In what instances would a dual system be necessary? What impact, if any, will ICD-10-CM/PCS have on transcription? What about form redesign? Find out the answers to your colleagues' ICD-10 implementation questions.
There are some Joint Commission EPs with which almost all hospital HIM departments struggle. Surveyors continue to focus on them, so chances are you should too.
When President Obama signed into law the HITECH Act as part of ARRA in February 2009, it meant a bevy of changes to the existing HIPAA Privacy, Security, and Enforcement Rules.
Legible.Complete.Dated, timed, signed, and authenticated.That's what section 482.24 of the Medicare Conditions of Participation requires of your medical records.
Somewhere between the third urgent item on your to-do list, getting your budgets prepared, and responding to the latest auditor's requests lies the omnipresent responsibility of nurturing the validity of the medical record. HIM professionals have traditionally been the legal custodians of the record. (After all, who else is daring enough to testify in court on the accuracy of the EHR?) Have we also by default become the custodians of data integrity?
Hardware, software, people, policy, and process must work together to achieve your organization's EHR goals. One of the earliest matters that policy must address surrounds organizational readiness for an EHR. In fact, having a policy of regular readiness assessment is an important step toward success. Even if a certain project with a certain group goes smoothly, that doesn't guarantee success for another project. You may think a policy that focuses attention on planning is not necessary, but implementing an EHR is a spiral of change, with each cycle repeating itself in many ways, often with new twists and turns.
