Comparative Health Information Management 4th Edition Peden Solutions Manual

Comparative Health Information
Management 4th Edition Peden

Solutions Manual
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CHAPTER 7
Mental Health: Long-Term and Acute Services
ANSWERS TO KNOWLEDGE-BASED QUESTIONS
1. Explain the difference between serious emotional disturbance and serious mental
illness.
Answer:
Serious emotional disturbance is a condition in which a young person (from birth to
age 18) has a diagnosable mental, behavioral, or emotional disorder resulting in
functional impairment that substantially interferes with or limits the child’s role or
functioning in family, school, or community activities. Serious mental illness (SMI) is
a condition in which a person has a diagnosable mental, behavioral, or emotional
disorder resulting in functional impairment that substantially interferes with or limits
one or more major life activities. The term SMI is usually applied to adults with an
illness that results from a chemical imbalance in the brain.
2. Name the three most prevalent types of serious mental illness.
Answer:
The most prevalent types of mental illness are schizophrenia, bipolar disorder (manic
depression), and clinical depression.
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Peden 7 - 1
3. What are two categories of dual diagnosis?
Answer:
Two categories of dual diagnosis are mental illness with mental
retardation/intellectual disability and mental illness with chemical addiction.
4. Give a term by which persons with mental illness who are living in the community
prefer to be called.
Answer:
Most persons with mental illness living in the community prefer to be termed mental
health consumers. (Note: The term “patient” is still appropriate for persons admitted
to an inpatient psychiatric hospital.)
5. Define “outpatient commitment.”
Answer:
Outpatient commitment is the judicial diversion, from inpatient to outpatient care, of
a person who has been certified as in need of psychiatric care, with stipulations
regarding behaviors such as taking medications, remaining sober, and maintaining
residence in a designated place. Failure to abide by the stipulations generally results
in involuntary commitment to an inpatient facility.
6. What are the main components of the mental health consumer case record?
Answer:
The main components of a mental health consumer’s case record are assessment,
treatment plan, progress notes, and discharge summary.
Peden 7 - 2
7. What is the basis for payment in the inpatient psychiatric facility prospective payment
system (IPF PPS)?
Answer:
Under the IPF PPS, inpatient psychiatric facilities (IPFs) receive per diem payments
that are adjusted up or down by four patient-level factors:
• The patient’s age (increasingly higher rates for patients age 45 and older through
age 80 and above)
• Variable per diem adjustments (higher per diem payments for the first days of the
patient’s stay, gradually decreasing through the 22nd day of hospitalization, with
no further decrease beyond that point)
• The Medicare severity diagnosis related group (MS-DRG) for the stay
• Certain co-morbidities. (Only one co-morbidity adjustment is made for each co-
morbidity category, but adjustments for more than one co-morbidity category are
possible.)
8. What is the relationship between the treatment plan and progress notes, and why is it
important?
Answer:
Progress notes document progress toward goals specified in the treatment plan.
Accreditation surveyors often check to see that every goal in a treatment plan has
corresponding progress notes. Progress notes also indicate that the treatment plan has
been reviewed and updated as necessary.
Peden 7 - 3
9. How did the “duty to warn” originate, and how does it affect confidentiality of mental
health information?
Answer:
The “duty to warn” originated with a 1976 court decision (Tarasoff v. Regents of the
University of California), which held that a therapist has an obligation to warn
persons against whom their clients make threatening statements, regardless of the fact
that such threats are made within a privileged context. Since this court decision, there
has been a trend to legislate “duty to warn” clauses into the states’ laws regarding
confidentiality.
10. What are the URS tables?
Answer:
The Uniform Reporting System (URS) tables are a set of tables by which each State
Mental Health Authority (SMHA) reports aggregate data to SAMHSA.
11. Provide examples of the national outcome measures (NOMs) for which client-level
data are reported.
Answer:
Employment/school attendance; stability in housing; criminal justice involvement;
readmission to state hospital; access/capacity: number of persons served with
demographic characteristics
Peden 7 - 4
ANSWERS TO CRITICAL THINKING QUESTIONS
1. Discuss how the mental health consumer empowerment movement may have affected
development of mental health data collection systems.
Answer:
Student answers may vary. Key points that the students may recognize are that the
consumer empowerment movement has led to consumer involvement in a number of
aspects of mental health planning and programming. Emphasis is placed on consumer
satisfaction; therefore, data collection includes outcome measures that are geared
toward determining consumer satisfaction with services. For example, “client-
centered” outcomes are included in the data that are collected and reported by the
states.
In considering data collected for the individual consumer’s record, there is
emphasis on documentation indicating consumer involvement in the treatment
planning process.
2. Discuss some of the areas in mental health services into which health information
managers may expand their roles.
Answer:
Increased use of electronic information systems within the community mental health
centers suggests that there will be a growing need for individuals with expertise in
computer applications and development of management information systems. The
complexity of billing sources within the mental health centers further suggests that a
Peden 7 - 5
specialization within health information management can be developed. Another area
is in the entrepreneurial sector, such as acting as consultant for the development of
management information systems designed to meet individual program needs and in
developing and marketing software for these purposes. Health information managers
with experience in the mental health field may move into higher administrative
positions, particularly if they obtain an appropriate graduate degree.
CASE STUDY
You are the director of health information services for a community mental health center
that is planning to expand its use of electronic information systems. You have been asked
to serve on the steering committee that will be guiding this initiative.
SUGGESTED RESPONSES TO THE CASE STUDY
1. What types of electronic systems might the committee investigate?
Answer:
Student answers may vary. From study of previous chapters, students may realize that
electronic information systems for patient registration and appointment scheduling
can be very beneficial. Coding and billing software, including edit checks to assist
with the submission of “clean claims,” is also helpful.
Students may focus on what would be needed in an electronic health record
(EHR) for a behavioral health facility. The EHR would need to accommodate the
special documentation requirements of a community mental health center, including
assessments, treatment plans, and progress notes. A case management module would
Peden 7 - 6
also be needed. Medication management and e-prescribing can be beneficial because
of the importance of medication in treatment of individuals with mental illness.
Appropriate reporting capabilities, including the ability to develop ad hoc reports
would be helpful in collecting aggregate data for the State Mental Health Authority
for the Uniform Reporting System tables.
Also, as de-identified client-level data begins to be required for reporting, a
system capable of producing such data would be needed. Obviously, any system
selected would need to meet appropriate standards for privacy and security of
protected health information. Because psychotherapy notes receive special protection
under HIPAA, the ability to provide enhanced security for these notes is very
important.
2. What special considerations might there be for a community mental health center
embarking on this project?
Answer:
Although behavioral health facilities were not included in the initial EHR incentive
program, students may choose to include “meaningful use” criteria in their list of
requirements for an electronic health record. Because the meaningful use criteria will
be changing by stages, the instructor may want to check the website of the Office of
the National Coordinator for Health Information Technology at healthit.hhs.gov for
the most current information on meaningful use.
Students may expand their list of ideas beyond those presented here by listing
other types of electronic information systems or modules along with an appropriate
Peden 7 - 7
rationale for inclusion of each.
Highlights from AHIMA Curricular Competencies
I. Domain: Data Content, Structure, & Standards (Information Governance)
Chapter 7 discusses various accreditation programs for behavioral health services
along with regulatory requirements for psychiatric hospitals. Documentation
requirements specific to mental health services are explained. The chapter also
covers the prospective payment system for inpatient psychiatric hospitals, along
with an introduction to the Diagnostic and Statistical Manual of Mental Disorders
(DSM). Other classification systems included in this chapter are ICD and
CPT/HCPCS. This chapter discusses the various means of delivery of mental
health services and how the service model has changed over time from a previous
emphasis on institutional services to the current community-based model. The
chapter also outlines the roles of various providers and disciplines in planning and
rendering treatment to consumers of mental health services.
II. Domain: Information Protection: Access, Disclosure, Archival, Privacy, &
Security
The chapter provides information on legal and regulatory requirements related to
mental health. Privacy and confidentiality in mental health care is emphasized,
including the impact of Tarasoff v. Regents of the University of California, on
patient privacy by creating a “duty to warn.” HIPAA in mental health settings is
discussed.
Peden 7 - 8
III. Domain: Informatics, Analytics, and Data Use
Chapter 7 describes various outcomes measures used in the mental health field,
including a discussion of the CMHS Mental Health Block Grant National
Outcome Measures (NOMS). The chapter also points out the emphasis on
consumer satisfaction as a component in evaluating the quality of Mental Health
Services. Aggregate benchmarking data is available at the state level through the
Uniform Reporting System (URS). The chapter describes quality management,
utilization management, and risk management issues in mental health. Chapter 7
discusses information technology innovations such as telepsychiatry and tele-
mental health. The increasing adoption of electronic health record (EHR) systems
and specific features that are useful in mental health, such as electronic
monitoring of progress notes and their correlation to the treatment plan, are also
noted. The case study for the chapter focuses on features of electronic information
systems that would be helpful to a community mental health center. HIE in mental
health is discussed.
IV. Domain: Revenue Management
Chapter 7 provides an explanation of various funding sources for mental health
services, including the inpatient psychiatric facility prospective payment system.
Understanding how mental health services are funded provides a foundation for
understanding the revenue cycle in a mental health organization, whether
outpatient or inpatient.
V. Domain: Compliance
Peden 7 - 9
Continuous quality improvement process is described. Performance improvement
in TJC accreditation is discussed. The mental health setting must comply with
regulations at the state and federal level.
VI. Leadership
The role of a HIM professional in a mental health setting is provided in the “Role
of the HIM Professional” section of the chapter.
Peden 7 - 10

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Comparative Health Information

Management 4th Edition Peden

Mental Health: Long-Term and Acute Services

ANSWERS TO KNOWLEDGE-BASED QUESTIONS

Serious emotional disturbance is a condition in which a young person (from birth to

age 18) has a diagnosable mental, behavioral, or emotional disorder resulting in

functioning in family, school, or community activities. Serious mental illness (SMI) is

a condition in which a person has a diagnosable mental, behavioral, or emotional

disorder resulting in functional impairment that substantially interferes with or limits

illness that results from a chemical imbalance in the brain.

2. Name the three most prevalent types of serious mental illness.

depression), and clinical depression.

Two categories of dual diagnosis are mental illness with mental

retardation/intellectual disability and mental illness with chemical addiction.

to an inpatient psychiatric hospital.)

5. Define “outpatient commitment.”

Outpatient commitment is the judicial diversion, from inpatient to outpatient care, of

regarding behaviors such as taking medications, remaining sober, and maintaining

residence in a designated place. Failure to abide by the stipulations generally results

in involuntary commitment to an inpatient facility.

treatment plan, progress notes, and discharge summary.

system (IPF PPS)?

that are adjusted up or down by four patient-level factors:

age 80 and above)

no further decrease beyond that point)

been reviewed and updated as necessary.

University of California), which held that a therapist has an obligation to warn

10. What are the URS tables?

Mental Health Authority (SMHA) reports aggregate data to SAMHSA.

data are reported.

Employment/school attendance; stability in housing; criminal justice involvement;

readmission to state hospital; access/capacity: number of persons served with

development of mental health data collection systems.

consumer empowerment movement has led to consumer involvement in a number of

aspects of mental health planning and programming. Emphasis is placed on consumer

toward determining consumer satisfaction with services. For example, “client-

In considering data collected for the individual consumer’s record, there is

emphasis on documentation indicating consumer involvement in the treatment

managers may expand their roles.

computer applications and development of management information systems. The

is in the entrepreneurial sector, such as acting as consultant for the development of

management information systems designed to meet individual program needs and in

positions, particularly if they obtain an appropriate graduate degree.

to serve on the steering committee that will be guiding this initiative.

SUGGESTED RESPONSES TO THE CASE STUDY

1. What types of electronic systems might the committee investigate?

electronic information systems for patient registration and appointment scheduling

with the submission of “clean claims,” is also helpful.

Students may focus on what would be needed in an electronic health record

special documentation requirements of a community mental health center, including

of the importance of medication in treatment of individuals with mental illness.

Appropriate reporting capabilities, including the ability to develop ad hoc reports

for the Uniform Reporting System tables.

Also, as de-identified client-level data begins to be required for reporting, a

protected health information. Because psychotherapy notes receive special protection

embarking on this project?

the National Coordinator for Health Information Technology at healthit.hhs.gov for

the most current information on meaningful use.

other types of electronic information systems or modules along with an appropriate

Highlights from AHIMA Curricular Competencies

I. Domain: Data Content, Structure, & Standards (Information Governance)

Chapter 7 discusses various accreditation programs for behavioral health services

along with regulatory requirements for psychiatric hospitals. Documentation

with an introduction to the Diagnostic and Statistical Manual of Mental Disorders