Review this help section for detailed instructions regarding creating an editable PDF in the MediTouch System. Review “Editable PDFs in Custom Forms” for more information regarding using Editable PDFs in the EHR.

• Adobe Acrobat Pro or a similar software should be used.
• Add attributes as desired (text fields, check boxes, etc.).
• Using HealthFusion field names will pre-populate the form.

• To rename a field, right click on the field and select “Rename Field.”

• Only standard fonts should be used (e.g. Ariel, Times New Roman, etc.).
• Using unsupported font will cause a 404 error when using the form.

The field name options are listed below:

Patient (23 fields)

Practice (11 fields)

Provider (20/32 fields)

Review this help section for instructions regarding how to write off a patient balance.

• In a patient’s chart in the EHR, click “Ledger.”

• Click on the blue dollar amount that you would like to write off.

• A separate box will pop up. Enter amount, reason, and note.

A patient balance write-off is the act of reducing the Patient Responsibility on a particular Date of Service (DOS). A write-off reversal is the act of increasing the amount previously written off. Review this help section for the steps required to reverse a patient balance write-off. For information regarding writing off a patient balance, review the “How to Write Off a Patient Balance” help section.

• Navigate to the patient’s chart in the EHR and click “Ledger.”

• Find the claim containing the write-off you would like to reverse and click the corresponding “+” icon.

• Expand the “Claim History” section.
• Click “Details.”

• Click “Reverse” to reverse the corresponding write-off.

• Enter the dollar amount to be reversed.
• Select a reason for the reversal.
• Add notes when applicable (Optional).
• Click “Submit” to complete the reversal.

Organizations that service nursing home facilities typically do not schedule visits for individual patients. Instead, they will usually reserve a block of time to spend at the facility. To facilitate this workflow, an optional “Resident Roster” view is available that allows providers to navigate through the roster of patients that have been identified as residents of the facility as opposed to navigating through the daily schedule.

• Navigate to the EHR Dashboard.
• Select “Resident Roster” from the dropdown menu.

• The patient roster displays all patients that have been identified as residents of the selected location.
• The Roster displays the Encounter Status for the selected date of service, the patient name, gender and date of birth.
• Use the “Search Roster” feature to search for an existing patient.
• Use the “Reset” button to clear the search results and display the roster.

• The “Encounter” column displays each patient’s encounter status for the selected date of service.
• “New” indicates that an encounter has not been started. Click to start a new encounter.
• “SOAP” indicates that an encounter is in progress. Click to navigate to the Encounter Preview.
• Finalized encounters will display the signing date. Click to navigate to the Encounter Preview.
• Clicking on a patient name navigates to that patient’s chart.

Create a New Patient

• Click “New Patient” to register a new patient.
• The abbreviated registration form displays only the necessary fields required to create a new patient chart.
• Check the checkbox to indicate that the patient is a resident of the selected practice location. This will add the patient to the location roster and populate the address and phone fields with the location’s information.

The “New Patient” feature, located within the Resident Roster section of the EHR Dashboard, allows users to quickly add a new patient as needed. This feature conveniently includes the option to indicate that the patient is a resident of a selected facility.

• Enter patient information and click “Save” when finished.

• Navigate to the Resident Roster in the Dashboard section of the EHR.
• Click “New Patient.”

• When providers are making nursing home rounds they may frequently have an encounter with a patient who is new to the home and therefore does not already exist in the system. The “New Patient” option can be used in such cases to simplify the workflow and facilitate an easy patient registration process.
• Check the “Patient is a resident” checkbox. This will auto-populate the address and phone number.

The Review of Symptoms feature allows users to easily customize templates for symptoms and body systems, both for the practice as a whole and for a specific rendering provider. This help section details how to conveniently customize these templates to suit the user’s needs.

• From the “Review of Symptoms” screen, click “Edit.”

• Select to edit the “Review of Symptoms” for either the entire practice or for the rendering provider alone.

System Content

• “System Content” is the default selection.
• Select a Specialty from the dropdown menu.

• To add a custom symptom, type the symptom into the text box and click “Add.”
• Note that the new symptom will be added only to the selected template (e.g. “Constitutional”) within the selected Specialty (e.g. “General”).

