing) information as quickly as could be done with paper charts (Scott, et al., 2005). Romano and Stafford (2010) stated that their study did not show an increase in quality when EHR was used. That was a concern, because the opposite conclusion was expected. However, even though the question of how well EHR will perform in the future has been raised by several studies, the use of it is still increasing in medical settings that have more than one doctor as opposed to solo practices.

The future of EHR is strong, despite some setbacks. As more and more hospitals and medical facilities work toward protecting their patients and streamlining their processes for insurance and for availability of records by other medical professionals, electronic heath records will continue to be used. Protecting those records from hackers is vital, but this is an area in which EHR has so far been able to excel. Health records can affect the medical treatment that a person receives, because he or she may not be in a position to tell the doctor and nurses everything that is wrong or everything to which he or she is allergic. When patients are not able to communicate those things and they do not have someone available to advocate for them, the only other way to get that information is through their medical records. Patients who do not have medical records accessible through EHR may not have the same level of treatment and security as patients who have electronic records that can be used by the hospital or other medical facility to more easily discover their problems.