Clinical Optimization

Transcription

1 Clinical Optimization Learning Objectives Uses of the Alt Key User Preferences to customize Accuro for you Home Section Tips Shortcut Keys and their functions Virtual Chart tips Use of the ALT Key Alt+ Click Side menu items to open new window New Window Acts independent Alt to open new Accuro start menu Type key words instead of searching through menu User Preferences Display-Configure Actions Uncheck only show primary actions Dock the Action Bar Display- Display-Edit Patient Status Bar Preferred contact will bold Move status bar Dock Patient Status Bar at the Bottom of Accuro Lines in claims section Scheduler Appointment Color- Stripe vs. Full Font Size Alternate Time stamp Prefix Use F12 to time stamp notes

2 Home Ctrl + F10 Order the Medical History Band to your preference User Preferences>display>EMR Workflow Renew a prescription from anywhere using Ctrl F10 Prescription Favorites Save by name of disease Auto Expire Falls off active medication list if on Turns red in list if off System setting to NOT auto expire continuous medications they turn red after 1 year Chart Item Conversations Have conversations about a task on a patient chart without having to open a new mail message or adding notes to the task and sending it back and forth Shortcut Keys Alt + F2- Opens Address Book F1 Patient Search F2 Provider Management F4 Appointment History Print Patient Schedule File > Print Patient Schedule View Cancelled Appointment Copy, Cut, Cancel Appointments F3 Quick Patient Summary (Can also use: CTRL + F3) F5 Documents Previewer F6 New Patient F7- Patient Tasks Create Future Tasks for Reminders Use a Macro to populate text in tasks Template Wizard> Edit Macro s Ctrl + enter Patient Flags- new icon set available F8 Patient Status History F9 Chart Sheets F12 Generate date/time stamp in EMR Letters/Clinical Notes CTRL + A Select All CTRL + B New Bill CTRL + C Copy CTRL + F Find

3 CTRL + I Find Invoice CTRL + K Find Claim ID CTRL + L Book on Waitlist CTRL + Q Quit CTRL + R Reporting CTRL + V Paste CTRL + X Cut CTRL + Y Redo CTRL + Z Undo Virtual Chart Print Entire Chart Fax Multiple items from the Chart One time fax recipient Fax a Document without loading to chart Default Recipient on Forms Form Editor, 3rd button from right Upload Documents Drag and Drop Copy and Paste Encounter Summary Tab User preference> display> EMR Workflow>third one down> "Show Encounter Summary Tabs" My comments:

4 Ontario Billing Enhancements Learning Objectives Find ways to speed up billing entry and reduce the amount of time spent making bills ready for submission Ensure all of your billing is recorded and submitted from the EMR Look at tips for correcting billing errors that have come back after a submission Learn how to read the Accounts Receivable screen and keep this area up to date Billing Entry Create Macros 1. ALT + Type Macros 2. Open Manage Billing Macros Add Edit Copy Delete Enter procedure and diagnostic codes from the Daily Claims or Unsubmitted Claims table Hospital Billing Workflow Manage Procedures to set up the Billing Codes that require Admission Date or Master Number 1. Start with a New Bill (CTRL + B) 2. Use Save and New once details are filled in 3. Right Click on Bill from the History at the bottom of the screen and use Copy Claim to Above 4. a) Modify the Date of Service and Procedure Code(s) 5. b) Use if the SAME code(s) are billed on multiple dates 6. Repeat Steps 2 through 5 as required Billing Rules 1. ALT + Type Billing Rules 2. Choose Rule Type (ex. Billed within Date Range) 3. Fill in Condition (ex. A205 billed 1 time(s) within 365 days of A205)

