The Additional Sig field is found on the Medication Sig page. This field is used for additional medication instructions that cannot be expressed using the medication sig. These instructions are printed on the medication label for the patient.

Example: Must be taken with food.

Note: Prescribers should use the Pharmacist Note field to communicate medication instructions or information to the pharmacist only (e.g., for custom drugs). Do not use the Pharmacist Note field for additional sig. The information in this field does not get printed on the medication label.

• Do not add duplicate instructions that are already entered in the medication sig. This may confuse the pharmacist and the patient.

• Do not enter information that conflicts with what is entered in the medication sig.

• If Add’l Sig is selected under Amount and/or Units, additional sig information becomes mandatory. A message will display requesting additional sig instructions.
• Enter the additional sig instructions in the text field.

Prior to electronically prescribing controlled substances (EPCS), the prescriber must complete EPCS registration and setup.

• From the patient’s chart, click the Medication tab.
• Select the Prescribing Dr. and Location.
• EPCS-activated prescribing providers are indicated by a green checkmark.
• Medications highlighted in red indicate that they are scheduled drugs.
• Scheduled drugs can only be e-prescribed by EPCS-activated prescribers.
• One or multiple medications can be selected from the medication list or click New Medication to add a new one.
• Note: Multiple controlled drugs can be submitted for a single patient in one batch.
• Select the checkbox(es) of the medication(s) you want to e-prescribe.
• Click ePrescribe.

• An alternative is to electronically transmit a single scheduled drug from the Medication Sig page.
• Click Save and ePrescribe.

• To view only the EPCS-activated pharmacies (displayed in red), select the EPCS checkbox.
• Select a pharmacy.
• Select the Default checkbox to make a pharmacy the default pharmacy.
• Click Transmit.

• Each e-prescribed controlled substance requires two-factor authentication before it is successfully transmitted to the pharmacy.
• Enter the prescriber’s Universal ID username and password (created during the EPCS identity proofing process).
• Click Continue.

• Select the method by which you want to receive the autogenerated one-time passcode.
• Verizon app: Select your device’s name. No passcode entry is necessary. See next step below.
• Text message: Select your mobile number and click Text Me. Enter the one-time passcode and click Continue.

• The Verizon app autogenerates passcodes. Swipe the cloud icon upward to automatically send the code to MediTouch.
• We recommend using the app. We find that this is the fastest one-time passcode delivery method.

A single set of 10 objectives is now required. No changes to clinical quality measures (CQMs) or reporting.

For specific information about objectives and measures required in the Modified Stage 2 Final Rule, refer to the EHR Incentive Programs: 2015 through 2017 (Modified Stage 2) Overview.

On Tuesday, October 6, 2015, CMS released the final rule for 2015. The final rule for 2015 also discusses Meaningful Use for years 2016 and 2017. The final rule for Meaningful Use Stage 3, which becomes mandatory in 2018, was also released.

The purpose of this update is to discuss what is required to meet the Meaningful Use requirements for 2016.

Please pay careful attention to the directions in this memo to understand what you must do to gain any remaining bonus payments and avoid the payment adjustments being imposed in 2018 based on this year’s performance.

Please read the Red Flags section carefully.

Measurement Period

The measurement period this year for all repeat attesters is one year; for first time attesters, it is any 90-day period. For any provider that was already enrolled in MediTouch’s Meaningful Use interface for 2015, we will automatically reenroll them for the one year measurement period beginning January 1st 2016. >

Every provider is responsible for checking their enrollment at Admin > Meaningful Use and Quality Measures.

Attestation Period

For 2016, CMS will not open the attestation portal until January 2017, and you will have through February 28, 2017 to report.

Review the Measures

We suggest that you review the Meaningful Use 2015 Objectives and Measures now and then return to this document.

Red Flags

There are two obvious red flags:

• Health Information Exchange
• Public Health

Red Flag #1: Health Information Exchange (Only Applies to Stage 2 Providers)

Objective: Health Information Exchange (this objective was previously Summary of Care)

Measure: EPs who transitions or refers their patient to another setting of care or provider of care.

(1) Uses CEHRT to create a summary of care record (CCDA); and
(2) Electronically transmits such a summary to a receiving provider for more than 10 percent of transitions of care and referrals.

Part 2 of the Health Information Exchange measure is the red flag.

What this measure is really asking the provider to do is to:

Part 1 – Create a C-CDA document (summary of care document) at the time the provider is referring a patient for a consult or any transition of care. After the C-CDA document is created, part 2 of the measure requires that the C-CDA is transmitted electronically via direct secure messaging to the receiving party.

To learn how to use direct secure messaging, review the direct messaging help page.

The reason why using direct secure messaging to transmit C-CDA summary of care documents at a transition of care is considered a red flag is because some providers in your referral network may not have a direct secure address. Over the past year, we have seen greater adoption of direct messaing by more and more EHRs. Remember, MediTouch has been live on direct messaging since June 2013. There never has been an easier time to comply, but compliance is dependent on adoption by your referral network.

What You Should Do

Make sure that enough of the providers that you transition care to, via the MediTouch Orders/New Consult module, have direct secure messaging enabled. Having more providers that you transition care to contributing to your denominator for this measure makes meeting the 10% threshold for the numerator achievable.

About the Exclusion for the Health Information Exchange Measure:

Exclusion: Any EP who transfers a patient to another setting or refers a patient to another provider less than 100 times during the EHR reporting period.

If you are a physician that makes less than 100 referrals or transitions in the measurement period, you can attest to this exclusion. It was far easier to meet this “less than 100 times” threshold in 2015 because the measurement period was just 90 days. This year, the measurement period is a full year, but the exclusion number will remain at 100.

None of the Providers I Transition Care to Have Direct Secure Messaging:

If you believe that none of the providers in your referral network have direct messaging, you can claim a hardship exemption some time in 2017. We advise to always try to comply and attest successfully. It will be up to you to prove that your referral network did not support the 10% threshold should CMS choose to audit your practice. The MediTouch team will not be able to provide documentation of this fact so please document carefully if you choose to claim a hardship exemption for this measure.

Red Flag #2: Public Health

Measure 1 – Immunization Registry Reporting: The EP, eligible hospital, or CAH is in active engagement with a public health agency to submit immunization data.

Measure 2 – Syndromic Surveillance Reporting: The EP, eligible hospital, or CAH is in active engagement with a public health agency to submit syndromic surveillance data.

Measure 3 – Specialized Registry Reporting: The EP, eligible hospital, or CAH is in active engagement to submit data to a specialized registry.

STAGE 2 PROVIDERS ARE REQUIRED TO REPORT 2 OF THE 3 MEASURES.

STAGE 1 PROVIDERS ARE REQUIRED TO REPORT 1 OF THE 3 MEASURES IN 2015 AND 2 OF THE 3 MEASURES IN 2016 AND 2017.

Definition of Active Engagement

Proposed Active Engagement Option 1 – Completed Registration to Submit Data: The EP, eligible hospital, or CAH registered to submit data with the PHA or, where applicable, the CDR to which the information is being submitted; registration was completed within 60 days after the start of the EHR reporting period; and the EP, eligible hospital, or CAH is awaiting an invitation from the PHA or CDR to begin testing and validation. This option allows providers to meet the measure when the PHA or the CDR has limited resources to initiate the testing and validation process. Providers that have registered in previous years do not need to submit an additional registration to meet this requirement for each EHR reporting period.

Proposed Active Engagement Option 2 – Testing and Validation: The EP, eligible hospital, or CAH is in the process of testing and validation of the electronic submission of data. Providers must respond to requests from the PHA or, where applicable, the CDR within 30 days; failure to respond twice within an EHR reporting period would result in that provider not meeting the measure.

Proposed Active Engagement Option 3 – Production: The EP, eligible hospital, or CAH has completed testing and validation of the electronic submission and is electronically submitting production data to the PHA or CDR.

Many providers may be able to claim an exclusion for one or more measures: Read the public health reporting exclusions

The rule works in a round-robin fashion. If you meet the exclusion criteria from one public health measure, you must report the other one or two depending on your stage. If you meet the exclusion criteria for two measures, you must report the remaining one. If you meet the exclusion criteria for all three measures, you need not report any.

Read This Carefully

Historically, CMS required active ongoing submission of data. Now, the public health measures simply required “active engagement” within 60 days from the start of the measurement period. This means that if you cannot be excluded from the measure, you must actively engage. Assuming you are a Stage 2 Provider that cannot use the exclusion criteria for more than one measure, you must report that you are actively engaged for the other two measures. Today, most providers are not actively engaged with two public health registries. Some may be actively engaged with one; usually an immunization registry, but very few are engaged with two registries. If you are a Stage 2 provider, you must be actively engaged with two registries.

NO PROVIDER SHOULD FAIL MEANINGFUL USE BECAUSE OF THE PUBLIC HEALTH MEASURES.

What You Should Do

If you do not meet the definition of active engagement with two public health registries today, you still have time to meet the definition of active engagement. You must actively engage within 60 days of the start of the last reporting period, which began on January 1, 2016.

REMEMBER ACTIVE ENGAGEMENT CAN BE AS SIMPLE AS COMPLETING REGISTRATION TO SUBMIT DATA AND RECEIVING AND SAVING THE ACKNOWLEDGMENT OF YOUR REGISTRATION.

IF YOU ACTIVELY ENGAGE WITH A REGISTRY AND THEY REQUIRE A FILE FORMAT THAT IS NOT EXPORTABLE FROM OUR SYSTEM, YOU MAY CLAIM AN EXCLUSION. YOU ARE NOT REQUIRED TO CREATE FILE FORMATS OR COMMISSION THE CREATION OF FILE FORMATS THAT WERE NOT BUILT IN TO THE SYSTEM AT THE TIME OF CERTIFICATION.

Takeaways

• Our team is confident that our providers can meet Meaningful Use for 2016, but it will require some extra attention from your team.
• We will automatically enroll any provider that had previously enrolled in Meaningful Use for 2015, regardless of stage for the full one-year measurement period for 2016.
• If you have not enrolled on our Meaningful Use enrollment interface, navigate to Admin > Meaningful Use and Quality Measures to do so.
• Pay careful attention to the red flags described above.

Note: CMS has warned that Meaningful Use may change again soon. Do not assume that Meaningful Use will not be enforced this year. Until this page is updated, assume that you must comply with the current Meaningful Use rule.

In the Document Inbox, the Page Viewer toolbar contains the tools to perform actions on a document’s page. Providers can annotate and sign pages, save those pages to a document, and associate that document with a patient chart.

• Navigate to the Document Inbox (EHR Dashboard > Documents > Document Inbox tab).
• Click a document to view the document details.
• Click a page to preview. The Page Viewer opens, which displays the page in full page view.
• The Page Viewer toolbar contains the tools can use to perform actions on the page.
• To associate this page to a patient chart, click the Add to Work List checkbox.
• Click the left and right arrows to navigate back and forward, respectively, in the document. Any actions to the page are temporarily saved while you navigate through the document. Any edits made to the document are lost if you exit the viewer without saving.

Zoom In/Out and Pan a Page

Pan up and down the page while the page is zoomed in.

• Click the zoom in icon and then click the pan icon.
• Click and drag the page up and down. Note: Using a mouse’s scroll wheel does not scroll the page up and down.
• To return to full page view, click the zoom out icon.

Annotate Using a Text Box

Annotate the page using the Text Box tool. Text boxes can be resized (except on iPads) and moved anywhere on the page.

• Click the T (text box icon). A menu displays with formatting options.
• Click Add. A text box displays on the page.

• From the tool menu, click a font color (default is black).
• Select a font style (default is sans-serif).
• Select a font size (default is normal).
• Enter text in the text box.
• To delete a text box, click the text box to activate the delete button and then click Delete.
• After you are done with page, click Save & Close.

Annotate or Sign Using the Draw Tool

Use the Draw tool to sign a page directly on the screen or annotate the page.

• Click the draw icon. A menu displays with formatting options.
• Select a line color (default is black).
• Select a line size (default is normal).
• Hold down your mouse button (on an iPad, use your finger or stylus) and draw annotations or a signature.
• To remove anything drawn, click Clear. Note: The Clear tool removes everything that was drawn.
• After you are done with page, click Save & Close.

Add a Saved Signature

Add a saved signature to a page using the Signature tool. For information on how to assign a signature, review the Document Library help page. Saved signatures are in text boxes so they can be resized (except on iPads) and moved anywhere on the page.

• Click the signature icon. A menu displays with the saved signatures that you can add to the page.
• Select a signature from the select menu.
• Click Add.
• After you are done with page, click Save & Close.

• To delete a saved signature from the page, click the signature text box to activate the delete button and then click Delete.
• After you are done with page, click Save & Close.

Rotate

The Rotate tool rotates the page 180 degrees.

• Click the rotate icon. The page rotates 180 degrees.
• After you are done with page, click Save & Close.

Print a Page

The Print tool generates a printer-friendly version of the page.

• Click the print icon.

• A printer-friendly page is generated on a new tab.

Delete a Page

The Delete tool permanently deletes the page. The page will no longer be available in the Document Inbox.

• Click the delete icon.
• A dialog message displays stating that you are permanently deleting this page.
• Click Proceed.

The Physician Quality Reporting System (PQRS) is a CMS reporting program that uses a combination of incentive payments and penalties to promote reporting of clinical quality measures (CQM). This program is separate from Meaningful Use. The deadline to submit your file is February 26, 2016.

Visit the CMS site for the PQRS timeline.

PQRS Requirements

• The PQRS program requires at least nine measures covering at least three of the National Quality Strategy (NQS) domains, AND
• Each measure must have at least one patient in the numerator (at least 1/1 counts as meeting the measure)
• Providers must report on at least one CQM for which there is at least one FFS Medicare patient
• The reporting period is January 1, 2015–December 31, 2015.
• Reporting the year 2015 will impact 2017 Medicare reimbursements.
• PQRS EHR reporting uses data from all patients, regardless of their insurance status

Note: Measures with a 0% performance rate (zero numerator) will not qualify. The performance rate must be greater than 0%, unlike Meaningful Use where 0 is an acceptable value. Make sure that you have nine measures from three NQS domains. Many measures require specific E/M codes for a patient to qualify for the denominator; therefore, E/M coding impacts the denominator count for certain measures.

MediTouch creates a special file (QRDA file) that your practice can export and submit via the EHR reporting method. You must obtain login credentials to the CMS Enterprise Identity Management (EIDM) system for the PQRS Portal. You must upload your PQRS QRDA file by the February 26, 2016 deadline.

Step 1: Obtain an EIDM Account

• In the PQRS Submission User Guide, click Establishing a New User Login ID and follow the instructions.

Step 2: Download Your PQRS QRDA File

• Navigate to EHR > Documents > My Reports and locate your PQRS_2015 XML file.
• Preview the report by clicking document name to ensure you have at least nine qualifying measures from three domains with at least one patient in the numerator.
• To download the file, highlight the row that contains the XML file and then click Download.

Step 3: Submit Your File via Your PQRS Submission Portlet

• In the PQRS Submission User Guide, click Using the PQRS Submissions Portlet and follow the instructions.

Step 4: Confirm Submission

• A notification should be sent to the e-mail address associated with the CMS EIDM account indicating that your files were submitted and received.
• Submission reports regarding your file upload should be available via the PQRS Submission Portal.

Support

• First-level user support and problem reporting: Call 800-562-1963 or e-mail cms_it_service_desk@cms.hhs.gov
• Help with the PQRS Submission Portal or the EIDM registration process (e.g., forgot ID, password resets, etc.): Call 866-288-8912 or e-mail qnetsupport@hcqis.org
• QualityNet hours of operation: 7:00 AM to 7:00 PM CST

The Patient Portal Co-branding Setup feature enables you to co-brand the YourHealthFile Patient Portal to resemble your practice’s website.

Co-branding

With Patient Portal co-branding, practices can display their practice’s website branding throughout YourHealthFile.

• Practices upload a practice logo to display in the Patient Portal header and within patient emails.
• Practices display their website URL in patient emails as the portal login link.

Practices have the option to host the login so that patients log in to the Patient Portal directly from the practice’s website.

• From the menu bar, click Admin and then click Patient Portal Co-branding Setup.

Website URL

• Enter your practice’s website URL. Your patients will be redirected to your practice’s website after they log out of the patient portal.
• Click Save.
• To remove the website URL or both the URL and the logo file, click Clear. To remove a previously saved URL or both a saved URL and logo file, click Clear and then Save.

Practice Logo

• Click Browse to search your computer for your practice logo file (.gif, .jpg, or .png file no larger than 150 kb), select the file, and click Open.
• Click Save.
• To delete a selected image, click Delete. To delete a previously saved image, click Delete and click Save.
• To remove a previously saved URL and logo file, click Clear and then Save.

• The practice logo is displayed in the Patient Portal header in place of the YourHealthFile logo.

• The practice logo is displayed at the top of patient emails.
• The practice website URL is displayed as the login link.

Hosted Login

Practices can host the Patient Portal login, enabling patients to log in from the practice’s website. Upon successful authentication, the patient is directed to YourHealthFile. Upon logout, the patient is redirected to the practice’s website. Unlike co-branding where the practice’s logo is displayed on YourHealthFile pages, a hosted login does not place the practice’s logo on the portal pages. All portal pages continue to display the YourHealthFile logo.

Practices can co-brand the Patient Portal so that the practice logo is displayed throughout the portal.

• The login form is displayed on the practice’s website by inserting an IFrame in the HTML code on one of the practice’s existing web pages. Alternatively, practices may create a new page intended specifically for portal information and login, such as the example here.

IFrame

The URL for the HealthFusion login must include “https” instead of the typical “http” to ensure that the patient’s login credentials remain encrypted during the login process.

Downtime

• The Patient Portal may be occasionally unavailable due to scheduled maintenance. Under normal circumstances, this downtime will not be scheduled during normal Monday–Friday business hours.
• If the Patient Portal is taken offline, the login screen will be replaced with a message alerting the patient of the downtime.

Practices assign permissions to reports for each practice role. MediTouch sets default reports role permissions, but each practice can customize them.

• From the menu bar, click Admin and then click Reports Role Permissions.

• Select the checkboxes to indicate which practice roles can access which reports.
• Click Save.
• To return the role permissions to the MediTouch defaults, click Set Defaults.
• To clear all of the role permissions, click Delete and then Confirm.

The Locations: Departments and Rooms administration page is where practices configure departments and rooms per location. To use this feature, you must create at least one department and one room. If your practice does not have departments, create room types instead. Each location can have a default department, which is configured on the Administration: Calendar Resources page.

Department and room selection is performed on the following pages:

• EHR Dashboard (appointment details)
• Vital Signs (entering vitals)
• Appointment check-in

• From the menu bar, click Admin and then click Locations: Departments and Rooms.
• The page displays all practice locations and their associated departments and rooms.

Manage Departments

• To add a department, click Add Department.
• Enter the department (or room type) name.
• Click Save Department.
• To continue adding departments, enter another department name and click Save Department.
• If you are done adding departments, click Cancel.

• To edit a department, click .
• Edit the department (or room type) name.
• Click Save Department.

• To delete a department, click .
• Click Confirm.

Manage Rooms

• To add a room, click Add Room.
• Enter the room name.
• Click Save Room.
• To continue adding rooms, enter another room name and click Save Room.
• If you are done adding rooms, click Cancel.

• To edit a room, click .
• Edit the room name.
• Click Save Room.

• To delete a room, click .
• Click Confirm.

The Reports (Beta) Reporting Suite enables you to generate and customize reports. Learn about formatted reports, data tables, and activity grids, and how to use the reporting tool.

Note: The data in the reports will usually be 15 minutes to an hour behind the real-time data.

Practices assign permissions to reports for each practice role on the Reports Role Permissions administration page. These roles can then be assigned to users in User Maintenance under Reporting Roles.

• From the menu bar, hover the cursor over Reports and then click Reports (Beta).
• The reporting tool opens in a new tab. Depending on your browser configuration, you may have to accept pop-ups.

• Select a report type.
• Select a report name.
• Additional filters display depending on which report is selected.

Formatted Reports

All accounts receivable (AR) reports are formatted reports. These reports are formatted so that they are printable and not designed to be manipulated in Excel.

• The generated report.
• Click Excel or PDF to export the report in those respective formats.
• Note: The PDF export will not be available in the initial release, but printing from the browser can be used.

Data Tables

Data tables are essentially on-screen Excel spreadsheets.

• Contain a limited number of columns so that they are printable.
• Have predetermined grouping and totaling (e.g., charge amount).

If you want greater control of the data that is generated into a report, select the analysis grid equivalent of the report name (e.g., use the transaction details analysis grid instead of the various transaction summary data tables).

• The charges by location report.
• Click Excel, CSV, or PDF to export the report in those respective formats.
• Note: The PDF export will not be available in the initial release, but printing from the browser can be used.

Analysis Grids

The primary difference between a data table and an analysis grid is the ability to manipulate the data to customize the reports.

• Analysis grids have more columns available.
• Columns are movable.
• Includes a number of great tools to customize the data (see below)

The following screen capture is an example of a charge summary analysis grid report.

Table Configuration Options

There are two sets of table configuration options, enabling you to customize reports.

• Advanced configuration options:
• Formula: Add columns using formulas.
• Filter: Filters the rows by the cell values.
• Add Chart: Create a chart based on the generated report.
• Add Crosstab: Creates a pivot table by pivoting columns of data into rows of data.
• Basic configuration options (click gear icon to show):
• Columns: Hides and shows columns.
• Sort: Sorts the table.
• Group: Organizes the rows by grouping columns.
• Aggregate: Provides calculations for top and grouped levels.
• Paging: Sets the number of rows displayed per page.

Export Options

• Export Report: Export everything that is on the page to an Excel, CSV, or PDF file (e.g., table and chart).
• Export: Export only the table or report information that is on the panel to an Excel, CSV, or PDF file.
• Note: The PDF export will not be available in the initial release, but you can print from the browser.

Formula

• Enter the name for the column.
• Select from the menu to insert column names individually into the formula and click Insert.
• Enter mathematical symbols to complete the formula.
• Select the data type.
• Select the data format.
• Click Add.
• To replace an existing formula with a new formula click Replace instead of Add.

Filter

• Select the filter column.
• Select the comparison.
• Select the value.
• Click Add.
• To replace an existing filter with a new filter click Replace instead of Add.

Add Chart

The reporting tool generates a chart based on what is currently displayed in the table. Create a new chart or edit the existing chart. To remove the chart, click the X on the right corner of the panel.

• Click the desired chart type.
• Select the label column.
• Select the data column and select whether to show percentage or value.
• Select the data aggregation.
• Select the relevance.

Add Crosstab

Like the Chart option, the reporting tool generates a crosstab based on what is currently displayed in the table. Create a new crosstab or edit the existing crosstab. To remove the crosstab, click the X on the right corner of the panel.

• Click the header values column.
• Select the label values column.
• Select the aggregate values column.
• Select the aggregate function.

Columns

• Click Columns.
• Select the checkbox(es) for the desired table columns to display.
• Click OK.

Sort

• Click Sort.
• Select the data column.
• Select the order direction.
• Click Add.
• To replace an existing sort with a new sort click Replace instead of Add.

Group

• Click Group.
• Select the grouping column. In this example (date of service), select year, quarter, month, or day; else, it will group by day.
• Click Add.
• To replace an existing sort with a new sort click Replace instead of Add.

Aggregate

• Click Aggregate.
• Select the data column.
• Select the aggregate function. Depending on which data column is selected, the aggregate function options change.
• Select results positioning (where the result will display). If you have more than one aggregate, the last position you selected will apply.
• Click Add.
• To replace an existing sort with a new sort click Replace instead of Add.

Paging

• Click Show all rows or Show paging.
• If you choose paging, enter the number of rows per page to display.
• Click OK.

Column Heading Configuration and Formatting Options

You have a limited number of configuration options accessible from the column heading. Formatting options are only available here.

• Click the column heading.
• Select an option from the pop-up menu.
• For illustrative purposes, both the Aggregate and Format select menus are displayed. They normally would be shown individually upon selection.

Bookmarks

• To access the bookmarks, click View Bookmarks.
• To save your report as a bookmark, click Save Bookmark.
• Note: Date span selection is important for bookmarks to be used properly. You must select the dates using the drop-down options (e.g., last month) on the Reports home page.

MediTouch encourages the use of strong passwords to help ensure account security. Strong passwords helps to prevent unauthorized access to patient information. Password strength is validated every time you log in. If your password does not meet our password criteria, you are prompted to change your password.

Your account password must be:

• At least eight characters
• At least one uppercase letter
• At least one lowercase letter
• At least one number

• From the menu bar, click Admin and then click Account Maintenance.

• Click Reset Password.

• Enter the old password.
• Enter the new password.
• To view the new password, click Show Password.
• Note: The password strength indicator box changes color and displays checkmarks as your password strength increases.
• Click Change Password.

• An example of a strong password.

This help page provides the minimum requirements for the Annual Wellness Visit (AWV) as documented by The ABCs of the Annual Wellness Visit.

History

Under the Patient Protection and Affordable Care Act, Medicare beneficiaries are eligible for an Annual Wellness Visit.

The national non-facility payment amount for 2016 (refer to the Medicare Physician Fee Schedule Overview):

• G0438 – Initial AWV = $172.58
• G0439 – Subsequent AWV = $117.08
• 99497 – Advanced Care Planning, 30 min = $85.93
• 99498 – Advanced Care Planning, additional 30 min = $74.83

Benefit Information

• An AWV is not the same as the Initial Preventative Physical Exam (IPPE) or “Welcome to Medicare” visit.
• Eligibility for an AWV begins 12 months after Medicare Part B coverage begins and an IPPE or AWV has not been received within the last 12 months.
• An initial AWV (G0438) is covered only once in a beneficiary’s lifetime, regardless of provider.
• A subsequent AWV (G0439) is covered once per year after the initial AWV.
• Beginning January 1, 2016, Medicare added separate payable codes (99497, 99498) for face-to-face optional voluntary Advanced Care Planning (ACP) services. Deductible and coinsurance payments are waived when these codes are a part of an AWV.

Before You Begin

Before you start to chart on the AWV, you must activate the following MediTouch Custom Forms (Admin > Custom Forms):

• ADLs > ADLs
• Annual Wellness > About Medicare AWV
• Annual Wellness > Annual Wellness Checklist
• Annual Wellness > Medicare AWV Checklist > click Copy As New > Rename (e.g., AWV 2016) > click Save
• Annual Wellness > Medicare Prevent Service > click Copy As New > Rename (e.g., Prevent Services 2016) > click Save
• Note: Since these forms will not save the previous information after new information has been saved (e.g., the previous year’s information will no longer be available when the current year’s information is applied), we provide the steps above to make a copy of the Medicare AWV Checklist and the Medicare Prevent Service. Use these steps if you wish to save the information for each AWV.
• Annual Wellness > Prevent Service Checklist
• Habits-Lifestyle > Habits-Lifestyle
• Plan > Advanced Care Planning
• Psychosocial > PHQ-9 Depression Scale
• Psychosocial > Psychosocial Risks
• Safety > Fall Risk Assessment
• Sexual History > Sexual History
• Well Visit > AWV

AWV Visit

All procedures are performed in an encounter. Prior to performing the SOAP menu procedures, document the patient’s care team.

1. Click the top Administrative tab.
2. Click the Providers view.
3. Scroll down to the Care Team section to add to, or edit, the patient’s care team.

Subjective

1. Document the hearing screening question, self assessment of frailty, and self assessment of physical functioning in Chief Complaint > Well Visit > AWV.
2. Add/update the past medical and surgical history in Patient Hx > Medical Hx and Patient Hx > Surgical Hx.
3. Add/update the current medications, including supplements, in Medication History.
4. Add/update allergies in Allergies.
5. Add/update the family history in Patient Hx > Family Hx.
6. Document tobacco and alcohol use in Patient Hx > Social Hx > Social Hx.
7. Document ADLs and IADLs in Patient Hx > Social Hx > ADLs.
8. Document diet, physical activity, and oral health in Patient Hx > Social Hx > Habits-Lifestyle.
9. Document the patient’s depression screening using the PHQ-9 Depression Scale in Patient Hx > Social Hx > Psychosocial > Depression Scale
   PHQ-9.
10. Document the patient’s additional psychosocial risks in Patient Hx > Social Hx > Psychosocial > Psychosocial Risks.
11. Document the patient’s home safety in Patient Hx > Social Hx > Safety > Safety (under Household).
12. Document the patient’s fall risk using Patient Hx > Social Hx > Safety > Fall Risk Assessment.
13. Document the patient’s sexual history use using Patient Hx > Social Hx > Sexual History > Sexual History.

Objective

1. Update vital signs including:
   
   
   • Height
   • Weight
   • BMI or waist circumference
   • BP
2. Document hearing assessment in the applicable section of Physical Exam.
3. Document cognitive abilities in the applicable section of Physical Exam.
4. Document preventive screening in Health Maintenance, if applicable.

Assessment

Use any applicable ICD-10 code.

Plan

1. Procedure Coding – HCPCS Code
   
   
   • Initial AWV – G0438
   • Subsequent AWV – G0439
   • 99497 – Voluntary Advanced Care Planning services, if applicable.
   • Modifier 33 – Preventive Services
   • 99498 – For each additional 30 minutes of voluntary Advanced Care Planning services.
   • Modifier 33 – Preventive Services
   • If an additional medically necessary E/M service is required, use the -25 modifier with the medically necessary E/M code.
2. Review risk factors, medical conditions and management, and create/update the care plan as needed. Use Care Plan.
3. Create orders as needed including:
   
   
   • Referrals
     
     
     • Orders > New Consult
4. Create a screening schedule using the Care Plan > Annual Wellness > Prevent Service Checklist.
5. Discuss, create, and/or review ACP in Care Plan > Plan > Advanced Care Planning.
6. Provide health educatio, as needed, in Patient Instructions. Some examples of health education may include:
   
   
   • Weight loss
   • Physical activity
   • Tobacco use cessation
   • Fall prevention
   • Nutrition
7. Use the checklists to ensure all necessary steps have been covered.

Reference and Document Confirmation

• For reference purposes, the Annual Wellness Checklist and Prevent Service Checklist are available in Care Plan > Annual Wellness.
• Care Plan > Annual Wellness > Annual Wellness Checklist
• Care Plan > Annual Wellness > Prevent Service Checklist
• If you do not wish for this information to be documented in the patient’s encounter note, DO NOT save. If documentation is desired for confirmation purposes, see the following step.
• For documentation confirmation purposes, the checklists are available in the top Administrative tab (Administrative > Annual Wellness). These forms will not save the previous information after new information has been saved. See Before You Begin for the steps to save the information for each AWV (available for Medicare AWV Checklist and Medicare Prevent Service).

To keep records, copy these forms annually and save them with the respective year. To minimize confusion and inadvertent changes to the prior year’s information, we recommend you deactivate the previous year’s forms when you copy/create the new year’s form. This will make the form read-only so that you may go back and refer to it, but changes cannot be made.

This help page provides minimum requirements for the Initial Preventive Physical Exam (IPPE) as documented by The ABCs of the IPPE.

History

Under the Patient Protection and Affordable Care Act, Medicare beneficiaries are eligible for an Initial Preventive Physical Exam.

The national non-facility payment amount for 2016 (refer to the Medicare Physician Fee Schedule Overview):

• G0402 – IPPE = $167.56
• G0403 – EKG for IPPE = $17.19
• G0404 – EKG tracing only for IPPE = $8.59
• G0405 – EKG interpretation and result only for IPPE = $8.59
• 99497 – Advanced Care Planning, 30 min = $85.93
• 99498 – Advanced Care Planning, additional 30 min = $74.83

Benefit Information

• An IPPE is not the same as the Annual Wellness Visit (AWV).
• Eligibility for an IPPE (G0402) begins within the first 12 months of Medicare coverage and is covered only once in a beneficiary’s lifetime, regardless of provider.
• Eligibility for an AWV begins 12 months after Medicare Part B coverage begins and an IPPE or AWV has not been received within the last 12 months.
• An initial AWV (G0438) is covered only once in a beneficiary’s lifetime, regardless of provider.
• A subsequent AWV (G0439) is covered once per year after the initial AWV.
• A screening EKG (G0403, G0404, G0405) is also a one-time benefit when done as a referral from an IPPE.
• Beginning January 1, 2016, Medicare added separate payable codes (99497, 99498) for face-to-face optional voluntary Advanced Care Planning (ACP) services. Deductible and coinsurance payments are waived when these codes are a part of an IPPE.

Before You Begin

Before you start to chart on the IPPE, you must activate the following MediTouch Custom Forms:

• ADLs > ADLs
• Annual Wellness > About Medicare IPPE
• Annual Wellness > IPPE Checklist
• Annual Wellness > Medicare IPPE Checklist > click Copy As New > Rename (e.g., IPPE 2016) > click Save
• Annual Wellness > Medicare Prevent Service > click Copy As New > Rename (e.g., Prevent Services 2016) > click Save
• Note: Since these forms will not save the previous information after new information has been saved (e.g., the previous year’s information will no longer be available when the current year’s information is applied), we provide the steps above to make a copy of the Medicare AWV Checklist and the Medicare Prevent Service. Use these steps if you wish to save the information for each AWV.
• Annual Wellness > Prevent Service Checklist
• Habits-Lifestyle > Habits-Lifestyle
• Plan > Advanced Care Planning
• Psychosocial > PHQ-9 Depression Scale
• Psychosocial > Psychosocial Risks
• Safety > Fall Risk Assessment
• Sexual History > Sexual History
• Well Visit > IPPE

IPPE Visit

All procedures are performed in an encounter. Prior to performing the SOAP menu procedures, document the patient’s care team.

1. Click the top Administrative tab.
2. Click the Providers view.
3. Scroll down to the Care Team section to add to, or edit, the patient’s care team.

Perform the following procedures from the SOAP menu.

Subjective

1. Document the hearing screening question in Chief Complaint > Well Visit > IPPE.
2. Add/update the past medical and surgical history in Patient Hx > Medical Hx and Patient Hx > Surgical Hx.
3. Add/update the current medications, including supplements, in Medication History.
4. Add/update allergies in Allergies.
5. Add/update the family history in Patient Hx > Family Hx.
6. Document tobacco and alcohol use in Patient Hx > Social Hx > Social Hx.
7. Document ADLs and IADLs in Patient Hx > Social Hx > ADLs.
8. Document diet, physical activity, and oral health in Patient Hx > Social Hx > Habits-Lifestyle.
9. Document the patient’s depression screening using the PHQ-9 Depression Scale in Patient Hx > Social Hx > Psychosocial > Depression Scale
   PHQ-9.
10. Document the patient’s additional psychosocial risks in Patient Hx > Social Hx > Psychosocial > Psychosocial Risks.
11. Document the patient’s home safety in Patient Hx > Social Hx > Safety > Safety (under Household).
12. Document the patient’s fall risk using Patient Hx > Social Hx > Safety > Fall Risk Assessment.
13. Document the patient’s additional behavior risks using Patient Hx > Social Hx > Sexual History > Sexual History and Patient Hx > Social Hx > Substance Use.

Objective

1. Update vital signs including:
   
   
   • Height
   • Weight
   • BMI or waist circumference
   • BP
2. Document visual acuity in the applicable section of the Physical Exam.
3. Document preventive screening in Health Maintenance, if applicable.

Assessment

Use any applicable ICD-10 code.

Plan

1. Procedure Coding – HCPCS Code
   
   
   • G0402 – Initial Preventive Physical Exam (IPPE)
   • G0403 – IPPE with screen 12 lead EKG, interpretation, and report.
   • G0404 – IPPE with screening 12 lead EKG, no interpretation, or report.
   • G0405 – IPPE with EKG interpretation and report only.
   • 99497 – Voluntary Advanced Care Planning services, if applicable.
   • Modifier 33 – Preventive Services
   • 99498 – For each additional 30 minutes of voluntary Advanced Care Planning services.
   • Modifier 33 – Preventive Services
   • If an additional medically necessary E/M service is required, use the -25 modifier with the medically necessary E/M code.
2. Create orders as needed including:
   
   
   • EKG
     
     
     • Orders > New Office Test if performed in the office. Results can be documented at the time the order is created or in O > Order Results.
     • Orders > New Consult if referring outside of the office.
   • Referrals
     
     
     • Orders > New Consult
3. Review risk factors, medical conditions and management, and create/update care plan as needed. Use Care Plan.
4. Discuss, create, and/or review ACP in Care Plan > Plan > Advanced Care Planning.
5. Provide health education as needed in Patient Instructions. Some examples of health education may include:
   
   
   • Weight loss
   • Physical activity
   • Tobacco use cessation
   • Fall prevention
   • Nutrition
6. Use the checklists to ensure all necessary steps have been covered.

Reference and Document Confirmation

• For reference purposes, the Annual Wellness Checklist and Prevent Service Checklist are available in Care Plan > Annual Wellness.
• Care Plan > Annual Wellness > Annual Wellness Checklist
• Care Plan > Annual Wellness > Prevent Service Checklist
• If you do not wish for this information to be documented in the patient’s encounter note, DO NOT save. If documentation is desired for confirmation purposes, see the following step.
• For documentation confirmation purposes, the checklists are available in the top Administrative tab (Administrative > Annual Wellness). These forms will not save the previous information after new information has been saved. See Before You Begin for the steps to save the information for each AWV (available for Medicare AWV Checklist and Medicare Prevent Service).

To keep records, copy these forms annually and save them with the respective year. To minimize confusion and inadvertent changes to the prior year’s information, we recommend you deactivate the previous year’s forms when you copy/create the new year’s form. This will make the form read-only so that you may go back and refer to it, but changes cannot be made.

Learn how to scan documents into MediTouch. Our scanning feature is compatible on all supported Web browsers. Scanned documents can be uploaded into a patient’s chart. Both Windows and Mac instructions are provided.

Note: Your scanning experience may vary depending on which OS and scanner you use.

Requirements

• TWAIN-compatible scanner (including all-in-one printers) with driver installed.
• Dynamsoft Dynamic Web TWAIN software installed

• From the EHR Dashboard, click Documents on the bottom blue bar.

• Click Scan a Document.

Install Software

• The first time you attempt to scan, you are prompted for a one-time installation of the Dynamsoft Dynamic Web TWAIN software.
• Click Download.
• Where the installation file downloads, depends on the configuration of your browser and your OS (e.g., the file may download in your Downloads folder or at the bottom of your browser window).

• The software prepares to install.

• The Dynamic Web TWAIN setup wizard launches.

• The installer is ready to install the software.
• Click through the installation process.

• Installation is complete.
• Click Close to exit the installer.

• Important: Do not attempt to install the software again.
• Now that installation is complete, make sure you refresh your browser.
• We recommend that you restart your computer. After you log back in to MediTouch, the software should be working as expected.

Scan Using Windows

These instructions are based on Windows 10.

• Place the page to be scanned on the scanner if you have not done so already.
• You do not need to make color or resolution selections if your scanner launches its own scanning tool.
• Click Scan.

• The ScanGear tool launches. Note: Your scanner may launch a different tool or behave differently.
• Make your scanning selections.
• Click Preview if you want to preview the document.

• Click Scan.

• A successfully scanned page. Note: You must repeat the scanning steps for each page of the document you wish to upload.
• Click Upload to upload the scanned document (see Upload the Document.

Scan Using Mac

These instructions are based on Mac OS X El Capitan (version 10.11).

• Place the item to be scanned on the scanner if you have not done so already.
• Select the color and resolution.
• Click Scan.

• A successfully scanned page. Note: You must repeat the scanning steps for each page of the document you wish to upload.
• Click Upload to upload the scanned document.

Upload the Document

• Make your selections.
• The Document Name is autofilled, but is editable.
• The Document Date is the current date.
• For more field descriptions, refer to Single File Upload.
• Click Save.
• The document displays on the All Documents page.

The Dashboard is where the medical staff views their schedule, encounters, recent patients, alerts, tasks, and messages. We want you to be able to accomplish more without having to leave the Dashboard. We created Patient Tracker to fulfill that goal.

Patient Tracker is the enhanced, schedule-focused Dashboard view that enables you to monitor and manage patient flow. You will be able to view the patient’s status, room status, and important information relevant to the patient’s appointment and encounter.

You notice the Dashboard’s new look immediately. We take full advantage of the expanded EHR layout and provide you access to more information, resulting in a quick and efficient experience for both the patient and medical staff.

More help pages are coming soon so check back for detailed information about Patient Tracker.

New Look and Feel

• The first thing you notice on the new Dashboard is how much more information is available to you.
• Also evident is the how easy it is to navigate through the Dashboard. You can quickly click the date back and forward (Date of Service). You can also filter which patients are waiting, in a room, or checked out (Patient Status).
• New on the view tabs are Patient Tracker and Room Tracker. We also moved Resident Roster to the view tabs, but kept the functionality the same.
• Patient Tracker’s two filter views are now Schedule and Encounters.

• Patient Tracker includes many new enhancements to the appointment summary information — room and status, wait time and appointment status, comments, follow-up information, age, sex, reason for visit, provider, whether vitals have been entered, and the patient’s priority.
• Sorting appointments is available by room name, time (the default), wait, patient, and priority.
• We redesigned the Dashboard to give you more access points to information by way of a Dashboard toolbar that displays throughout the EHR (on the top right), filters, and a slide panel that displays either the encounter details, messages, or tasks.
• Click the new Patient Tracker icon from anywhere in the EHR to return to Patient Tracker. Clicking Dashboard on the bottom frame will also navigate you to Patient Tracker.
• Dashboard tools are available to perform a page search, view messages or tasks, and navigate to the Pharmacy Alerts or Orders page. Indicators (colored dots) display on the icons alerting you of a new message, task, pharmacy renewal, or order that requires your attention.
• There are also new EHR tool icons that display throughout the EHR (on the left).

Room Tracker

• Room Tracker is a departments and rooms-focused view and displays the current status of each room separated by department.
• Room Tracker enables you to monitor which patient is in which room and when rooms become available.
• Filter displayed rooms by department or room status.
• Room statuses are displayed for the current day only.

Room Status

• Room statuses are color-coded; each color represents a different status.
• A room status can be selected for rooms that are associated with departments.
• Click a room status (colored square) to launch the room status widget where you can select or update the room status.

Encounter Preview

To allow you to view a patient’s encounter details without leaving the Dashboard, we created a slide panel that slides out from the right to display the Encounter Preview. The Encounter Preview is accessible from both Patient Tracker and Room Tracker.

• Click the patient row to display details about the patient’s encounter on the slide panel.
• Included at the top are the reason for visit, check-in time, in-room time, and visit time.
• We are developing new functionalities to make the Encounter Preview even more useful to medical staff such as enhanced tasking and encounter chat. These new functionalities will be available in future releases.

My Messages

Messages and announcements are now displayed on the slide panel.

• Click the messages icon to display your messages on the slide panel.
• Indicators (colored dots) display in the left corner of the icon to alert you that you have a message that needs your attention.
• The functionality of the tasks and messaging tool is the same as before.
• When we have new announcements, they will display here and the slide panel will open automatically.
• To view the most recent announcements at any time, click the megaphone icon.

My Tasks

Tasks are now displayed on the slide panel.

• Click the task icon to display your tasks on the slide panel.
• Indicators (colored dots) display in the left corner of the icon to alert you that you have a task that needs your attention.
• The functionality of tasks and messaging tool is the same as before.

Pharmacy and Order Alerts

• Click the pharmacy alerts icon to navigate to the Pharmacy Alerts page.
• Indicators (colored dots) display in the left corner of the icon to alert you that you have a pharmacy renewal that needs your attention.

• Click the orders icon to navigate to the Orders page.
• Indicators (colored dots) display in the left corner of the icon to alert you that you have a order that needs your attention.

Patient Tracker is the schedule-focused Dashboard view that enables you to monitor and manage patient flow. View the patient’s status, room status, and important information relevant to the patient’s appointment and encounter.

Patient Tracker is the default view of the EHR Dashboard and contains two views — Schedule and Encounter. Click the Patient Tracker icon to return to Patient Tracker from anywhere in the EHR. Clicking Dashboard on the bottom frame also navigates you to Patient Tracker.

Schedule

Notes for iPad users: If you use private browsing in Safari, some settings and selections will not be remembered when you navigate back to Patient Tracker.

• Resource: The last selected resource will not be remembered. If you are a provider, your name defaults as the resource. If you are staff member, the default resource is the first resource in alphabetical order.
• Hide checked out: This option is located beneath Patient Status. The checkbox will always be unchecked.

Note about department and room selection: If you configured a default department on the Calendar Resources page and you return to a page where you can select a department and room, the default department is preselected on the menu. If you did not set up a default department, Select Department is preselected on the menu. This behavior occurs on the appointment type window in Patient Tracker and Room Tracker and when entering vitals on the Vital Signs page.

• Resource: Select a calendar resource.
• View: Select Schedule or Encounter.
• Date of Service: To change the date, click the date back and forward using the previous and next buttons or click the current date to launch the date picker.
• Patient Status: Filters the displayed appointments by patients waiting, in a room, and checked out. Select the Hide Checked Out checkbox to view only the appointments that have not been checked out. This option is only available when All is selected as the Patient Status filter. Your selection is remembered every time you return to Patient Tracker unless you use private browsing on an iPad.

• Room: The room status and the room name. To assign a room to a patient, click the Appointment Type and select a department (if available) and a room. If no department is available, enter a room name in the text box.
• Time: Click the appointment time to start a new encounter.
• Wait: Patient status and wait time. The possible statuses are new, checked in, and checked out.
• One time displayed: Wait time from check in until the start of the encounter
• Two times displayed: Time 1 = Wait time from check in until encounter start. Time 2 = Wait time from encounter start until check out. Adding the two times together produces the total visit time (found in the Encounter Preview).
• Patient: Click the patient’s name to open the patient’s chart. Beneath the patient’s name, comments and follow-up information display. Comments are entered in the appointment type window. Follow-up information are entered either in the appointment type window or during scheduling.
• Appointment Type: Click the appointment type to view the appointment details. From the appointment type window, you can select a priority, change the rendering provider, select or change the department and room, enter comments, and enter or edit follow-up information.
• Age: Age of the patient.
• Sex: Sex of the patient.
• Reason for Visit: Entered by the scheduler in the Notes/Reason text box during the scheduling process.
• Provider: Rendering provider
• Vitals: A green checkmark indicates that vital signs have been entered for the encounter.
• Priority: Indicates if a patient’s priority is high (up arrow), normal (blank), or low (down arrow). Click the appointment type to select a priority.

Room Status

• Room statuses are color-coded; each color represents a different status.
• A room status can be selected for rooms that are associated with departments.
• Click a room status (colored square) to launch the room status widget where you can select or update the room status.
• Note: Checking out a patient does not remove a patient from the room. You must remove the patient from the room by changing the room status to either one of the Empty statuses. This will free up the room and also stop the timer on the Visit Time (in Encounter Preview).

Appointment Type

• The appointment details that were entered during scheduling.
• Select the priority (default is normal).
• Select the department (if applicable) and room.
• Note: You will only see the department and room menu options if you have configured them for your practice in Locations: Departments and Rooms; else, you will see a text box to fill in the room. Default locations are set up on the Calendar Resources page.
• Enter comments or follow-up information. These display below the patient’s name in Patient Tracker.
• Click Save Appointment.

Reason for Visit

• The reason for visit is entered by the scheduler in the Notes/Reason text box (found in Schedule > Daily Schedule or Schedule > Calendar > any view).
• Also worth noting is that the follow-up information entered here displays beneath the patient’s name in Patient Tracker and Room Tracker. This is also editable from the appointment type window, also in Patient Tracker and Room Tracker.

Encounter

• To see the encounter’s status and diagnosis for the selected resource’s schedule, select Encounters from the View menu.
• If there are any data in the Diagnosis or Status columns, this means that the encounter has been started. Diagnosis indicates the assessment of the encounter and the status indicates where the encounter last left off.

Encounter Preview

To view a patient’s encounter details without leaving the Dashboard, we created a slide panel that slides out from the right to display the Encounter Preview. The Encounter Preview is accessible from both Patient Tracker and Room Tracker.

The Encounter Preview is a condensed version of the Encounter Summary Preview and displays the following:

• Patient demographics and insurance information
• Encounter tasks
• Subjective: Chief complaint, medication history, allergies, and review of systems
• Objective: Vital signs
• Assessment: Diagnosis
• Plan: Procedure coding, orders, prescribed medications, problem list

Also included at the top are the appointment date, reason for visit, chart number, check-in time, in-room time, and visit time.

• Click the patient’s row to open the Encounter Preview slide panel.
• In Room: Any time the room status changes or you move the patient into a different room, the In Room time updates. The time clears when the room status changes to either one of the Empty statuses.
• Visit Time: The timer does not stop until you have changed the room status to one of the Empty statuses. Checking the patient out does not remove the patient from the room.

Other help pages you may be interested in:

• Encounter Preview
• Navigate the EHR Dashboard
• Room Tracker

Room Tracker is the departments and rooms-focused view of the EHR Dashboard. Room Tracker enables you to monitor which patient is in which room and when rooms become available.

To use the room status feature of Room Tracker, you must have rooms associated with departments. To configure departments and rooms for your practice, go to Admin > Locations: Departments and Rooms.

Room Tracker displays the current status of each room separated by department. You will only see the department and room menu options if you have configured them for your practice in Locations: Departments and Rooms; else, you will see a text box to fill in the room. Default locations are set up on the Calendar Resources page.

• Room Tracker displays the current status of each room separated by department.
• Use the Departments and Room Status filters to narrow the displayed rooms by department or room status.
• Room statuses are displayed for the current day only.
• Appointment information (columns) are the same as Patient Tracker.

Select a Room

Click the appointment type to select a department (if configured for your practice) and a room. Note: You will only see the department and room menu options if you have configured them for your practice in Locations: Departments and Rooms; else, you will see a text box to fill in the room. Default locations are set up on the Calendar Resources page.

Department and Room

Note about department and room selection: If you configured a default department on the Calendar Resources page and you return to a page where you can select a department and room, the default department is preselected on the menu. If you did not set up a default department, Select Department is preselected on the menu. This behavior occurs on the appointment type window in Patient Tracker and Room Tracker and when entering vitals on the Vital Signs page.

• Select the department and room.
• Click Save Appointment.

No Department

• Select No Department and enter the room name in the text box.
• Click Save Appointment.

Room Status

• Room statuses are color-coded; each color represents a different status.
• A room status can be selected for rooms that are associated with departments.
• Click a room status (colored square) to launch the room status widget where you can select or update the room status.
• Note: Checking out a patient does not remove a patient from the room. You must remove the patient from the room by changing the room status to either one of the Empty statuses. This will free up the room and also stop the timer on the Visit Time (in Encounter Preview).

• When there is no patient assigned to the room, the only status options available are Empty – Ready for Patient and Empty – Needs Cleaning.

Encounter Preview

To view a patient’s encounter details without leaving the Dashboard, we created a slide panel that slides out from the right to display the Encounter Preview. The Encounter Preview is accessible from both Patient Tracker and Room Tracker.

The Encounter Preview is a condensed version of the Encounter Summary Preview and displays the following:

• Patient demographics and insurance information
• Encounter tasks
• Subjective: Chief complaint, medication history, allergies, and review of systems
• Objective: Vital signs
• Assessment: Diagnosis
• Plan: Procedure coding, orders, prescribed medications, problem list

Also included at the top are the appointment date, reason for visit, chart number, check-in time, in-room time, and visit time.

• Click the patient’s row to open the Encounter Preview slide panel.
• In Room: Any time the room status changes or you move the patient into a different room, the In Room time updates. The time clears when the room status changes to either one of the Empty statuses.
• Visit Time: The timer does not stop until you have changed the room status to one of the Empty statuses. Checking the patient out does not remove the patient from the room.

Other help pages you may be interested in:

• Encounter Preview
• Locations: Departments and Rooms
• Navigate the EHR Dashboard
• Patient Tracker

Encounter Preview is a condensed version of the Encounter Summary Preview with the additional appointment information. Encounter Preview is accessible from both Patient Tracker and Room Tracker on the EHR Dashboard and allows you to view the patient’s encounter details from a split screen slide panel without leaving the Dashboard.

• Click the patient’s row to open the Encounter Preview slide panel.
• There is no Encounter Preview content yet since the encounter has not been created.
• This patient has not been checked in so there is no check-in time.
• To start the encounter, click the appointment time.

• Now that encounter information has been entered, content displays on the Encounter Preview.
• Reason for Visit: Entered by the scheduler during the appointment scheduling process.
• This patient has been checked in and placed in a room so there is a check-in time and an in-room time.
• Check In: Time that the patient was checked in.
• In Room: Time that the patient was placed in a room. Note: Every time the room status changes or you move the patient into a different room, the In Room time updates. The time clears when the room status changes to either Empty – Ready for Patient or Empty – Needs Cleaning.

• Visit Time: The timer does not stop until you have changed the room status to one of the Empty statuses. Checking the patient out does not remove the patient from the room.

• Beneath the appointment information the following displays (presented in collapsed view to show the complete list):
• Patient demographics and insurance information
• Encounter tasks: Tasks created while in an encounter display here.
• Subjective: Chief complaint, medication history, allergies, and review of systems
• Objective: Vital signs
• Assessment: Diagnosis
• Plan: Procedure coding, orders, prescribed medications, problem list

Other help pages you may be interested in:

• Patient Tracker
• Room Tracker

The transaction roll forward reports are designed to track balance-changing transactions (for both insurance and patient) and balance the AR. The purpose of this report is to prove that the AR is balanced.

We group the transaction roll forward reports by provider and by payer so you can generate a report for each. Run an AR report to compare to the transaction roll forward report. Run the AR report on the same day of close to match total AR balances.

Calculations

How to balance AR: Starting AR (SAR) + Change in AR (CAR) = Ending AR (EAR).

• Ending AR = Starting AR + Change in AR
 
• CAR = Charges – Total Payments – Adjustments – Write-offs
• True end of month AR = Ending AR – CAR of overlapping transactions

Definitions and Notes

• Starting AR: Ending AR from the previous month
 
• Ending AR: Total balance from charge ledger on the month end close date. Captured on the night of the selected close date each month.
• Balance-changing transactions: Includes charges, insurance payments, patient payments, adjustments, and write-offs. These represent the CAR.
 
• CAR events: Reported by ledger date in the closed month.
• Overpayments: Included in the report to track total applied payments. It is not included in the CAR calculation because It does not reduce the balance of the claim.
• Overlapping transactions: Subtracted from the Ending AR. Created from the start of the new month until the current month’s month end close date with a ledger date in the new month.
• Example: Month end close date for May is June 5. Transactions posted from June 1 through June 5 with a ledger date in June are overlapping transactions.
 
• Transaction roll forward reports contain content as of March 2016.
 
• The previous month is preselected by default in the report.

 

 
• From the menu bar, hover the cursor over Reports and then click Reports (Beta).
 
• For Report Type, select Month End.
 
• For Report Name, select either Transaction Roll Forward by Payer Report or Transaction Roll Forward by Provider Report.
 
• Click Generate Report.

 
• This is an example of a report grouped by provider.
 
• The prior month is selected for the report date by default. If you want a different report date, select a different month (and year, if necessary) and click Generate Report.
 
• If there is no data, the report generates all zeros.

Using the last entry (Jack Johnson) as an example, to calculate the true end of month AR, we must first calculate the Ending AR.

• SAR = $86,528.74
• CAR = Charges ($1001.74) – Total Payments ($0) – Adjustments ($0) – Write-offs ($20) = $981.71
• EAR = SAR ($86,528.74) + CAR ($981.71) = $87,510.45

To calculate the true end of month AR, we need to calculate the CAR of April’s overlapping transactions. If the month end close date for April is May 5, we take all of the posted transactions from May 1 to May 5 that have a May ledger date. Remember that transactions that are posted in May do not necessarily have a May ledger date. Assuming that that following May ledger date transactions posted from May 1 through May 5, these are the overlapping transactions for April:

• Charges = $1000
• Total payments = $100
• Adjustments = $75
• Write-offs = $25

The CAR of April’s overlapping transactions = $1000 – $100 – $75 – $25 = $800.

The true end of month AR = Ending AR ($87,520.45) – CAR of overlapping transactions ($800) = $86,720.45

Upload and scan documents into a patient’s chart from the Patient Documents page.

• Navigate to a patient’s chart (e.g., Patient Roster, Recent Patients).
• Click Documents. You are navigated to the Patient Documents page.

• Uploaded documents display.
• Under the Options column, options are available to edit, download, preview, or delete the document.

• Documents are also accessible from the Administrative tab of the patient’s chart on the EHR.

Upload Documents

• Click Upload Document.

• Document Title: Enter the document title (required).
• File: Click Choose File to browse for the file (required).
• Document Type: Select the document type (required).
• Provider: Select the rendering provider.
• Document Date: Defaults to the current day. To change the date, click the date to open the date picker tool.
• Notes: Enter notes.
• Click Upload.

Scan Documents

Requirements

• Scanner with driver installed
• Dynamsoft Dynamic Web TWAIN software installed

The first time you attempt to scan, you are prompted for a one-time installation of the Dynamsoft Dynamic Web TWAIN software. You must install this software to use the scanning feature.

• Click Scan Document. The Scan a Document window opens.

• Click Scan.

• The ScanGear tool launches. Note: Your scanner may launch a different tool or behave differently. If you are using a Mac, ScanGear will not launch.
• If you want to preview the document, click Preview.
• Click Scan.

• A successfully scanned page.
• Continue to scan each page of the document you wish to upload.
• Click Upload to upload the scanned document.

• Document Title is autogenerated and Document Type defaults to Other.
• Edit the document properties as necessary.
• Click Save.

Search Documents

• To find an uploaded document, click .
• Document Type: Default is All or select the document type.
• Provider: Default is Any or select the rendering provider.
• Uploader: Default is Any or select the user who uploaded the document.
• Document Date: Default is empty or select a date range. Date range is limited to 365 days.

• Upload Date: Default date range is 30 days from current date or select a date range. Date range is limited to 365 days.
• Name Contains: Enter words that are in document title.
• Upload Date/Document Date: By which date you want the search results ordered. Default is Upload Date.
• After you enter your search criteria, click Search.

• Search results display.
• Click to return to the complete document list.

Other help pages you may be interested in:

• Patient Chart: Administrative
• Scan Documents