Healthcare Information Systems and Technology
Systems that carry the encounter
Access work runs on the EHR and its integrations. Know the electronic transaction set: 270/271 is eligibility request and response, 276/277 is claim status, 278 is prior authorization, 837 is the claim, and 835 is the remittance advice. Real-time eligibility queries the payer at registration and returns active coverage, copay, remaining deductible, and network status.
Concepts to name
- Master patient index and its enterprise version; duplicates and overlays are the primary threat to data integrity, and prevention starts with a two-identifier search at registration.
- ADT messages feeding the EHR, billing, and case management; HL7 messaging and FHIR APIs for exchange.
- Role-based access and audit trails: access must be job-related; credentials are never shared, and viewing a VIP or coworker record is sanctionable even when the system technically allows it.
- Downtime procedures: paper forms, manual logs, and back-entry after restoration, held to the same accuracy standards.
- Security safeguards: encryption, unique logins, multi-factor authentication, phishing awareness, workstation locking, and secure handling of scanned documents and portal accounts.
Traps in questions
Mixing up 270/271 with 276/277 is the classic error. Others: assuming system access rights define what is permitted (they do not, job role and minimum necessary do), treating downtime paper records as exempt from data entry, or using the patient portal to disclose to an unverified proxy.
Worked example
Registration returns an eligibility response of coverage not found. Before asking the patient to pay cash, verify spelling, member ID, and group number; check the payer's product line or sub-scope; confirm the effective date against the date of service; and rerun the 270. Document the response, and if it fails again, call the payer and record the reference number. That audit trail is the evidence the verification was attempted.