About the eHealth Initiative and the Foundation for eHealth

What they are – How they work

By Staff Reporters

The eHealth Initiative and the Foundation for eHealth Initiative are independent, non-profit affiliated organizations, whose shared mission is to improve the quality, safety, and efficiency of healthcare information technology [HIT].

Protean Stakeholders

Both organizations are focused on engaging diverse stakeholders–including hospitals and other healthcare organizations, clinician, consumers and patient groups, employers and purchasers, health plans, manufacturers, public health agencies, academic and research institutions, and public sector stakeholders–to define and then implement specific actions that will address the quality, safety and efficiency challenges of domestic medical care through the use of interoperable HIT.

Membership

Since 2001, the eHealth Initiative has represented a diverse membership that is improving HIT. Over the years, eHI membership has grown to over 200 organizations.

Coalition Growth

In 2005, eHI launched the eHI Connecting Communities Membership, a rapidly growing coalition of leaders representing more than 200 state, regional and community-based initiatives focused on improving health through information exchange.

In 2009, eHI adopted the Information Therapy (Ix) Action Alliance. The IxAction Alliance, previously a part of the Center for Information Therapy – an eHI member – resides at the intersection of patient-centered care and HIT, focusing on issues relating to the prescription and use of targeted health information to help people make good health decisions and lead healthy lives.

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Assessment

The adoption of e-health initiatives promises to revolutionize health care in the United States by reducing errors, improving the quality of care delivered, reducing costs, and empowering consumers to better understand and address their own health care needs.

eHI is one of the few organization that represents all stakeholders in the industry. eHI advocates for the use of health IT that is practical, sustainable and addresses stakeholder needs, particularly those of patients.

Conclusion

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Risk Assessment of Medical Coding Services

Office of Inspector General

By Pati Trites MPA CHBC, with Staff Reporters

Any readers considering enrolling in a medical coding school should read this ME-P.

Why? Because the written policies and procedures concerning proper health insurance and Medicare coding should reflect the current reimbursement principles set forth in applicable statutes, regulations and Federal, State or private payer health care program requirements, and should be developed in tandem with organizational standards.

Furthermore, written policies and procedures should ensure that coding and billing are based on medical record documentation; which is now the “reality” rather than just a “reflection” of the reality.

Focus on the Codes

Particular attention should be paid to issues of appropriate diagnosis codes, CPT, DRG and MS-DRG coding, individual Medicare Part A and B claims (including documentation guidelines for evaluation and management services) and the use of patient discharge codes. The billing company should also institute a policy that all rejected claims pertaining to diagnosis and procedure codes be reviewed by the coder or the coding department. This should facilitate a reduction in similar errors.

Problem Areas

Among the risk areas that some billing companies who provide coding services should address are:

  • Internal coding practices;
  • “Assumption” coding;
  • Upcoding and Downcoding;
  • Alteration of medical records and documentation;
  • Coding without proper documentation of all physician and other professional services;
  • Billing for services provided by unqualified or unlicensed clinical personnel;
  • Availability of all necessary documentation at the time of coding; and
  • Employment of sanctioned individuals.

Assessment

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Billing companies that provide coding services should maintain an up-to-date user-friendly index for coding policies and procedures to ensure that specific information can be readily located.

Similarly, for billing companies which provide coding services, the physician-executive and billing company should assure that essential coding materials are readily accessible to all coding staff.

Finally, billing companies should emphasize in their standards the importance of safeguarding the confidentiality of medical, financial and other personal information in their possession.

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Conclusion

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