For many people, an EMR is merely a digital copy of a patient’s health chart prepared by a clinician. However, with advancement in technology EMR has slowly started moving towards EHR – a system that allows ACOs to do much more than maintain soft copies of patient records.
ACOs, or Accountable Care Organizations, are steadily growing in number. As their popularity continues to rise and they gear up to capture a large chunk of the market share in the healthcare industry, their needs have evolved too. Electronic Medical Record or EMR, an essential requirement for any healthcare facility, no longer fits the bill when it comes to serving the requirements of large entities like ACOs. Such organizations have much higher expectations from this tool. A vanilla solution that only acts as a digital warehouse for storing patient charts is, therefore, not sufficient. It is vital to have a much more sophisticated approach to tie the various healthcare practices and physicians who come together to form an ACO so that they can function smoothly as a single organism. At this point, the EMR system metamorphoses into an EHR (Electronic Health Record). Some functions of this all-in-one solution are as follows:
- Credentialing – A new-age EMR system includes automated credentialing which helps in ascertaining appropriate billing and enables an organization to make accurate financial projections.
- Auditing and Pre Billing – Features like MRA calculators, HEDIS criteria billing, and creating projections for funding are all part of the new system.
- Referrals – Managing referrals better by linking them to utilization and reviewing the financial implications of managed care are both possible using a sophisticated EMR system.
- Business Intelligence – Smart systems help physicians recover their CPT levels by suggesting document improvements and preventing cloning of claims. They also assist in the area of HEDIS, MRA, utilization management, compliance, data analysis, reporting, and financial reviews.
- Clearing House Functions – Well-designed EMRs directly connect with plans and eliminate the middlemen. This link helps in ensuring that the claims reach the payers, expenses are controlled, and lesser effort and time is spent on processing claims and preparing MRA and HEDIS data.
- Reporting – An advanced EMR system can generate reports that are sent to CMS periodically by ACOs and PCMHs, making it an easier task.
If things continue to progress at this rate, the day is not far when a physician’s office will depend entirely on an EMR system for almost all administrative tasks. Such state-of-the-art EMR technology will possess enough potential to help physicians lower costs, optimize profitability, and provide much better service.
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