Electronic Health Records An Audit and Internal Control Guide

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ISBN: 9780470258200 | 0470258209
Cover: Hardcover
Copyright: 8/11/2008

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This book focuses on the infrastructure of an electronic health record and the impact that the government's new criteria will have on the private and public marketplace. Walking readers through what to look for in a health care record management system, it includes implementation tips and other helpful guidance.

Preface
About the Author
Acknowledgments
Introduction
Market Background
E-Health
How is Electronic Information Created?Information Technology Considerations
How is Health Information Created?Review of Primary HCC Market Players
Patients
Providers
Third Party Vendors
Payers
Review of HCC Secondary Market Players
Major Initiative for E-Health
Audit Implication Overview
Industry Application
Public Uses
Private Uses
Information Continuum
Market Standards and Initiatives
Agency for Healthcare Research and Quality
Health Level Seven
Certification Commission for Healthcare Information Technology
Department of Defense Records Management Program
Association of Records Managers and Administrators
Audit Implication Overview
Impact of E-Health on Case Management
Financial Picture
Hospital-Based FCM Application
Background Information and Provider Perspective
Problem: Getting Paid Correctly for Services Provided
Findings
Additional Findings
Summary
Consumer-Based FCM Application
Market Problems: The Industry as It Operates Today
Consumer FCM Model
Healthcare Portfolio Application
Virtual Case Management
VCM Payer Model
VCM Patient Model
VCM Hospital Model
VCM Physician Model
VCM Allied Health Services
VCM Nontraditional Health Services Model
VCM Other Business Services Model
Audit Implication Overview
Data in an E-Health Environment
Data Library
Data Intelligence
New Data
More New Data
Processed Data
Data Warehouse
Audit Implication Overview
Algorithms
Background
Understanding Algorithms
Data Elements
Case Study
Algorithm SelectionAuditor Implication Overview
Data-Driven Health Decisions in an E-Health Environment
Knowledge Models
Primary Healthcare Continuum
Secondary Healthcare Continuum
Information Continuum
Third-Party Vendor Knowledge Model
Knowledge Models For White-Collar and Organized Crime
Sample Identity Theft Case
Medical Identity Theft
Medical Identity Theft - Definition
How Medical Identity Theft Occurs
Damages To Primary Victims
Medical Identity Theft From A Consumer Perspective
When The Consumer Is Not Aware
When The Consumer Is Involved
When An Individual Wants Products Or Services
Damages To Secondary Victims
Medical Identity Theft From An Entity's Perspective
Auditor Considerations
Sample Fraud Case
Sample Pharmaceutical Fraud Case
Audit Implication Overview
Examples Of Worldwide Activity
Analytic Tools and Audit Checklists
E-Health And Healthcare Business Processes
Patient Business Process
Financial Case Management Advocacy
Clinical Case Management Advocacy
Provider Business Process
Lack Of Electronic Internal Controls
Lack Of Internal Controls With User Identity
Lack Of Internal Controls For Services Provided And Charged
Payer Business Process
Use And Loss Of Health Information - Handling Subcontracted Vendors
Lack Of Insurance - Processing Fraudulent Claims For Enrolled Beneficiaries
Plan Sponsor Business Process
Employee Working Environments
Employer Increase In Healthcare Expenditures
Third-Party Vendor Business Process
Problem Increase In Pharmaceutic
Table of Contents provided by Publisher. All Rights Reserved.

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Electronic Health Records An Audit and Internal Control Guide

Summary

Author Biography

Table of Contents

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Electronic Health Records An Audit and Internal Control Guide

Summary

Author Biography

Table of Contents

Supplemental Materials

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