Your eClinicalworks Support and Training may not cover medical practice basics.   However, most people in the industry should know the roles and lingo.  We pulled together some practice basics for those who don’t and entering the space without having gone to medical or nursing school. We show how an EMR integrates with overall workflow of a practice.    In this series of posts,  we will teach the workflow of a medical practice and groups plus dabble a bit into the eClinicalworks interface itself.

First, let’s begin with roles and titles within a small practice.

• Medical Assistants:
  • Medical assistants are the support staff for medical and health professionals whose responsibilities include taking vitals including blood pressure and pulse, recording medications, administering injections, and preparing lab tests among other duties.
  • Often times certifications and accreditation programs are available for these individuals
• Administrative Assistants:
  • This includes front desk receptionists, office coordinators, office managers, executive assistants, and patient services representatives
  • Administrative assistants are not medical assistants. They cannot do injections and vitals
• Physician Assistants:
  • People choose this path because it is a lot of what the doctor does but without all of the extra schooling requirements
  • Physician assistants cannot perform surgeries and are always under the supervision of a doctor.
• Physicians/Doctors
  • The term physician and/or doctor can relate to a wide range of various specialists in different fields and areas of focus. Here are just a few we work with and their specialities:
    • General Practitioner or Family Practice
      • This is your primary care physician before they redirect or refer you to a more specific specialist if you need more care
    • Otolaryngologist (ENT)
    • General Surgeon
    • Urologist

eClinicalworks Per Provider Model

• eClinicalworks EMR software pricing model is based on how many providers are at the practice.  Both Doctors and PA’s are considered “providers”.   The eClinicalworks cost associated with these providers may vary.  Practices make the mistake of having ten year ongoing subscriptions when they should have bought the service out right.  However, it may better a choice to place your EMR in the cloud as internet connections become more stable and hosting becomes more secure rather than hosting it on-premise.  Call eClinicalworks Support and Training staff at eClinicalworks for more details as we do not provide advice on this topic.

Insurance Carriers

Understanding a member’s insurance really gives insight on who gets what treatment at a practice.  Here are some popular insurance carriers names and plans in the San Diego region:

• Care First HMO
• Molina HMO
• Health Net HMO
• Community Heath Group (CHG) HMO
• Aetna Health HMO
• Sharp HMO
• Cigna HMO
• Blue Shield HMO
• Medi-cal (low income) HMO
• Medicare (65 and older) HMO

Certain individuals carry the PPO plan.   PPO plans are more expensive insurance plans that allow the patient to choose whatever doctor he or she wants.  Practices generally give priority to PPO unless the HMO carrier is bleeding out because the compensation for the visit is better. Commercial and PPO plans can reimburse about $80, while HMO plans reimburse at $20 for a similar service.

Capitated Contracts

• These are plans that allow a flat fee payment for each patient it covers. Under a capitation contract, an HMO or managed care organization will pay a fixed amount of money to the health care provider for its members.
• Medi-cal  (HMO) is under a Capitated Contract.  This particular practice receives Medi-Cal members on an annual basis.   2,000 members are received and Medi-cal requires the practice to contact them.  While this is done by the practice, calling 2,000 members is incredibly time consuming especially when the practice is basically being compensated a fixed, lower amount by Medi-Cal.

eClinicalworks Support and Training Staff Continued:

• Patient Outreach Programs

Additional eClinicalworks IT Support Resources:

• We provide the required Network and Security Assessments for HIPAA.
• HIPAA Audit: A Cautionary Tale From An Office Administrator
• HIPAA Compliance Questions
• eClinicalworks Medical Staff Roles, Insurance 101, and General Workflow Training
• eClinicalworks Patient Outreach Options
• eClinicalworks IT Support Contact Information and Additional Troubleshooting Services
• eClinicalworks Fax and Scan Support and basic workflow explained
• eClincialworks MODI and Body Images
• eClinicalworks Dymo Label Maker Setup and Troubleshooting Support
• eClinicalworks Network Scanner How To