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July 1, 1998

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Medical-Records Management and Related Services

Medical-Records Management and Related Services

By Cary F. McGovern

Medical-records management is quite different from records management for all otherindustries, and it offers several unique opportunities. For some, the business climate maybe perfect for operating a records-storage business exclusively targeting the healthcareindustry. 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 ofrecords that are maintained for extended periods of time. The three most predominant areas follows: Patient files Business office records X-ray or imaging records.Patient files represent the medical record of a patient for one of four typicalmedical-service scenarios: in-patient stay, outpatient treatment, emergency-room visitsand home-healthcare. After the service is complete, each of these records is maintained inthe medical-records department under the control of its director. Business office filesrepresent the billing records of each patient service. One of these files is generated foreach patient service encounter. X-ray or imaging files represent files generated as aresult 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 otherhealthcare agencies and facilities--participate in the Joint Commission on Accreditationof Healthcare Organizations (JCAHO). This is a self-governing body that sets processstandards and benchmarks for hospitals to follow, including record-keeping requirements.Medicare and Medicaid, which are federally funded and regulated programs, also havestipulations regarding records. Medical-records directors normally have a degree in medical-records management andtypically have one of two certifications: registered records administrator (RRA) oraccredited records technician (ART). The RRA certification has rigorous educational andtesting requirements and is the higher-level certification of the two. An RRA is amanager, as well as information specialist, who interacts with medical, financial andadministrative staff to interpret data for patient care, research, statistical reportingand planning. An ART certification is generally required for the coding functions relatedto medical records. An ART is skilled in analyzing health information and examines medicalrecords for accuracy, reports patient data for reimbursement and creates diseaseregistries for researchers.Medical-record coding is a process that each medical file undergoes within 30 days ofthe conclusion of any service. The coding is to provide standardization to the diagnosticrelated groupings, an essential part of the hospital record-keeping requirement. Codinginsures that the hospital recovers the maximum amount allowed by Medicare and Medicaid andother insurance carriers.Hospitals maintain closed medical records for several years in the medical-recordsdepartment, then they package them for off-site storage. Lately, there is a trend to storemore current years of files off site because of space limitations on site in the fileroom. Commercial records centers have jumped at this opportunity and have adapted theirstorage 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. Description 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: General, psychiatric, children's and rehabilitation hospitals; Healthcare networks, including health plans, integrated delivery networks and preferred provider organizations; Home-care organizations, including those that provide home-health services, personal care and support services, home infusion and other pharmacy services, durable medical equipment services, and hospice services; Nursing homes and other long-term-care facilities, including sub-acute-care programs, dementia programs and long term care pharmacies; Behavioral healthcare organizations, including those that provide mental health, chemical dependency, and mental retardation/developmental disabilities services for patients of various ages in various organized service settings and managed behavioral healthcare organizations; Ambulatory care providers, including outpatient surgery facilities, rehabilitation centers, infusion centers, group practices and others; and Clinical laboratories. Source: The JCAHO Web site at www.jcaho.com Special RequirementsMedical 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 twodigits of the file number. Commercial-records centers mirror these filing systems inopen-shelf filing. The files are kept on shelves rather than in boxes because there is ahigh volume of retrievals. Charges for this service are generally assessed by the linearfoot rather than by the cubic foot. Additionally, it is common for the full service ofpick-up and delivery charges to be bundled with the storage cost. Service requests arelikely to be emergency delivery requirements called "STAT" in the healthcareindustry. 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 childbecomes an adult. These and other more specialized files have long-term value and offerthe 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. Thisprotection is usually in the form of temperature and humidity control. X-ray files areheavy 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 thatextracts the silver content from the film. Release of InformationEvery healthcare organization is required to release medical information to patients,insurance carriers with patient approval and attorneys who have court orders approved forthe release. This practice is called release of information. It most commonlyrequires an RRA or an ART to oversee the release process. It is important that onlyapproved records be copied and released. Most states regulate the cost of copies for thispractice. In many states the cost is $1 per page up to 25 pages, then 25 cents per copyabove that. Needless to say, it is a very profitable business. Several companies have beenin the release-of-information business. You may encounter Healthcare CorrespondenceCorporation or SMART. Both of these companies operate in hundreds of hospitals around theUnited States. These companies normally service the customer within the medical-recordsfile room, collect the fee or bill for the service, and share some of the profit with thehospital.File-Room ManagementIf you manage the off-site files for a hospital, you may want to provide the system andmanpower for on-site file-room management. It is essentially the same service, but withmore activity. File-room management will be discussed more completely in next month'scolumn. If you need a more comprehensive discussion of this service, you can find areference on the File Managers Inc. Web site at www.fileman.com.  DRG Coding Diagnostic-related grouping coding is a function that can be outsourced to thecommercial records center. This service requires specific expertise and great care.Service providers have consolidated this function into their services and have therebyadded value to their healthcare records management services.A Warning of SortsYou should always keep in mind that records management has many related services thatcan be provided as individual services or as packaged sets of services. It is essentialthat the commercial-records center owner/manager understands the service requirements ofthe 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 FileManagers Inc., a records-management consulting firm that also provides outsourcingservices, file-room management and litigation support services for the legal industry. Formore 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: [email protected] or Web: <ahref="http://www.fileman.com">www.fileman.com.

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