PREPARING FOR PCMH CERTIFICATION

WHILE MAINTAINING HIM

RESPONSIBILITIES
B Y:
T RACY H I N K L E

GOAL STATEMENT
The goal of the project is to learn how a Health
Information Department functions in a Physician
Practice while working to become PCMH certified.
This will be accomplished by assisting with the
practice in their day-to-day operations and
updating their records allowing them to run
reports required by PCHM.

PROJECT SCOPE
The scope of the project centers on assisting with the
preparation of PCMH Certification while maintaining day-today operations at Anderson Hills Pediatrics. The
responsibilities of the HIM department are:
Registration of newborns and transferred patients
Add prior medical history, allergies and medications in patients
charts
Physician credentialing process
Audit physicians charts checking for errors and consistency in
documentation
Scrub medical claims to validate correct payment
Scan medical records to patients charts
Release of information per HIPAA guidelines
Prepare for PCMH Certification

DELIVERABLES
Complete the following blank data field elements for PCMH reports:
Language from Blank to English
Race from Blank to Undetermined
Ethnicity from Blank to Other/Undetermined

Monitor/review new patient registrations

Prepare a paper record for release of information
Fax requested patient reports to Humana for HEDIS requests
Observe operation of front desk
Offer suggestions on ways the office could improve their daily work flow

RESOURCES
Centricity CPS 12 (EHR system used)
PCHM Website

PCMH Manual

Copier

Fax Machine

Health Information Specialist

RISKS

Following HIPAA guidelines

Locking computer when stepping away from desk
Faxes are to be sent to a secure fax line only
Emails consisting of patient information are sent through an
encrypted email or the patient portal

PATIENT CENTERED
MEDICAL HOME (PCMH)
Model of medical care that is patient centered
Care emphasizes on coordination of care and
communication to transform primary care into
what patients want it to be
Recognition is based on 6 measures
Anderson Hills Pediatrics is currently working on:

Measurement 1 - Patient Centered Access: Elements A, B and C

Measurement 2 - Team-Based Care: Elements A, C and D
Measurement 3 - Population Health Management: Elements A, C, D
Measurement 4 - Medication Management: Elements A & C
Measurement 6 - Performance Measurement and Quality
Improvement: Elements A, C & D

PCMH CHALLENGES
These 6 measures are to be achieved while performing day to day
operations
Anderson Hills did not have the appropriate software to run the
required PCMH reports
Once software was installed they quickly realized many records were
missing data for Language, Ethnicity and Race.
Required reports could not be run until these fields were complete
Front desk needed to begin filling in this data, even if the parents did
not document on their patient registration.
English, Other & Other are acceptable

TEAM-BASED CARE: CULTURALLY AND

LINGUISTICALLY APPROPRIATE SERVICES
This is Element 2C of Measurement 6 to show that Anderson
Hills Pediatrics engages in activities to understand and meet
the cultural and linguistic needs of its patient/families by:
1. Assessing the diversity of our patient population
2. Assessing the language needs of our patient population
3. Providing interpretation or bilingual services to meet the
language/communication needs of our patient population
4. Providing printed material in the appropriate languages for our
patient population.

REGISTRATION SCREEN

Patient demographics, Guarantor

& Insurance information is
entered on the Registration screen.
The 3 fields circled in red had to
be completed before any PCMH
Reports could be run.

PCHM
REPORT

Shows the number of parents who completed a developmental screening tool

for children 0-5 years of age.

PCHM
REPORT

Shows the screenings for Clinical Depression & Follow-Up Plan

PCHM
REPORT

Shows Immunizations for Adolescents

ADDING NEW MEDICATIONS

Signature alert for new

medication.

Alert icon indicating drug

interactions & contradictions

BILLING

Check codes to ensure no duplicate billing

BILLING
CONT.

BILLING
CONT.

SUMMARY
Learned about HIM within a physician office
Learned about PCMH Certification & the importance of
completing all fields with an EHR system
Prepared a paper record for release of information
Observed the billing and claim scrubbing process
Observed the registration process