• To hide a symptom, click the “X” next to that symptom.
• Hiding a symptom will hide the symptom from only the selected body system (e.g. “Constitutional”) within the selected specialty template (e.g. “General”).
• Click “Show Hidden” to display the symptoms that have been hidden.

• Click “Delete” to delete the selected template from the selected Specialty.

• Click “OK” to confirm.

Body Systems

• Upon navigation to Body Systems, the body systems for the selected Specialty will populate.
• Click the “X” next to a system to hide that system.
• Click the “+” symbol to make the selected system visible again.

• Click “Show Hidden” to display all hidden systems.
• Click “Close” when done.

• Changes made in the Body Systems tab will be reflected in the System Content tab for the selected Specialty.

A common industry requirement when billing Durable Medical Equipment (DME) to Medicare is to split the charges and send the DME service lines codes to DMERC and all other service line codes to Medicare. For the biller’s convenience, MediTouch automatically splits the DME service line codes into separate claims when charges are being generated in the EHR. When charges are being generated in the PM, the biller must manually enter separate charges for DME and non-DME services. This help section reviews the setup of DMERC codes and requirements for using the DME Split feature.

DME Setup

The system is pre-configured with a default DMERC code panel as supplied by CMS. The code panel can be modified as needed by removing existing codes or adding new codes.

• Select “DME Setup” on the “Admin” page.

• Click “Toggle Display of Current Codes” to display the entire code panel.
• To remove a code, uncheck the checkbox of the applicable code and click “Save” to update the panel.

• To add a code, use the select list to view procedure code categories and search for the desired code.
• Double click the code to add it to the panel.
• Click “Save” to update the panel.

Using the DME Split

The DME Split feature is only applicable to patients with the Medicare and DMERC insurance profiles. Navigate to the patient chart to review the patient’s insurance information.

• Both DMERC and Medicare must be active insurance profiles.

• During an encounter, navigate to the “P: Procedure Coding” page and document the applicable procedure codes.
• If both DME and non-DME codes are present when the user clicks “Generate PM Billing” the service lines will be split and will result in 2 User Hold claims in the PM.

Under a new chronic care management program authorized by CMS and taking effect in 2015, you can bill $42.60 per 30-day period for 20 minutes of chronic care activity (non-encounter based follow up care). This help section reviews how to get started with CCM billing. For more information on the CCM rule see the Chronic Care Management page.

Obtain Patient Permission

CCM services can only be billed for Medicare Fee For Service (FFS) patients. Before billing, you must inform the patient that you will be providing them with this service and obtain their signed permission on an agreement that you make part of the medical record.

• Navigate to the patient chart and click the “Documents” link at the top of the chart.

• Click the “Upload Document” link.
• Choose the file to upload.
• Select the “Chronic Care Permission” Document Type.
• Select the “Provider” that has been granted permission.
• Click “Upload” to upload the document.
• Click the “Back to Patient Chart” link to return to the chart.

• Click the “View/Edit Details” link at the top of the chart.
• Navigate to the “Insurance Information” tab and edit the patient’s “Medicare” insurance profile.
• Ensure the “MEDICARE FFS” Payer Class has been selected.
• The “CCM Permission” option will be displayed.
• Select the “Yes” option if permission has been obtained.
• Select the Rendering Provider that the permission has been granted to.
• Click “Save Changes” to update the insurance profile.

CCM Billing

Once permission has been recorded, MediTouch will begin tracking clinical activities for the patient. A “CCM Billing” module is provided in the EHR to help providers identify which patients have accrued recent activity and may be ready to bill.

• From the EHR Dashboard click the “Documents” button in the bottom navigation menu.
• Click “My Reports” and then “CCM Billing” to continue.

• The CCM Billing module consists of 4 tabs:
• Ready to Bill
• Billed Recently
• No Recent Activity
• FFS Patients w/out Permission
• Select a provider from the “Permission on File” select list.
• Select an option from the “Display Format” to toggle between ICD9, ICD10, and SNOMED for the display of the patient’s chronic conditions.

Ready to Bill

The “Ready to Bill” tab consists of patients who have granted CCM Permission to the selected provider, have at least 2 active chronic conditions, and have had recent activity during the 30 day period.

• The Recent Activity column identifies clinical activity recorded in the patient chart within the 30-day period.
• Click the checkbox in the first column and “Create Claim” to send the User Hold claim to the PM system.

Note: It is the provider’s responsibility to evaluate whether the displayed activity constitutes at least 20 minutes worth of time spent on the patient.

Billed Recently

The “Billed Recently” tab consists of patients who have granted CCM Permission to the selected provider, have at least 2 active chronic conditions, and have had a CCM claim generated in the past 30 days.

• The “Bill From” and “Bill To” columns identify the billing dates for the claim.
• The “Last CCM Claim” identifies the claim creation date of the last CCM claim.

No Recent Activity

The “No Recent Activity” tab consists of patients who have granted CCM Permission to the selected provider, have at least 2 active chronic conditions, but have not had recent activity during the 30 day period.

• The “Bill From” and “Bill To” columns identify the billing dates for the claim.
• The “Last CCM Claim” identifies the claim creation date of the last CCM claim.

FFS Patients w/out Permission

The “FFS Patients w/out Permission” tab consists of Medicare FFS patients who have not granted CCM Permission to any provider in the practice.

What is Recent Activity?

Recent activity will include the following activity as long as the activity occurred outside the scope of a face-to-face encounter:

• Secure Message communication to or from the patient portal
• Orders created, resulted or reviewed
• Medications ordered, renewed, or edited
• Adds / Edits to the Allergies or Problem List
• Phone encounter documented
• The receipt and import of a Transition of Care C-CDA

Reviewing the Patient Chart

It may be necessary to review the patient chart to help determine if CCM billing is appropriate for the patient. Two features facilitate the chart review: Patient Chart “Blue Tab” and a shortcut button to the complete chart.

• Click any row to highlight it and bring the patient into context.
• The blue tab in the upper left corner of the screen is displayed and allows summary access to the patient chart.
• Click the button in the “Patient” column to navigate to the complete patient chart.

• Coding
• Dates
• Duplicate Claim
• Eligibility
• Payer
• Provider

Coding

1. Rejections for coding errors are related to payers not accepting information contained in Box 24. HealthFusion scrubs your claim for CPT, ICD and modifier codes based on the valid codes for the date of service submitted. These code scrubs do not always prevent a payer from rejecting certain codes even if the codes are valid. The payer may only allow a subset of the code database based on their own adjudication rules.

2. Some helpful hints related to coding errors:

   1. Always make sure you use codes that are accepted by your payers (check with your payers before submitting claims)
   2. Make sure your place of service is accurate for the claim you submit
   3. Make sure your CPT and ICD codes are age and sex compatible
   4. Some payers allow just 4 or 6 diagnosis pointers and will reject the claim for invalid or too many diagnosis codes and pointers

3. If you are rejected for a Coding error, it is best to call the payer first and they will have the best explanation as to why your claim was rejected.

Dates

1. Payers will reject claims that have procedure codes that require a date if the date is missing or invalid. Most of the time the date should have been placed in Box 16, 18 or 19 (if you are editing claims in the edit claim screen on our portal)

2. Below is a list of common reasons why your claim may be rejected for the Dates reject category:

   1. Missing manifestation date for acute condition
   2. Accident indicator and date were required
   3. Date of illness was after service date on line charge
   4. The claim was missing the date of current illness onset
   5. An admission date was required
   6. Transaction date was before the birth date
   7. Date of service was later than the discharge date

3. If you are rejected for a Dates error, it is best to contact HealthFusion first and let us try to assist you prior to you calling the plan.

Duplicate Claim

1. The HealthFusion duplicate claim screening process usually prevents this type of rejection. If you see this type of rejection it may be related to a claim that was sent both on paper and electronically. If your practice only sent one claim and you are getting rejection for duplicate it could be related to an error at the payer’s gateway.

2. If you are rejected for a Duplicate Claim error, it is best to call the payer first and they will have the best explanation as to why your claim was rejected.

3. Hint: some payers may accept your claim if you change the charge amount (even by one cent).

Eligibility

1. The most common reason why a claim is rejected at the payer’s gateway is related to an eligibility problem. Usually this is because the payer has determined that the patient was not eligible for the dates of service submitted in the claim. Sometimes the user has mis-keyed the member ID information in the claim. Please verify that the member ID on your copy of the member ID card matches the data on the claim.

2. To avoid this error use HealthFusion’s real time eligibility check for all payers supported and call for eligibility on the other plans.

3. If you are rejected for an Eligibility error and you are convinced that the patient is eligible then it is best to call the payer first and they will have the best explanation as to why your claim was rejected.

Payer

1. Rejections related to Payer usually mean that the claim was sent to the incorrect payer or that the payer information was incomplete or invalid.

2. The most common reasons why a claim is rejected for payer is as follows:

   1. The group number is missing or invalid (Box 11)
   2. COB information is missing or invalid
   3. The claim was sent to the incorrect Tricare division
   4. Medicare was billed in the wrong order

3. If you are rejected for a Payer error, it is best to make sure that the correct payer was billed. You may want to contact the patient and confirm the payer billing information. If you believe that all of the payer data is correct then it is best to call the payer, they will have the best explanation as to why your claim was rejected.

Provider

1. The second most common reason why a claim is rejected at the payer’s gateway is related to a problem with one of the provider fields. The Provider reject category can be caused by a provider data error in any of the commonly used provider identification fields. Those fields include:

   1. Billing Provider (Box 33)
   2. Rendering Provider (Box 31)
   3. Referring Provider (Box 17)
   4. Service/Facility (Box 32)

2. Common reasons for provider related rejections errors include:

   1. Your NPI or Tax ID is not on the Payer X-Walk or the NPI Database X-Walk.
   2. For Medicare – your NPI, Tax ID and your Medicare ID must match the NPI Database National Plan and Provider Enumeration System (NPPES).
   3. Medicare Contractors are turning on edits to begin validating the NPI/legacy pair against the Medicare NPI Crosswalk. If the pair on the claim is not found on the crosswalk, the claim will reject.
   4. You must not confuse your Group ID (Box 33) with your Individual ID (Box 31) and if you use a Group NPI and Individual NPI they must be placed in the proper location on the claim – this is true for all payers including Medicare.
   5. HealthFusion is not allowed to register your providers on a Payer X-Walk or at the NPI database.
   6. Do not make the mistake of assuming that if you register your NPI with the NPI enumerator that you have also registered with the payer. You must register your NPI with each payer you submit to.

3. For plans that require enrollment, your group and each provider must be enrolled in the plan. Your practice must use the same identifiers in their claim submission that were used in the enrollment process.

4. The naming convention for the Billing Provider (Box 33) should stay consistent. If you send Smith, John always send the name in that order. Example: do not send John Smith. Many payers alias your Billing Provider name precisely, so consistency in this field will pay off!

5. Always identify the Referring Provider with their ID in addition to their name. It is now appropriate to use the Referring Provider NPI for most payers.

   1. Any provider can be found in the NPI database, Search the National Plan and Provider Enumeration System (NPPES).
   2. Many payers and almost all Medicare Intermediaries reject the non-specific UPIN OTH000

6. Until May 23, 2008 include your legacy ID only for payers that still require the ID. For Medicare please read the following:
   

   Effective March 1, 2008, your Medicare FFS claims must include an NPI in the primary provider fields on the claim (i.e., the billing, pay-to provider and rendering provider fields). You may continue to submit NPI/legacy pairs in these fields or submit only your NPI. The secondary provider fields (i.e., referring, ordering and supervising) may continue to include only your legacy number, if you choose. Failure to submit an NPI in the primary provider fields will result in your claim being rejected, beginning March 1, 2008. Also, as of May 23rd, 2008 Medicare will not allow any legacy ID’s on the claims, NPI only, including the referring provider field.

7. Provider Error Checklist:

   1. My provider IDs are registered with the payer and the NPI database
   2. I used the appropriate group number in the Billing Provider (Box 33)
      ID field and the Individual ID in the Rendering Provider (Box 31) ID field
   3. I am enrolled with HealthFusion for the plans I am submitting to and my IDs in my claim match the IDs that I used in my enrollment
   4. I am always formatting the Billing Provider Name field the same way and the format for the field matches claims that have already been accepted by that payer
   5. I have identified the Referring Provider (Box 17) properly and if I get a rejection for the Referring Provider (Box 17). I understand that I can send the NPI in that field for most payers, I know I can find the NPI for any provider on the Search the National Plan and Provider Enumeration System (NPPES).

8. If you are rejected for a Provider error, it is best to contact HealthFusion first and let us try to assist you prior to you calling the plan.

The Lab Orders feature allows users to document lab results, as well as send and receive these results. Both electronic and non-electronic options are available. Review this help section for detailed information regarding this feature.

Electronic Lab Orders

The “Electronic” lab order feature is used to send lab orders to the lab and to receive results electronically.

Note: This requires an electronic connection to the lab company. If you do not have a connection to a lab company, use the Non-Electronic option or contact Labs@HealthFusion.com to request a connection.

• Open the patient’s chart and navigate to the Orders tab.
• Click the “Lab” button to begin a new lab order.

• The “Electronic” option is selected by default.
• Select the lab that the order will be sent to.
• Complete the order form and click “Create Order” to submit the lab order.

New Lab Order: Non-Electronic

The “Non-Electronic” lab order feature is used to document lab orders when an electronic lab connection is not available or not applicable.

• Open the patient’s chart and navigate to the Orders tab.
• Click the “Lab” button to begin a new lab order.

• Click the “Non-Electronic” option.
• Select “OFFICE” if the lab test is to be performed in the office.
• Select “PAPER” if an external lab company is providing the lab services and no electronic connection exists.
• Complete the order form and click “Create Order” to submit the lab order.

Lab Results

All lab test results with a numeric, positive/negative, or Normal/Abnormal result type, whether electronically received from a lab or manually documented using the Quick Results feature, will always be incorporated as structured data.

• The lightning bolt icon identifies that electronic results have been received.
• Click the icon to view the results.

• When electronic results are not available for a lab test result are entered manually.
• Click the table row to highlight the test.
• Click “Results” to proceed.

• The results form defaults to the “Quick Results” option.
• Select a result status for each test displayed, “Normal” or “Abnormal.”
• Select “Yes” or “No” to set the “Clinically Significant” flag.
• Click “Quick Save” to save the result.

Note: Additional result information can be documented using the “Browse and Upload” and “Order Result Forms” features. However, only the Normal/Abnormal Quick Results will be assessed when calculating this percentage for this measure.

For information regarding how to set up a lab orders label printer, review the “Setting Up a Lab Orders Label Printer” help section.

The Daily Schedule feature within the EHR allows the user to schedule and edit appointments, and to view the schedule for a selected Calendar Resource and date.

• Select the working Location by clicking the location name in blue bar in the upper left of the screen.
• Select the desired Calendar Resource to view the schedule for the selected Date of Service.
• The Calendar Resources list contains all calendars for the selected Location.

• Select the working Location by clicking the location name in blue bar in the upper left of the screen.
• Select the desired Calendar Resource to view the schedule for the selected Date of Service.
• The Calendar Resources list contains all calendars for the selected Location.

• Clicking “Appointment Type” opens a popup window with detailed appointment information.
• Select the Priority and Rendering Provider, and add comments if desired.

• Select “Encounters” to view the encounters for the selected provider on the selected date of service.
• Select “Resident Roster” to view the roster of patients that have been identified as residents of the facility, including the the Encounter Status for the selected date of service. Review the “Resident Roster” help section for more information about this feature.

The Daily Encounters feature is located within the EHR Dashboard and allows users to view the encounters for a selected provider on a selected date of service.

• Click “Encounters” to see the status of the encounters for the selected schedule.

Note: If there is any data in the Diagnosis or Status columns, this indicates that the encounter has been started. The diagnoses indicates the assessment of the encounter and the status indicates where the encounter last left off.

The All Location View feature within the EHR enables users to view all appointments for a given Calendar Resource and Date, which is helpful for providers who often visit multiple Locations on the same day.

• Select the All Location View tab.

• Select the Calendar Resource.
• Select the Date.

• Click the Date box to open the calendar and select the date.

The Recent Patients feature displays a list of the most recently viewed patient charts for the current user.

• Select the Recent Patients tab.
• Click the “Chart No.” to open the desired patient’s chart.

The Open Encounters feature within the EHR allows users to view all open encounters for a given date range.

• Click the “Open Encounters” tab.
• For more information, view the “Open Encounters” help section.

The My Alerts feature provides color-coded button navigation to the “Pharmacy” and “Orders” modules as well as “Overdue Tasks.”

• Pharmacy Alerts: Check for failed electronic prescriptions, electronic renewal requests, and check the prescriber report to see what a provider has prescribed. View the “Pharmacy Alerts” help section for detailed information about this feature.
• Orders: See all orders ever created in MediTouch. View the “Orders” help section for complete information.
• Overdue: View all overdue alerts, tasks and messages. Review the “Overdue Alerts” help section more more information.
• Click “Staff Messages” to view all messages sent to the user ID.
• Select a Priority to sort the messages by priority.

Color Coding, in the Tasks & Messages section of the EHR, signals the priority of all tasks and messages in the selected view.

• Note the color codes as they appear in the example at left:
• Green indicates a low priority task.
• Yellow indicates a medium priority task.
• Blue indicates a system task.
• Beige indicates a normal priority task.

• Red indicates a high priority task.

• Create a Message, Task, or a Chart Note for a specific patient.

This help section reviews the Obstetric Hx feature, in which pregnancy history and active pregnancies are added and updated. This feature is used to record the Estimated Date of Delivery (EDD) details, and information regarding the initial physical exam and daily observations, as well as to review and print ACOG forms.

Obstetric HX

• Click “Add a Pregnancy” to add a past pregnancy.

• Complete details and click “Save Changes” to save.

Encounter Information

• Navigate to the “Encounters” tab of the EHR and select the desired encounter.
• Click “S” from the SOAP bar, and then select “Patient Hx” followed by “Obstetric Hx.”

Add an Active Pregnancy

• Click “Add an Active Pregnancy.”

• Complete EDD details.
• Click “Save Changes” to save.

• Select the “Newborn & Provider” tab.
• Complete information and click “Save Changes” to save.

Vital Signs

• Select “O” from the SOAP bar and click “Vital Signs.”
• Complete Vital Signs information and click “Save” when complete.
• Information saved here, including the blood pressure, pain level, height and weight, will pre-fill within the physical exam observations.

• Four custom lab urine tests are available.
• Complete information and click “Save” to complete.
• Information saved here will also pre-fill within the physical exam observations.

Physical Exam

Initial Physical

• Navigate to the encounter and complete the Obstetric Initial Physical tab.
• This information will pre-fill within the physical exam observations.
• A follow-up will create a follow-up on the Recall List.

Observations

• Select the Observations tab.
• Enter complete information. Click “Next Appointment” to schedule a follow-up appointment.
• Click “Save Changes” when complete.

• Make selections for the follow-up appointment.
• Click “Save.”

• Scheduled follow-ups will appear on the Recall List.

ACOG

Review Details

• Review details in the Obstetrics tab of the patient’s chart.

Print ACOG

• Click “Print” in the “Active Pregnancy” window to produce the ACOG form.
• Click “OK” in the pop-up window.

• Find the document via the “Administrative” tab of the patient’s chart.

• Click on the document to open. The document may be printed once it has been opened.

This help section details the steps necessary to allow MediTouch to begin tracking a user’s Meaningful Use and Quality Measures. For more information and answers to commonly asked questions regarding managing and reporting 2014 EHR Certified CQMs, review About PQRS and Meaningful Use Clinical Quality Measures.

• Select “Meaningful Use and Quality Measures” from the “Admin” page.

• Click the “Edit” icon to select a Meaningful Use measurement period, PQRS reporting measures, or Health Maintenance measures for the selected provider.

Enrollment

Meaningful Use Enrollment

• The “Enrollment” tab is the default selection.
• Select the Stage 1/Stage 2 Medicare/Medicaid program, and select dates if applicable.

PQRS Enrollment

• Check the box to participate in PQRS enrollment for the current year.

• Click “Save.”

Quality Measures

CMS Quality Measures

• Select the “Quality Measures” tab.
• Within the CMS Quality Measures section, select at least 9 Health Maintenance measures across 3 domains.

Health Maintenance

• Health Maintenance measures may be used for preventive care and wellness but not for CMS Programs.
• Enable 5 Health Maintenance measures approved for Meaningful Use when setting the measurement period. The measure will pass, provided that 9 CQMs have been activated.

Patient Centered Medical Home (PCMH)

• For detailed information regarding PCMH, review Patient Centered Medical Home made Easier with MediTouch.
• Select at least one Unhealthy Behavior and two Diseases or Conditions.

• Click “Save” once all selections have been made.