5 4. Exceptions if you link Billing Codes to Appointment Types 5. Actions Show Violation Warning will have a pop up warning when billed Change to allows you to choose a code Accuro will automatically change the incorrect code to Validate during submissions Accuro will indicate the error when you Approve Claims Billing Submission - make sure everything is submitted Approve Claims Empty out the tab regularly Billing Reconciliation - make sure everything is getting paid Unmatched Remittances Match everything in Unmatched Remittances In the Unmatched Remittances tab, review and clear any claims that need to be "matched". Accuro places all claims the Ministry sends back that do not match exactly to a claim which was billed through Accuro in the Unmatched Remittances tab for you to deal with. Some examples of claims that may be found in this tab are: Claims submitted outside of Accuro from another office or a previous software Claims the Ministry has changed from what you originally submitted Or, Claims which were entered twice into Accuro (duplicate entries) Claims in the Unmatched Remittances tab, will not appear anywhere else in Accuro. Clear the Unmatched Remittance by clicking on one row at a time from the top half of the screen, and then: Situation A: if there are rows displayed in the bottom half of the screen, then determine which record most closely matches the highlighted row in the Unmatched Remittances section. Click on the appropriate row so that it is highlighted, and press Match" Situation B: if there are no rows displayed in the bottom half of the screen and there is nothing further to do with the claim (ie. resubmit a rejection) then click on Mark NOF (NOF stands for Not On File, aka the claim does not need to exist in Accuro). If there are several claims which are not related to Accuro, Match everything you can first, then highlight ALL of the remaining claims and choose Mark NOF Not Reconciled Resubmit Claims that have been refused with a three character code, did not meet the Ministry minimum requirements and must be corrected and resubmitted. There are 2 types: Patient Demographic Errors: the most common claim refusal is a Mismatched Version Code (EH2), but could also be related to gender, DOB or insurance number. Edit your patient s demographics through the Right Click menu and then resubmit the claim

6 Claim Errors: this is related to information that can be changed in the Claim Details screen such as diagnosis, procedure, master number, admission date or referring physician. Double Click to open the Claim Details and make changes as necessary, then check the Resubmit box for all affected claims, and Save and Close Adjust all Overpayments to Paid If there are any overpayments in the Not Reconciled Tab, right click on ANY row to choose Adjust all Overpayment to Paid. Accuro will tell you how many claims are overpaid and ask if you want to continue, choose Yes. You will then be prompted to enter an optional reason to complete the adjustment Adjust to Paid and Write Off Adjust to Paid Claims that have a payment with an explanatory code, or have been underpaid, or not paid at all have been processed by the Ministry and appear on your RA. We really have 2 options: Agree: when you agree with the Ministry s assessment you can either click on a single row, or use the filter to focus on all claims with a specific error code. Select the affected rows and right click to choose Adjust to Paid Disagree: when you disagree with the Ministry's assessment, place a tracking pin on the claim and then open the Remittance Advice Inquiry form through the Right Click menu. The form will populate with all of the claim information from Accuro, you just need to fill in the remarks to explain why you feel you should have been paid for this claim. This form is then faxed to the Ministry with the Fax button, or Print and Fax manually. This method is also used to inform the Ministry of a correction you need them to make, for example a claim was billed on the wrong date Write Off Do not use Write Off to clear billing errors. This should only be used for claims that are not paid but based on Ontario billing rules you should have been paid for however due to circumstance are not paid. ie. a mismatched version code that cannot be resolved before the claim is stale-dated. DO NOT USE Accept Response It is strongly recommended that Accept Response is NEVER used and Adjust to Paid is used in its place. The only time Accept Response is acceptable is when the Billed amount and the Paid amount are identical. Tracking Pins Tracking Pins can be used for any claim that cannot be dealt with right away. To create a Tracking Pin, open the Accuro Start Menu and type Tracking select Manage Claim Tracking. Add a new Pin with the Green Plus (+) and fill in the desired details. To set a Tracking Pin on a claim, right click on the claim from any screen and choose Set Tracking Pin. If you are trying to remove a Tracking Pin, choose the None option in the Set Tracking Pin menu Accounts Receivable Tab Sort by Date or Submission Date Ignore claims that have been submitted in the last billing cycle Investigate why claims are not paid, that should be

