By Cary F. McGovern
Medical-records management is quite different from records management for all other industries, and it offers several unique opportunities. For some, the business climate may be perfect for operating a records-storage business exclusively targeting the healthcare industry. If so, it's crucial to understand the nature of the beast.
The Nature of Medical Records
In the healthcare industry, there are several types that comprise the great volume of records that are maintained for extended periods of time. The three most predominant are as follows:
- Patient files
- Business office records
- X-ray or imaging records.
Patient files represent the medical record of a patient for one of four typical medical-service scenarios: in-patient stay, outpatient treatment, emergency-room visits and home-healthcare. After the service is complete, each of these records is maintained in the medical-records department under the control of its director. Business office files represent the billing records of each patient service. One of these files is generated for each patient service encounter. X-ray or imaging files represent files generated as a result of an X-ray, MRI or CAT Scan. These are related to both of the other files.
Hospitals are highly regulated organizations. They--along with clinics and other healthcare agencies and facilities--participate in the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). This is a self-governing body that sets process standards and benchmarks for hospitals to follow, including record-keeping requirements. Medicare and Medicaid, which are federally funded and regulated programs, also have stipulations regarding records.
Medical-records directors normally have a degree in medical-records management and typically have one of two certifications: registered records administrator (RRA) or accredited records technician (ART). The RRA certification has rigorous educational and testing requirements and is the higher-level certification of the two. An RRA is a manager, as well as information specialist, who interacts with medical, financial and administrative staff to interpret data for patient care, research, statistical reporting and planning. An ART certification is generally required for the coding functions related to medical records. An ART is skilled in analyzing health information and examines medical records for accuracy, reports patient data for reimbursement and creates disease registries for researchers.
Medical-record coding is a process that each medical file undergoes within 30 days of the conclusion of any service. The coding is to provide standardization to the diagnostic related groupings, an essential part of the hospital record-keeping requirement. Coding insures that the hospital recovers the maximum amount allowed by Medicare and Medicaid and other insurance carriers.
Hospitals maintain closed medical records for several years in the medical-records department, then they package them for off-site storage. Lately, there is a trend to store more current years of files off site because of space limitations on site in the file room. Commercial records centers have jumped at this opportunity and have adapted their storage and retrieval business to the requirements of the healthcare industry.
The Joint Commission on Accreditation of Healthcare Organizations
The mission of the JCAHO is to improve the quality of care provided to the public through the provision of healthcare accreditation and related services that support performance improvement in healthcare organizations.
The Joint Commission evaluates and accredits more than 18,000 healthcare organizations and programs in the United States. An independent, not-for-profit organization, the commission is the nation's predominant standards-setting and accrediting body in healthcare. Since 1951, the Joint Commission has developed state-of-the-art, professionally based standards and evaluated the compliance of healthcare organizations against these benchmarks. Commission evaluation and accreditation services are provided for the following:
Source: The JCAHO Web site at www.jcaho.com
Medical records are usually filed in terminal-digit order by year of service. Terminal-digit filing allows for filing in groups of 100 or 1,000, based upon the last two digits of the file number. Commercial-records centers mirror these filing systems in open-shelf filing. The files are kept on shelves rather than in boxes because there is a high volume of retrievals. Charges for this service are generally assessed by the linear foot rather than by the cubic foot. Additionally, it is common for the full service of pick-up and delivery charges to be bundled with the storage cost. Service requests are likely to be emergency delivery requirements called "STAT" in the healthcare industry. This requires 24-hour-a-day, seven-day-a-week availability.
Pediatric records have a retention period of 21 years or are held until the child becomes an adult. These and other more specialized files have long-term value and offer the commercial-records center the opportunity for long-term storage of files.
X-ray files are a type of film media and, therefore, require special protection. This protection is usually in the form of temperature and humidity control. X-ray files are heavy by comparison to standard record files because of the silver content of the film. Special racking is required to support the weight and size of these special files. Healthcare organizations recycle their old X-ray files through a third-party vendor that extracts the silver content from the film.
Release of Information
Every healthcare organization is required to release medical information to patients, insurance carriers with patient approval and attorneys who have court orders approved for the release. This practice is called release of information. It most commonly requires an RRA or an ART to oversee the release process. It is important that only approved records be copied and released. Most states regulate the cost of copies for this practice. In many states the cost is $1 per page up to 25 pages, then 25 cents per copy above that. Needless to say, it is a very profitable business. Several companies have been in the release-of-information business. You may encounter Healthcare Correspondence Corporation or SMART. Both of these companies operate in hundreds of hospitals around the United States. These companies normally service the customer within the medical-records file room, collect the fee or bill for the service, and share some of the profit with the hospital.
If you manage the off-site files for a hospital, you may want to provide the system and manpower for on-site file-room management. It is essentially the same service, but with more activity. File-room management will be discussed more completely in next month's column. If you need a more comprehensive discussion of this service, you can find a reference on the File Managers Inc. Web site at www.fileman.com.
Diagnostic-related grouping coding is a function that can be outsourced to the commercial records center. This service requires specific expertise and great care. Service providers have consolidated this function into their services and have thereby added value to their healthcare records management services.
A Warning of Sorts
You should always keep in mind that records management has many related services that can be provided as individual services or as packaged sets of services. It is essential that the commercial-records center owner/manager understands the service requirements of the organization and hires the appropriate experts needed to provide these services.
Medical Record Administrator
Medical record administrators plan the systems for developing, acquiring, storing and retrieving or releasing records and the information in them. They are responsible for directing the department responsible for keeping patients' medical records and compiling medical statistics for the healthcare facility; supervising medical-record technicians and clerical staff; increasingly acting as health information analyst and broker. A description of work activities includes: designing systems for clinical records; planning procedures to collect clinical records; processing medical records and data; assisting clinical staff in evaluating quality of care; and releasing medical records to authorized personnel.
Source: University of Missouri School for medical records directors
Regular columnist Cary F. McGovern is a certified records manager and owner of File Managers Inc., a records-management consulting firm that also provides outsourcing services, file-room management and litigation support services for the legal industry. For more information about records management, contact Mr. McGovern at File Managers Inc., P.O. Box 1178, Abita Springs, LA 70420; phone (504) 871-0092; fax (504) 893-1751; e-mail: firstname.lastname@example.org or Web: www.fileman.com.