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RPMS SupportCoding Queue for New EHR Users DRAFTPurposeCoding Queue is for the review of data in PCC. When it is marked complete in Coding Queue, a visit is then queued to be transferred to Third Party Billing package. The coder needs to ensure that the visit is complete (and ready for billing), that uncoded elements have been appropriately coded and additional codes supported by other documentation in the EHR including provider notes have been added to the PCC record.Procedure Site preparation before you begin:Review the CASP, site parameters for the Coding queue. Which visit types will you not code? E.g. Telephonic? Chart review? (Note: Hospitalization = Inpatient stay. In-hospital = visit to an outpatient clinic, such as Physical therapy, while admitted as an inpatient.Set system to include visits without primary provider. You will need to correct these.You may or may not want to require a reason for a chart to be marked incomplete on review. If yes, define your ‘Reasons’ using the ACDR function. This is probably only useful if you are going to follow up incomplete charts sorted by deficiency reason.Determine how many days late you expect your providers to be (often called ‘suspense’ days). Check with the site CAC that the Lock parameter on the EHR is set for that number of days or fewer. Locking the visit on EHR will prevent providers from adding or deleting charges and diagnosis codes, but it will not prevent them from addending or completing their Progress Notes. You will use this suspense days range when you specify the ‘end’ date for your Coding session.Determine how many days that you need to wait for lab reports to be completed. Lab charges drop into PCC (and from there appear in the Coding Queue) when the lab test is completed. This can take time for reference lab tests, especially esoteric labs, mycology and mycobacteriology. How are you going to know if lab charges are posted? Should a different mechanism be installed for lab charges that are known to take a long time to come back?Daily before the Coding QueueIf you review pending labs, ask the Lab supervisor for what is on the “Incomplete Test Report”.Review and fix uncoded diagnoses entered via EHR. (May be done in Coding Queue.) DEU | SUP | ICD | POVReview and fix uncoded CPTs entered via EHR. (May done in Coding Queue.)Mark visits as complete for certain non-medical groups. Run ACCL for Dental, Telephone and Chart Review. ENT | EHRC | ACCLLook for and followup for unsigned charts. [TIU Menu for Medical Records | Search for Selected Documents SSD]SSDSelect Status : UNSIGNED (and repeat later for UNCOSIGNED)Select Clinical Documents: Progress NotesSelect Search Categories: All CategoriesStart reference date: T-x (where x is the number of days that you want to look back)Ending reference date: T-n (where n is the number of days grace allowed to providers to finish their notes, and x is more than n.)This results in a list of documents meeting the criteria. Note that you use the ‘>’ to see the columns off the right hand side of the page.Auto-complete Pharmacy Education visits (if you have a pharmacist doing these) ENT | EHRC | ACRX.Daily for CodingRun the ALL option for : Zero dependent entries; No POV or provider; Multiple visits on same day; Workload transmission error. DEU | SUP | VRR | ALL. Make corrections as appropriate.Run the Coding Queue. ENT | EHRC | EHRD.Choose beginning date and end date. The end date should not be any more recent than ‘T-x’ where x is the number of suspense days.You may filter the visits to be reviewed in your session by clinic stop (i.e. type of clinic, such as medical, pharmacy, etc.), location (or taxonomy (i.e. group) of locations) (locations are the individual clinic names – system of naming is site-defined), provider (or taxonomy of providers), or by chart deficiency reason (if defined at your site). You will want to exclude demo patients for routine work. The system will ask you how you want to sort. We recommend sorting by chart number; sometimes you identify visit merges in this review.In the review screen, select D to display visit. Select N to view Note (or view Note in EHR.) Note that Modify and Append are separate functions (this behavior relates back to the original PCC data entry functions.)Option J to review BH note is for Behavioral Health access. Additional privacy rules apply to BH notes.Use the right angle bracket ‘>’ to see the right hand side of the screen. ‘<’ to move back. The last column (STATUS) runs off the right side of the screen. Look for ‘NO POV’ and ‘.9999’ for uncoded CPT.Asterisk ‘*’ in the first column after the number indicates an incomplete visit. But all visits need to be reviewed and marked complete before they will pass to Billing. ‘Q’ to quit this display function. Use ‘+’ to move down a page. Use ‘–’ to move up a page.Weekly or PeriodicallyReview for unsigned charts before your coder works the Coding Queue. (Unsigned Notes will not be visible to the coder.) TIU for Medical Records | SSD. Look for unsigned Progress Notes and un-co-signed Progress Notes by range of dates.After hours visits may begin before midnight, but ordering of ancillary services may occur after midnight. These need to be identified and manually merged.Review multiple visits on same day “MRG” function DEU | SUP | VRR | MRG.Review visits not reviewed recently. ENT | EHRC | VNRReview visits in a date range that are incomplete. This will list the data that IS present. Other data may need to be gathered manually. ENT | EHRC | LIR.Fix uncoded problems. DEU | SUP | ICD | PRBFix uncoded CPTs.If you bill for labs that are not resulted the same day as collected, determine how you will know whether your charge entry is complete. You may need to consult with the Lab manager for the “Incomplete Test Report” in the Lab package.You may want to auto-complete Dental, Telephone and Chart Review visits. See ENT | EHRC | ACCL. (assuming that you bill Dental through another mechanism).You may want to check for Chart Review and Telephone calls with ancillary data. It is possible that these should be in billable locations – not recorded as Chart Review or Telephone. DEU | SUP | OTH | CTANotes and TroubleshootingA taxonomy of locations, etc can be created if the workload is divided by location, etc. See your CAC.For special analysis, you may want to review all cases for one patient. Use the ENT | EHRC | PEHR for a single patient for all dates.Taskman runs background processes, including the auto re-linker. Lab, Radiology and Pharmacy create separate visits in their own packages, and the re-linker combines an ancillary service visit where the ordering provider for the test/exam/med matches a provider for a medical visit on the same day. Visit type (ambulatory, chart review, telephone) also needs to match.To see what has been linked (visits merged), see DEU | SUP | MDL | VRLR (List of visits modified by the visit re-linker).Widespread problems should be referred to your site manager. PCC linkages are also defined in UPMC pleted tests move to the Billing module as part of a midnight process (scheduled in Taskman).If you are missing lab charges that really should be there, check with the lab supervisor that the Link to PCC is running. (There is an LS function (link status) that s/he should be checking daily.)If certain labs are missing charges, check with the lab supervisor that the Lab CPT code file is up to date. It supports repeat CPTs and modifiers.Radiology charges are inherent in the Exam definition in the Radiology package. They are included when the Radiology exam comes over to PCC at completion.If you have IHS Dentrix, ADA codes are transmitted by an internal HL7 interface. However, Dentrix can be set up with Henry Schein billing, in which case dental charges should be excluded during the Billing process. However, the codes in PCC are valuable for workload and GPRA exports.Pharmacy is typically set up with Point-of-Sale billing in that case does not show up in Billing. Pharmacy only visits should be configured with an automatic ICD9 code, so check with your CAC if this is not occurring.If you are given a visit IEN in a report, use the function VIEN to view.Registration staff have a QA report called the FAUD report. This should be worked periodically.DefinitionsCAC: Clinical Application Coordinator (for EHR and RPMS support)GPRA: a Federal Quality measurement programPCC: Patient Care Component (the center of the medical record)IEN: Internal Entry Number (file system reference into a file)ReferencesRPMS Documentation requirements – per your site’s requirementsProcedure historyWritten: K. Gosney (Alaska Area CAC, ANTHC RPMS Support, 1-888-650-1515), 12/5/13Revised: K. Gosney 1/10/14 (APCD 2.0p10, BJPC 2.0p9) ................
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