7 Viewing Past Billing Information F4 Right Click > Claim History There is a lot of information about the status of a claim that you can get from this window Patient Name and DOS At the very top of the window, the patient s name and date of service for the claim will always be shown Main Procedure Information A claim will always have a Main Procedure code. In this dark purple bar you will see details about that procedure code as they are right now. The Tariff Code is the current procedure code entered in the first line of the claim, Diagnostic Code is the current diagnostic code entered in the first line of the claim, Last Submission is the date of the last time this claim was submitted (even if it was submitted multiple times) and Bill ID is a number that Accuro gives to each claim internally Dark Grey Bars: Bill Status This area gives you details about the status of the claim. If the claim

8 My comments: has been marked as: No Show, No Charge, Adjust to Paid or Write Off you will see a Yes next to the heading. If there is a reason associated with the Adjust to Paid or Write Off Action, this is displayed in a dark grey bar right underneath the claims status. Each Procedure that is part of a claim has their own status, so you will see the dark grey bar under each Main Procedure and Sub Procedures Gross Billed Amount/Gross Taxed Amount Underneath the bill status there is another dark grey bar that indicates the bill s gross amount for Amount Billed and Taxed Amount. This area will indicate the amount billed on the claim initially, regardless of the current status. For example, when you adjust to paid a claim that was paid $0, the amount billed also becomes $0. Essentially losing the initial amount billed on the claim, this value can now be viewed in the Grossed Billed Amount field under Claim History Adjustment Reason/Write Off Reason If the status of the bill has been Adjust to Paid or Written Off, and you have entered a reason into Accuro to record why the action was taken, this area of the dark grey bar displays the reason you had typed in as to why the bill was adjusted or written off Submitted On/Retrieved On Each time a claim is submitted or a response is retrieved that matches to that claim, a light grey bar will appear with the date of the submission or retrieval. The Claim # is included with a retrieval and is a number that OHIP gives each claim they receive and process on an Assessment Report. The Service Code which is included on the Submission line is the Procedure Code that was submitted at that time, and may be different than the details seen in the Main or Sub Procedure bars Response The response that came along with the Retrieval will be visible in red text. How much was billed, If the bill was paid, and how much and any explanations that came from OHIP Sub Procedure Information Any Procedure code that is part of the Claim that is not the first Procedure (Main Procedure) is called a Sub Procedure. There is no limit on the amount of sub procedures that may be displayed, and they will be labelled #1, #2, #3, etc Hide/Show All button If you have clicked onto the Claim History on a single procedure on a Claim that has many sub procedures, by pressing Show All you can see the details for all other procedure codes that are part of that claim. After pressing Show All, the button becomes Hide All (as seen above) and when pressed will only show the details for the claim you originally selected The Claim History window rarely looks the same twice

9 Query Building Learning Objectives Build a query that will give a list of patients who need an annual physical Generate a more advanced query that will give a list of diabetic patients who require follow up Create a query that contains missed billing opportunities Print out letters that advise patient s they are due for a follow up appointment from query results Add an alert to a patient s chart to notify you of missing information Report on data input onto a form with a query (if time permits) Terminolgy Query A customizable report that pulls a list of patients based on data input into the EMR Definition The name of your query Constraint A filter or condition that must be satisfied Rule A set of 1 or more constraints that make up your definition Alert Matches The list of patients matching your rules Building a Query ALT + Search for Query in the Accuro Start menu Green Plus to create a new query Enter a name so you can find your query later Choose a Category where in the EMR is the information saved? Choose a Sub-Category Add new Constraints for your Rule (if necessary) 1. Choose your Rule Options 2. Doesn t Match 3. Patient Records Only 4. Instances

10 Run the Report Queries Annual Physical 1. Create a query for all patients over 40 who have not had an Annual Physical appointment in the last year Advanced Option: COPY the query once built, and add another constraint to narrow the results down to only female patients Diabetic Follow Up 1. Create a query for Diabetic patient s who have not had an appointment in the last 6 months, between the ages of 18 and 65 and are taking either Lipitor or Coversyl Create Bills from Query Results (Basic) 1. Create a query for patient s who have had an INR result sent to the EMR in the last month that have not been billed a G From the results choose the Create Bill action Create Bills from Query Results (Advanced) 1. Create a query for patient s with Congestive Heart Failure, that have had 2 or more visits in the last 365 days where a CDM Flowsheet for CHF is in the chart and have not been billed a Q050 in the last 365 days 2. From the results choose the Create Bill action Generate a Letter from Query Results 1. Create a query for female patients over the age of 21 who have not had a PAP in the last 2 years or have had an abnormal result 6 to 9 months ago 2. From the results choose the Create Forms action Add Dynamic Alerts to Patient Charts 1. Create a query for patient s who do not have a Referring Dr. or an Enrolled Provider added into their demographics 2. Under the Options button, choose to Include in Tasks 3. Must also ensure that the User Preference under Display > Alerts > to check for outstanding items when loading a patient for Alert Violations Reportable Forms (if time permits) 1. First need to create a Reportable Form in the Form Editor, and mark the

11 components you would like to report on 2. Now you can create a query to find if a box was checked off in a form for your patients or if a certain word was entered into a text field/text area or if a certain date is on the form Create a Reportable Form 1. Open the Form Editor and open the form you would like to report on 2. Mark the Form as reportable under the Advanced button Right click on the component you want to report on and choose Edit (Text Fields and Areas, Checkboxes and Radio Buttons and Date fields are components that can be reported on) 4. Check off the Reportable button in the component 5. Give the component a Name Queries to Download KI Annual Physical KI Diabetic Patient Management KI Billing for CHF KI Billing for INR (ON) KI PAP Follow Up KI Not Enrolled KI Missing Referring Physician KI Reportable Form Fields My comments:

12 Advanced Form and Template Creation Learning Objectives Generate a letter from filling out a patient intake form Use checkboxes on a form to calculate a total Save lab values to a patient chart by typing into a form Pull lab values from a patient chart onto a form or a note template Calculate average values with a formula in a form Populate a calculated date on a form by entering an initial date Create macros which can be used on the fly when typing Terminology Form: This is a paper form that has been turned into an electronic format. Generally will contain check boxes, or text fields where data can be recorded. Forms use components to pull patient specific information to help fill in different areas of the form document. Can be thought of as Requisition Forms, Questionnaires, Intake Forms, etc. Template: This is the starting point of either an encounter note or a letter. Templates use queries and tags to pull patient specific information. They will consist of only words, and use basic word document formatting. When a template generates into a letter, the template consists only of the BODY of the letter you are sending. Generate a Letter from a Form Form Editor 1. Layout your form 2. Give meaningful tag names to components that will be used to populate the information from the form onto the letter 3. Provide output text for check boxes or radio buttons

13 Template Wizard 1. Have an idea of what your letter will say 2. Start to type the letter, pulling the tags (right click) when the information is patient specific or will be first input onto the form 3. Use clickable lists when more than one option on the form may be selected Using the Form/Template in the EMR 1. Open the form, and fill in the information required 2. Right click on the saved form, and choose Generate Letter 3. Read through the letter, making corrections where necessary and complete selections 4. Generate and send the letter Total up Checkboxes Give each check box a value and a value ID Enter value ID s into value total component Save Lab Results from entry on a Form Create custom lab test with results (if necessary) Add existing lab text field components onto a form Use form on a patient chart, and enter values Values will be saved as lab results in the patient chart Pull saved Lab Results onto a Note or Form Form Editor 1. Create custom components in the form editor with the type query to pull most recent result Template Wizard 1. Use i button to insert a lab result query onto the template to pull most recent results Calculate a Value from a Formula 1. Add a name or tag name on each component that will be part of the formula 2. Create formula with formula field component Note: all components must have a value or else the formula will not calculate the answer

14 Populate one Date from another 1. Enter tag name on date text field component 2. Edit second date text field component and enter details to populate from another date Create and Use Macros 1. Create Macros in the Template Wizard, OR 2. Create Macros when typing notes in the EMR by selecting text and right clicking to choose Create Macro 3. Use Macros by typing your keyword and then press CTRL + ENTER on your keyboard Forms to Download Pediatric Intake Form Medical History Test Forms to Letters PHQ Questions with scores Average Blood Pressure (training) *Updated Antenatal Record v1.3 (Ontario) My comments: