Clinical Optimization

Learning Objectives

Uses of the Alt KeyUser Preferences to customize Accuro for youHome Section TipsShortcut Keys and their functionsVirtual Chart tips

Use of the ALT Key

Alt+ Click Side menu items to open new windowNew Window Acts independent

Alt to open new Accuro start menuType key words instead of searching through menu

User Preferences

Display-Configure ActionsUncheck “only show primary actions”Dock the Action Bar

Display- Display-Edit Patient Status BarPreferred contact will bold

Move status bar“Dock Patient Status Bar at the Bottom of Accuro”

Lines in claims sectionScheduler Appointment Color- Stripe vs. FullFont SizeAlternate Time stamp Prefix

Use F12 to time stamp notes

Home

Ctrl + F10Order the Medical History Band to your preferenceUser Preferences>display>EMR Workflow

Renew a prescription from anywhere using Ctrl F10Prescription Favorites

Save by name of diseaseAuto Expire

Falls off active medication list if onTurns red in list if offSystem setting to NOT auto expire continuous medications they turn redafter 1 year

Chart Item ConversationsHave conversations about a task on a patient chart without having to open anew mail message or adding notes to the task and sending it back and forth

Shortcut Keys

Alt + F2- Opens Address BookF1 – Patient Search F2 – Provider Management F4 – Appointment History

Print Patient ScheduleFile > Print Patient Schedule

View Cancelled AppointmentCopy, 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 RemindersUse a Macro to populate text in tasks

Template Wizard> Edit Macro’sCtrl + enter

Patient Flags- new icon set availableF8 – Patient Status History F9 – Chart Sheets F12 –Generate date/time stamp in EMR Letters/Clinical NotesCTRL + A – Select All CTRL + B – New Bill CTRL + C – Copy CTRL + F – Find

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 ChartFax Multiple items from the ChartOne time fax recipientFax a Document without loading to chartDefault Recipient on FormsForm Editor, 3rd button from rightUpload Documents

Drag and DropCopy and Paste

Encounter Summary TabUser preference> display> EMR Workflow>third one down> "ShowEncounter Summary Tabs"

My comments:

British Columbia Billing Enhancements

Learning Objectives

Find ways to speed up billing entry and reduce the amount of time spent making billsready for submissionEnsure all of your billing is recorded and submitted from the EMRLook at tips for correcting billing errors that have come back after a submissionLearn how to read the Accounts Receivable screen and keep this area up to date

Billing Entry

Create Macros1. ALT + Type “Macros”2. Open Manage Billing Macros

Add | Edit | Copy | Delete

Enter procedure and diagnsotic codes from the Daily Claims or Unsubmitted Claims table

Hospital Billing Workflow1. Start with a New Bill (CTRL + B)2. Admit date is Date of Service3. Last day of Visit is entered into the specific field4. Manually change quantity to reflect number of days5. If hospital stay falls over the last day of the month, start a new bill for the next month

with the 1st as the DOS

Billing Rules1. ALT + Type “Billing Rules”2. Choose Rule Type (ex. Billed within Date Range)3. Fill in Condition4. Exceptions – if you link Billing Codes to Appointment Types5. Actions

Show Violation Warning – will have a pop up warning when billedChange to – allows you to choose a code Accuro will automatically change the

incorrect code toValidate during submissions – Accuro will indicate the error when you ApproveClaims

Billing Submission - make sure everything is submitted

Approve ClaimsEmpty out the tab regularly

Billing Reconciliation - make sure everything is getting paid

All Refusals and Adjusted RemittancesResubmit

Claims that have been refused, must be corrected and resubmitted. There are2 common types of refused claims:

Patient Demographic Errors: these could be related to Health Carderrors, gender, DOB or patient name. Edit your patient’s demographicsin the Claim Details screen and then resubmit the claimClaim Errors: this is related to information that can be changed in theClaim Details screen such as diagnosis, procedure or referringphysician. Double Click to open the Claim Details and make changes asnecessary, then check the Resubmit box for all affected claims, andSave and Close

Adjust to Paid and Write OffClaims that have a payment with an explanatory code, or have been underpaid, ornot paid at all have been processed by the Government and appear on theAdjusted Remittances Tab. We really have 2 options:

Agree: when you agree with the assessment you can either click on a singlerow, or use the filter to focus on all claims with a specific error code. Selectthe affected rows and right click to choose “Adjust to Paid”Disagree: when you disagree with the assessment, you can generally openthe Claim Details, and enter an MSP Note to go along with the claim whenyou Resubmit it. There are also the Submit Codes that can be used to adviseMSP of the action you would like to take.

Do not use Write Off to clear billing errors. This should only be used for claims thatare not paid but based on MSP billing rules you should have been paid for howeverdue to circumstance are not paid. ie. a patient health card error that cannot beresolved before the claim is stale-dated.

Tracking PinsTracking Pins can be used for any claim that cannot be dealt with right away. Tocreate 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 thedesired details.To set a Tracking Pin on a claim, right click on the claim from any screen andchoose “Set Tracking Pin”. If you are trying to remove a Tracking Pin, choose the“None” option in the Set Tracking Pin menu

Accounts Receivable TabSort by Date or Submission DateIgnore claims that have been submitted in the last billing cycle

Investigate why claims are not paid, that should be

Viewing Past Billing Information

F4Right Click > Claim History

There is a lot of information about the status of a claim that you can get from thiswindow

Patient Name and DOS– At the very top of the window, the patient’s name and date of service for theclaim will always be shownMain Procedure Information – A claim will always have a Main Procedurecode. In this dark purple bar you will see details about that procedure code asthey are right now. The Tariff Code is the current procedure code entered inthe first line of the claim, Diagnostic Code is the current diagnostic codeentered in the first line of the claim, Last Submission is the date of the lasttime this claim was submitted (even if it was submitted multiple times) and BillID 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 claimhas been marked as: No Show, No Charge, Adjust to Paid or WriteOff you will see a “Yes” next to the heading. If there is a reasonassociated with the Adjust to Paid or Write Off Action, this is displayedin a dark grey bar right underneath the claims status. Each Procedurethat is part of a claim has their own status, so you will see the dark greybar under each Main Procedure and Sub ProceduresGross Billed Amount/Gross Taxed Amount – Underneath the bill statusthere is another dark grey bar that indicates the bill’s gross amount forAmount Billed and Taxed Amount. This area will indicate the amountbilled 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 alsobecomes $0. Essentially losing the initial amount billed on the claim, thisvalue can now be viewed in the Grossed Billed Amount field underClaim HistoryAdjustment Reason/Write Off Reason – If the status of the bill has beenAdjust to Paid or Written Off, and you have entered a reason into Accuroto record why the action was taken, this area of the dark grey bardisplays the reason you had typed in as to why the bill was adjusted orwritten off

Submitted On/Retrieved On – Each time a claim is submitted or a response isretrieved that matches to that claim, a light grey bar will appear with the dateof the submission or retrieval. The Claim # is included with a retrieval and is anumber that MSP gives each claim they receive and process on anAssessment Report. The Service Code which is included on the Submissionline is the Procedure Code that was submitted at that time, and may bedifferent than the details seen in the Main or Sub Procedure barsResponse – The response that came along with the Retrieval will be visible inred text. How much was billed, If the bill was paid, and how much and anyexplanations that came from MSPSub Procedure Information – Any Procedure code that is part of the Claim thatis not the first Procedure (Main Procedure) is called a Sub Procedure. There isno limit on the amount of sub procedures that may be displayed, and they willbe labelled #1, #2, #3, etcHide/Show All button – If you have clicked onto the Claim History on a singleprocedure 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 thatclaim. After pressing Show All, the button becomes “Hide All” (as seen above)and when pressed will only show the details for the claim you originallyselected

The Claim History window rarely looks the same twice

My comments:

Query Building

Learning Objectives

Build a query that will give a list of patients who need an annual physicalGenerate a more advanced query that will give a list of diabetic patients whorequire follow upCreate a query that contains missed billing opportunitiesPrint out letters that advise patient’s they are due for a follow up appointment fromquery resultsAdd an alert to a patient’s chart to notify you of missing informationReport 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 intothe EMRDefinition – The name of your queryConstraint – A filter or condition that must be satisfiedRule – A set of 1 or more constraints that make up your definitionAlert Matches – The list of patients matching your rules

Building a Query

ALT + Search for “Query” in the Accuro Start menuGreen Plus to create a new query – Enter a name so you can find your query laterChoose a Category – where in the EMR is the information saved?Choose a Sub-CategoryAdd new Constraints for your Rule (if necessary)

1. Choose your Rule Options2. Doesn’t Match3. Patient Records Only4. Instances

Run the Report

Queries

Annual Physical

1. Create a query for all patients over 40 who have not had an Annual Physicalappointment in the last year

Advanced Option: COPY the query once built, and add another constraint tonarrow 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 last6 months, between the ages of 18 and 65 and are taking either Lipitor or Coversyl

Create Bills from Query Results

1. Create a query for patient’s who have had an INR result sent to the EMR in thelast month that have not been billed a 00043

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 inthe 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. added into theirdemographics

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 thecomponents 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 yourpatients or if a certain word was entered into a text field/text area or if a certaindate is on the form

Create a Reportable Form1. Open the Form Editor and open the form you would like to report on

2. Mark the Form as reportable under the Advanced button

1. 3. Right click on the component you want to report on and choose “Edit” (Text

Fields and Areas, Checkboxes and Radio Buttons and Date fields arecomponents that can be reported on)

4. Check off the “Reportable” button in the component5. Give the component a Name

Queries to Download

KI – Annual PhysicalKI – Diabetic Patient ManagementKI – Billing for INR (BC)KI – PAP Follow UpKI – Missing Referring PhysicianKI – Reportable Form Fields

My comments:

Advanced Form and Template Creation

Learning Objectives

Generate a letter from filling out a patient intake formUse checkboxes on a form to calculate a totalSave lab values to a patient chart by typing into a formPull lab values from a patient chart onto a form or a note templateCalculate average values with a formula in a formPopulate a calculated date on a form by entering an initial dateCreate 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 differentareas 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 willconsist of only words, and use basic word document formatting. When a templategenerates into a letter, the template consists only of the BODY of the letter youare sending.

Generate a Letter from a Form

Form Editor

1. Layout your form2. Give meaningful tag names to components that will be used to populate the

information from the form onto the letter3. Provide “output text” for check boxes or radio buttons

Template Wizard

1. Have an idea of what your letter will say2. Start to type the letter, pulling the “tags” (right click) when the information is

patient specific or will be first input onto the form3. 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 required2. 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 IDEnter 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 formUse form on a patient chart, and enter valuesValues will be saved as lab results in the patient chart

Pull saved Lab Results onto a Note or Form

Form Editor1. Create custom components in the form editor with the type “query” to pull

most recent result

Template Wizard1. 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 formula2. Create formula with formula field component

Note: all components must have a value or else the formula will not calculate theanswer

Populate one Date from another

1. Enter tag name on date text field component2. 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, OR2. Create Macros when typing notes in the EMR by selecting text and right clicking

to choose “Create Macro3. Use Macros by typing your keyword and then press CTRL + ENTER on your

keyboard

Forms to Download

Pediatric Intake Form – Medical HistoryTest – Forms to LettersPHQ – Questions with scoresAverage Blood Pressure (training)*Updated Antenatal Record v1.3 (Ontario)

My comments: