Assignment 1: You are interviewing for a position with a hospital to lead a new Electronic Medical Record (EMR) system search and meeting with the Business Office Director tomorrow. She asked you to p

HIT/450 v4

HIT/450 Case Study: EMR System Upgrade

The Business Office Director of ABC Healthcare has called a meeting to discuss a new Center for Medicare and Medicare System (CMS) regulation. It is your job as the project manager to assess the regulation, the current state of the system abilities, and determine what the project will entail. This regulation requires the following:

1. The professional billing claim to be submitted with a procedure code representing a bundle of services (99999)

2. The Electronic Medical Record system to record the individual procedure codes as dictated by the provider. (81000, 84436,85025)

When there is only one Diagnosis Code (DX) of E66.9 The current Electronic Medical Record (EMR) system does not have the ability to identify a segment of codes and bundle them into one code, so a new system must be selected. It must be determined which IT systems will be affected, which is the most appropriate solution to the problem, and what the detailed business requirements will be to ensure the desired outcome. The system must be able to bundle only when all identified procedure codes are complete, when one or more DX codes are present in the chronic ill list provided by CMS, and only for selected payors. For this reason, new functionality is needed in both the EMR and the practice management system. The new regulation requirements impact the patient service documentation requirements (medical necessity, provider dictation, and other supporting document for the services), the billing claims, and payment posting processes.

• The provider (system user) will be documenting each procedure code by service when the service is completed.

• The provider will need guidance on the regulation requirements and if there are any changes he/she will need to make in the process completed to record procedure codes.

• The billing system will need to be able to reflect the procedure codes as individual codes for when services are provided independently. It also needs to reflect when the services are not for a Medicare or Medicaid patient to meet the reimbursement requirements for the commercial and contracted services.

• The system will need the ability to apply a bundle code (combined services) payment by electronic transaction to a procedure code listed individually. The system will need to do this accurately without applying incorrect amounts due by the patient.

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