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  • 1. How do e-prescription refill requests from the pharmacy to PrognoCIS work?
     

    Electronic refill requests directly from a pharmacy into PrognoCIS is a feature that must be individually registered with Surescripts and enabled for each provider.

    Note: Once enabled, if the doctor does not process a refill request within 60 days, Surescripts will automatically disable the feature for non-use.

    1.) When you are ready to start processing electronic refills, be sure to fill out the Surescripts_Registration_Form completely.

    Note: Each individual DEA must be certified and registered individually with Surescripts for this feature

    2.) Open a case through the resource center and attach the above form, or email the form to support@bizmaticsinc.com.

    3.) Your request will normally be processed within 48 hours, however if you were using Surescripts with another EMR system, the transfer may take 7-10 business days, so please plan accordingly.

    Once Surescripts enables the feature, you will start to receive eRefill Requests within 48 hours in your PrognoCIS –> Messages –> Inbox.  You can then either approve, deny, or modify and then approve the contents of the refill request.  Upon your response to the pharmacy, a new Refill Request or Denied Refill Request encounter will be generated and an entry recorded to the patient’s Document List and prescription history.

  • 2. What is Medication Management for Adherence?
     

    Medication Management for Adherence is a feature from Surescripts that enables providers to monitor patients' prescription activity and medication usage. View the documentation for Medication Management for Adherence in PrognoCIS EHR.

  • 3. How does an ICD auto-populate my assessment if I enter it somewhere else on my encounter?
     

    There are multiple ways that an ICD code documented on an encounter can be auto-populated to the Assessment screen so it does not have to be rekeyed.   For some options, setup is involved while for others it is simply setting a property to the desired value under the Assessment Properties.

    Encounter –> HPI

    • Select the desired complaint
    • Primary ICD as assigned under Workflow –> Complaints master will default to Assessment screen

    Encounter –> Template (HP, PH, RS, SC)

    • Select the desired template
    • Answer the applicable bullet/element (defined as Master Search)
      Note:  Requires assessment.addicd.from.htest4types property* be defined accordingly per category.
    • The ICD selected under the binocular will save to the procedure template but also auto-populate the Assessment –> ICD tab.

    Settings –> Configuration –> Admin –> Properties –> Assessment

    • *assessment.addicd.from.htest4types
      • Specify category (Vitals, HPI, ROS, Physical, Specialty)
      • Requires the template in that category include a bullet/element defined with a Master Search result type
    • assessment.addicd.fromlab
      • If ICD is added to the Lab Order using the + (because it is not otherwise available on encounter assessment yet), then it will flow to Assessment from the order screen
    • assessment.addicd.frompmh
      • Adds any ICD Code (not ailment) from Face Sheet –> Past Medical History
    • assessment.addicd.fromrad
      • If ICD is added to the Radiology Order using the + (because it is not otherwise available on encounter assessment yet), then it will flow to Assessment from the order screen
    • assessment.addicd.fromvac
      • ICD pulls from the Vaccine Master if applicable
        Note:  The ICD must be defined to the applicable vaccination under Settings –> Configuration –> Codes/Drugs –> Vaccine.
    • assessment.icdcopy
      • Provides a copy button which allows the user to select any previously assessed ICD from the patient encounter history
    • assessment.autocopy
      • Allows the user to define specific detail that is to be autocopied from the most recent (last) encounter (i.e.: ICD, CPT, HCPC, Notes)
      • This property is valid up through version 2 build 9 (became obsolete in b11, as it was enhanced into the Specialty designation to provide doctor-specific functionality per provider specialty).
  • 4. Why can’t I close my encounter?
     

    1.) The ability to close an encounter can be a security permission determined by the User Role and system properties. By default, only a Provider can close an encounter. However, other roles can be defined as a system property to permit other specific individuals this right (if the provider chooses). If such roles are not defined in the property, then all users with basic Update rights to the Encounter itself will also be able to close an encounter.

    2.) There are Encounter Close properties defined at the system level that determine if you are able to close your encounter or not. In this situation, until the requirements are fulfilled on the encounter, even the provider will not be able to close the encounter. (Common requirements are things such as PMH, Current Meds, Assessment ICD, etc.).

    Property Examples: enc.close.assessment.must, enc.close.checkifdone, enc.close.enm.must,

    3.) In addition to the Encounter Close properties, another level of edits that will prevent a user from closing an encounter is in conjunction with outstanding orders. Such indicators will be displayed in the CPOE Status/Checkout Grid on the Encounter Close screen itself. If there are pending Order Sheet items (Lab, Radiology, Rx, Letters Out), they will display in red. If there is no ICD or E&M Code present but required based on properties, these warnings will also display in red. These items will have to be completed on the appropriate screen(s) before you will be able to close the encounter.

    enc close orders

  • 5. How do I modify an encounter after I have closed it?
     

    The correct way to make a correction to a closed encounter is to add an Addendum. This option is disabled for open encounters but becomes enabled once the encounter is closed. In cases where it is necessary to add an addendum to a closed encounter, the system will automatically append it to the locked Progress Note. There are also properties at the system level that dictate how the addendum will display on the closed Progress Note.

    For providers who prefer to not do an addendum, there is a specific User Role that can be assigned that will allow a closed encounter to be reopened. This Role is typically reserved for the Attending Provider of the Encounter or any other user designated by the provider. In this case, there are Addendum-related properties that will force the user who reopens it to also add an automated addendum for an accurate audit trail.

    Apply Reopen Permission to a User

    1.) Go to Settings > Configuration > Admin > User Role

    2.) Select the user to apply permissions

    3.) Check the box for "Reopen" as shown below.
    permissions reopen

    4.) Click Save.

    Reopen an encounter1.) Be sure the above permission is granted

    2.) Proceed to Encounter > Encounter Close > Reopen.

    encounter close reopen

    Note: An encounter must be opened in order to add to or modify its contents. It is not advisable to reopen a closed encounter.

  • 6. How do I “un-arrive” a patient/appointment marked as arrived in error?
     

    Once an appointment has been arrived and accessed by a clinical staff or provider, that appointment becomes locked as an open encounter (status will = With MA, With RN, or With Doctor).  If the appointment has been arrived but has not yet turned into an encounter, it remains an appointment.

    To un-arrive a patient where documentation has not yet begun, return to Scheduled status:

    1.) Access Appointments –> Schedule
    2.) Select the applicable appointment
    3.) Click the Patient Workflow button (icon_Patient Workflow)
    4.) Select Scheduled from the Status dropdown

    un-arrive screenshot 5
    If the encounter has been started (meaning it has been accessed by a clinician or provider), it must be deleted:

    1.) Access the encounter in question by going to Appointsments -> Schedule
    2.) Select the applicable appointment
    3.) Click the Encounter button (encounter button)
    4.) Select Encounter Close –> Delete
    5.) Click "OK"

    encounter close - delete 3

    If documentation exists, the system will prompt you accordingly; click Yes, which will delete the data and the encounter; returning it to an appointment in a Scheduled status.

  • 7. How do I start an encounter?
     

    Encounters are automatically created by the system by arriving an appointment. An encounter may also be created manually, however, in cases where there is no current appointment to mark Arrived.

    Start an encounter from the Home Page from an existing appointmen
    1.) Select the patient of a confirmed appointment
    2.) Click the Arrive icon

    Note: If the appointment is not confirmed (i.e.: status = Tentative), a warning will prompt there is no appointment. Clicking YES will create a new encounter without an appointment.  Also, if there is an existing Open Encounter (or encounters), the most recent one will open by default and there will be no error displayed. Be careful to notice the Encounter Date in the patient band.

    Start an encounter from the Schedule from an existing appointment

    1.) Select Appointments → Schedule
    2.) Single-click the desired appointment on the calendar
    3.) Click the Arrive icon

    … OR …

    1.) Click the Patient Workflow icon icon_Patient Workflow
    2.)  Select Arrived in the pick list
    3.) Enter applicable Room Number (optional)
    4.) Enter Comment (optional)
    5.) Click OK button

    Manually start an encounter

    1.) Select the desired patient
    2.) Via the Select Patient icon … OR …
    3.) Via Patient → Encounter → green binocular icon
    4.) Select Start Encounter option
    5.) Enter the Encounter Date
    6.) Select the Attending Doctor
    7.) Select the Encounter Type
    8.) Select the Location
    9.) Click Save button

  • 8. How do I refill a prescription?
     

    There are a couple of different ways to request a prescription refill within PrognoCIS depending upon whether or not the request is in conjunction with a live encounter or independent. In addition, the pharmacy may request a refill directly on behalf of the patient.

    No open encounter Select CPOE  Refill and search for/select the desired patient. The prescription screen will launch. Complete the prescription details as normal. (See the FAQ titled: “Completing a Prescription” for more details.)

    Notes:
    • If the patient selected already has an open encounter, it will automatically default to the Prescription screen for that encounter.
    • If there is no current encounter, the system will auto-generate one with an Encounter Type = Refill Request. If the user completes the prescription without breaking the sequence of screens, the encounter will also auto-close. If the screen flow is broken, however, the Refill Request encounter will remain open and must be manually closed as any other encounter.

    Open encounter Select the applicable encounter and access Current Medications on the Face Sheet. For the applicable drug to be refilled, select the check box in the far-left margin under the title “+Rx”. This will immediately copy the details of that specific prescription (as previously ordered) to the Prescription screen of the current encounter. The prescription can then be approved and ordered by the provider as any other prescription.

    Patient Portal requests by the patient If your practice has enabled the Patient Portal module, a patient may also be given the ability to request a prescription refill directly from the portal. In this case, the attending provider for the patient will receive a message inside his/her PrognoCIS Messages. Clicking the magnifying glass icon link inside the message will launch the prescription and allow the provider to order the refill.

    Pharmacy requests the refill directly Occasionally, the patient will contact the pharmacy who will then contact the doctor directly. This is common for e-prescriptions and is automated by the Surescripts certification for the provider. A message will be sent to the provider via his/her PrognoCIS Messages. Clicking the magnifying glass icon link inside the message will launch the prescription and allow the provider to approve the refill.

  • 9. How do I schedule a new appointment?
     

    There are several ways to create an appointment in PrognoCIS, e.g.: at the Schedule or System level and either ad-hoc or based upon pre-defined work patterns. In addition, an appointment can be scheduled for an existing or a new patient.

    Schedule Level

    Pre-defined Work Patterns of Provider/Location

    • Select Appointments  Schedule tab
    • Select to view the desired Provider/Location schedule
    • Double-click the desired time slot and date on the calendar
    • Complete the Schedule Appointment dialog details as follows, e.g.:
    • The Date, Time, Provider, & Location will default based upon the selected time slot
    • Select the Encounter Type from the pick list
    • Select or enter the Patient Name

      Note: See the “Selecting/Adding a Patient to an Appointment” heading below for more details.

    • Enter the Reason for the appointment
    • Click the Schedule button

    Ad-hoc Appointment

    • Click the Add New Appointment icon at the top of the calendar
    • Complete the Schedule Appointment dialog details as follows, e.g.:
    • Enter the desired Date and Time
    Note: The date will default to the date that is currently being viewed on the schedule
    and the hour will default to midnight.
    • Select the Provider & Location from the pick lists
    • Select the Encounter Type from the pick list
    • Select or enter the Patient Name

      Note: See the “Selecting/Adding a Patient to an Appointment” heading below for more details.

    • Enter the Reason for the appointment
    • Click the Schedule button

    System Level

    Ad-hoc Appointment

    • Click the Take Appointment icon from the system icons at top of the page
    • Complete the Schedule Appointment dialog details as follows, e.g.:
    • Enter the desired Date and Time
    Note: The date will default to the current system date and the hour will default to midnight.
    • Select the Provider & Location from the pick lists
    • Select the Encounter Type from the pick list
    • Select or enter the Patient Name

      Note: See the “Selecting/Adding a Patient to an Appointment” heading below for more details.

    • Enter the Reason for the appointment
    • Click the Schedule button

    Notes:
    • If the date, time, provider, location combination selected does not qualify based upon pre-defined work patterns, the system will alert you with an error that the doctor is not available at the location for the chosen time. Click the Anytime check box to force the appointment.
    • If the date, time, provider, location is already scheduled, the system will alert you with an error that the slot is occupied. Select the Yes radio button to overload the time slot.

    Selecting/Adding a Patient to an Appointment

    Existing Patient

    • (1) Enter the last name of the patient
    • A list of existing patients will pop-up along with the Date of Birth
    • Select the patient by clicking it with the mouse or pressing the key
    • (2) Click the binocular icon to search for the patient
    • Enter the desired data to search (e.g.: Name, DOB, SSN, Chart #, etc.)
    • Select the patient and click the OK button

    New Patient

    • (1) Click the Add a Patient icon in the upper left of the dialog window
    • Enter the patient’s Last and First Name
    • Enter the patient’s Date of Birth
    Note: This is known as the “Quick Register” and allows you to create an appointment for a new patient without obtaining all of the required demographics. Demographics can be entered later.
    • Enter any other desired (optional) data
    • Click the OK button

  • 10. How do I view all of my doctors’ appointments at all locations in one place?
     

    Viewing appointments can be done in two different ways within PrognoCIS – from the Home Page or from the Schedule page.

    Home Page

    • Navigate to the desired calendar date
    • Select the Filters button
    • Select the desired provider(s)
    • Select all Visit Types
    • Select all Appointment Statuses
    • Select all Locations
    • Click the OK button

    Scheduled Page

    • Select the Appointments  Schedule tab
    • Select the desired View (e.g.: Daily, Weekly)
    • Select the desired Provider from the pick list
    • Select All Locations from the pick list
    • The schedule page will automatically refresh to show the applicable appointments

  • 11. How do I know how much money I collected at the front desk today?
     

    PrognoCIS provides numerous reports – both standard and custom. These are typically found under the tabular reports.

    • Select Report  Tabular
    • Select Daily Collection Report
    • Select the Time Period Option = Today
    • Click the save button

    NOTE: This will include all payments collected by the front desk and entered through the $ icon (Co-Pay screen).

  • 12. How do I attach a document to a patient’s chart?
     

    In PrognoCIS, the Messages Attach Center allows you to process incoming faxes as well as documents that are scanned locally. Once the incoming fax has been received, or the document has been scanned and FTP’d to PrognoCIS from the local computer, the document can be attached to the patient’s Document List which is part of the chart. The Attach Center screen is presented in 3 segments – the Select List, the Document Details, and the Preview Pane.

    Select List

    • Select Messages  Attach
    • Select the Fax or Scan folder from the pick list
    • Select the applicable document within the Folder List
    Note: The item that is highlighted in blue is simply the one being previewed in the right side
    of the screen. You must actually click in the check box (a check mark will display) for
    the file to actually be moved to the patient’s chart.

    Define the Document Details

    • Enter/select the Patient Name whose chart applies
    • Select the appropriate Attach type
    • Select applicable Order No./Encounter Note (optional)
    • Enter the Date for the attachment
    • Select person/entity From whom the document came
    • Select specific Name of sender (optional)
    Note: The values are filtered by From selected above
    • Select applicable Category
    Note: The values are filtered by Attach type above and are user-defined under Group Types.
    • Enter free-text Subject (optional)
    • Select internal employee to send Message
    • Click the attach button

  • 13. How do I create a custom lab panel?
     

    Custom panels are called “Order Sets” within PrognoCIS. Any user with the appropriate access to system setup can create a lab panel by associating the desired components.

    • Select Settings → Configuration → Workflow → Order Set.
    • Click the Add new button
    • Assign a Name
    • Select Lab from the Order Set Type pick list
    • Click the + sign to select all lab tests to be included
    • Click the save button

    Once an order set has been created, it can be ordered from the Lab Order screen by clicking the second plus-sign-in-a-red-circle icon.  It will explode all of the individual components (i.e.: lab tests) onto the order though you only have to select the one entry.

    Note:  In order to associate a component to a panel, it must already exist in the system as a Lab Test.

  • 14. How do I review the encounters of my PA’s and ARNPs?
     

    Typically, encounters attended by a Nurse Practitioner or Physician Assistant must be reviewed by his/her supervising MD in the practice.  The system accommodates this based upon a combination of setup and user activity at the encounter level.

    Provider Master setup

    • ARNP/PA must be assigned as Review → Mandatory or Optional
    • Applicable MD must be assigned as the Reviewer for each ARNP/PA

    User activity at encounter level

    • ARNP/PA must document the encounter
    • ARNP/PA must assign Ready to Review status
    • MD must view Reports → Review Encounter
    • Specify the desired Period/Date Range to review
    • Click the Enc Date hyperlink opens the encounter
    • Click the magnifying glass icon to enter Review comments
    • Select check box “Reviewed”
    • Enter Comments (optional)
    • Click OK button
  • 15. I documented the wrong patient – how do I transfer my documentation to the correct encounter?
     

    Note:  A similar issue arises in the case of duplicate patients, where the same patient is assigned more than 1 chart number under Patient Register.  That is addressed under a separate FAQ although there are similarities between these two scenarios.

    When encounter-level documentation occurs on the wrong encounter, there are two possible ways to correct the issue without involving Technical Support.  The correct method will be based upon whether it is the same or different patient and whether or not there are other encounters associated with the charts.

    • If the chart under which the encounter was documented erroneously does not have any other encounters (whether the same or different patient), it can be merged into the correct one by the system.
    • If the chart under which the encounter was documented erroneously does have other encounters, then
      • If it is the same patient, it can be merged into the correct one by the system.
      • If it is a different patient, it will have to be manually fixed by deleting all of the erroneous documentation from the wrong encounter and re-entered to the correct encounter.

    It is critical during documentation, that you observe the color of the patient band as well as the Encounter Date for that encounter.  Open encounters will have a light blue background and closed encounters will have a charcoal gray background.  If you allow multiple open encounters in your practice, it is possible to access the wrong encounter and start documenting it in error.

    Patient Band-Open Enc    Patient Band-Closed Enc

    Required Setup:

    • User Role ReplacePatient must be assigned.
    • Patient Registration property patient.merge.onreplace must be defined to the desired level of merging, e.g.:
      • If set to “N”, only the encounter details will merge
      • If set to “Y”, both encounter and demographics will merge

    Steps to Combine/Merge:

    • Select the wrong patient under Patient Registration.
    • Click the merge into button.
    • Select the right patient to which it belongs.
    • Click ok when asked to confirm.

    Note:  This option will only work in the case of 2 charts in Patient Register with either the same Name and/or same DOB. 

  • 16. How do I define my physician’s schedules?
     

    The Appointment module allows you to define the hours each provider is available by day of week and location.  This work pattern interfaces with the scheduling module to alert you when a doctor is or is not available.  In addition, this allows you to search for the “next available” appointment based on specified criteria.  The system allows you to define a standard/default schedule as well as an unlimited amount of exceptions as needed.

    Default Work Pattern

    • Select Appointments → Work Pattern
    • Click the down-arrow to select the desired Provider from the pick list
    • Select the Default New Record from the grid of schedule patterns at the bottom of the screen (the default will be highlighted in blue; the other defaults are gray).
    • Enter the Start & Finish Dates for the schedule
    • Assign a name for the schedule
    • Select the day of the week
    • Select the Location, Start Time, & End Time the doctor is available
    • Click save button

    Exceptions Work Pattern

    • Select Appointments → Work Pattern
    • Click the down-arrow to select the desired Provider from the pick list
    • Select an undefined Exception New Record row fom the grid of schedule patterns at the bottom of the screen (it will be one of the ones highlighted in green).
    • Enter the Start & Finish Dates for the schedule
    • Assign a name for the schedule in the Remarks field
    • Select the day of the week
    • Select the appropriate pattern to be applied for that day of the week
    • Select the Location, Start Time, & End Time for the exception
    • Click save button
  • 17. How do I know if my lab result has posted or not?
     

    A Lab Order must be in a completed status (i.e.: Approved or Ordered) to qualify for results to be posted.  There are system properties that determine if nurses or doctors have “full access” to view such orders as well as what status will display.  If these properties are not defined correctly, then only Ordered tests will display under the Lab Results search screen under CPOE.

    Note:  Until a result is actually posted, you will not see it on the encounter screen under the Lab Results option.  It will only be available under the CPOE search screens.  Once it is posted, it will also be viewable from the Encounter screen.

    To find a previously ordered test and its results status:

    • Select CPOE → Lab Orders
    • Search for the desired patient/test
    • Notice the status of the Order
      • E – Entered, results cannot be posted
      • A – Approved, results can be posted
      • O – Ordered, results can be posted
      • R – Results have been received/posted
      • C – Completed either by physician review or results posted by the physician

    If you cannot find the test you are looking for, it is probable that the property is not defined to display the status of the test you ordered, or that you are logged in as a nurse who does not have full access to view the orders/results for the doctor.

  • 18. How do I create/use Patient Alerts?
     

    Patient Alerts can be viewed by all users; however, each alert is associated to the user who creates it.  Only the creator can delete an alert; however, each user can hide alerts that are not applicable if created by another user.

    To create an alert, select the Patient Alerts icon from one of the following screens:

    • Patient Register
    • Appointment → Schedule → no appointment selected
    • Appointment → Schedule → specific appointment
    • Patient Encounter

    Select the My Alerts tab:

    • Enter the alert text
    • Click the calendar to assign Up To Date (optional)
    • Select check box to identify where the alert will be viewed
      • Appt – will be viewed on the Schedule screen
      • Enc – will be viewed on the Encounter screen
      • Bill – will be viewed on the Claim Details screen
    • Click the OK button

    If you want to hide an alert you have already read and no longer requires your attention, on the View Alerts tab, select the Hide check box and click OK button.

    You can view an alert either manually by clicking on the icon, or you can define a system parameter that will cause it to automatically pop-up when accessing a screen associated to the alert.  When an alert is present, the face of the icon will display a green check-mark, and the color of the exclamation point will display as red.  If the exclamation point displays as green and there is no check mark, then there is no alert present.

    By default, alerts are programmed to auto-display on the Appointment dialog when the patient name is selected.  This same property can be modified to also cause the alert to auto-display on the Encounter screen and/or the Claim screen as needed.

  • 19. How do I combine duplicate charts – the patient is registered twice.
     

    Note:  A similar issue arises in the case of documenting the wrong patient or the wrong encounter (same or different patient).  That is addressed under a separate FAQ although there are similarities between these two scenarios.

    When creating a new patient record within Patient Register, it should always be verified that the user does not already exist by doing a lookup.  Sometimes a name is misspelled and a duplicate chart gets created.  The system will allow you to combine duplicate charts in this instance; however, the process depends upon whether or not there is documentation associated to either chart.

    Required Setup:

    • User Role ReplacePatient must be assigned.
    • Patient Registration property patient.merge.onreplacemust be defined to the desired level of merging, e.g.:
      • If set to “N”, only the encounter details will merge
      • If set to “Y”, both encounter and demographics will merge

    Steps to Combine/Merge:

    • Select the wrong patient under Patient Registration.
    • Click the merge into button.
    • Select the right patient to which it belongs.
    • Click ok when asked to confirm.

    Notes:

    • A duplicate patient is identified when there are more than one charts with the exact same First & Last Name and/or the exact same DOB.
    • If there are open encounters with documentation, they must all be closed before the merge will work correctly.
    • Observe the applicable system setup noted above.
  • 20. How do I set the PRN check box on Prescription screen to always be selected by default?
     

    Select Settings → Configuration → Admin → Properties → Prescription Parameters and define the appliacble value to therx.prn.checkbox.status property.

    • C = the check box will always be selected by default.  The user will have to manually deselct the box on each individual prescription where PRN is not applicable.
    • U = the check box will always be de-selected by default.  The user will have to manually select the box on each individual prescription where PRN is applicable.
  • 21. How does the data exchange between my PMS & PrognoCIS flow when something changes?
     

    PrognoCIS works in conjunction with numerous PMS systems (i.e.: AdvancedMD, Medial Mastermind, Avisena, etc.).  In all cases where a PMS is used, the source of demographic and scheduling data it primarily the PMS.  The interface then feeds the data via the HL7 interface into PrognoCIS.  There is no limit to the number of times such a data exchange can occur.

    NOTE:  In such cases, it is STRONGLY RECOMMENDED that all data corrections to demographics or scheduling data be performed only on the PMS and not directly into PrognoCIS.  Unless the PMS does not provide a scheduling feature, you will typically not be trained on the PrognoCIS internal scheduling and demographic functions except on an as-needed basis.

    The following points summarize the specifics with regards to transaction and data flow regarding demograhpics, appointments, and assessment (Billing) information.

    1. Patient Demographics are entered in the Practice Management System (PMS) and flows over into PrognoCIS EMR for synchronization.

    2. Scheduling Data is entered in the PMS and flows over into PrognoCIS EMR Appointments Schedule module for synchronization.  Only in cases where the PMS does not offer a Scheduler will it be necessary for you to enter appointments directly into PrognoCIS.

    3. Billing Information (ICD / CPT / HCPCS/ Modifiers) can be entered into PrognoCIS under the Assessment screen on the encounter.  This information then flows back over to the PMS for billing. The biller can edit this information during the billing process within the PMS.  If the changes made are related to this assessment data, however, it will not be reflected in PrognoCIS.  If such changes to the coding are required, it may be preferred to delete the claim from the PMS and make such changes in PrognoCIS Assessment so it will flow back to the PMS again.  This is strictly based on local practice, as the billing information does not synchronize from the PMS back into PrognoCIS.

    Typically, a bi-directional Interface for Patient Demographics and Scheduling data is not available.  It is best practice for you to maintain data entry control in ONLY ONE SYSTEM.

    There is NO LIMIT on how many times a patient record can be updated. Every time it is updated on the PMS, it will flow over to and synchronize in PrognoCIS EMR. Please note, however, when it comes to appointments, once it has been marked as ARRIVED in PrognoCIS, there are typically no further updates accepted for that record.  Once an appointment is arrived, it becomes an ENCOUNTER in PrognoCIS, which has numerous other dependencies within the EMR that are not part of a PMS synhronization.

    The Scheduled Process for the Interface

    The flow of demographics and scheduling information to EMR is actually under control of the Practice Management System.  Since the PMS is pushing the information to EMR, any update done to the demographics section will trigger a Data Transfer Request from the PMS to EMR.  In case of AdvancedMD PMS, PrognoCIS pulls the information from AdvancedMD at a regular interval; thus, and update performed on any patient record is automatically included and syncrhonized into PrognoCIS in the next cycle.

    As for the billing Information flow from PrognoCIS EMR to the PMS, the data is typically generated when a user closed the encounter. (On an as-needed request, there is an option to generate the data transfer into the interface when the data entry occurs under the Assessment screen while an encounter can be open OR closed.)

  • 22. How do I make the ICD stop defaulting from my HPI?
     

    To manually remove the association of a Primary ICD from auto-populating to the ICD tab of the Assessment screen from the HPI Complaint, follow these steps.  The Optional ICD Codes do not have to be removed, and in fact most doctors like having them available (they display under the “C” button Assessment screen ICD Tab).

    1. Settings –> Configuration –> Masters –> Workflow –> Complaints.
    2. Select the HPI complaint.
    3. Click the clear hyperlink that displays on the ICD line
    4. Click the save button

    The Optional ICD Codes do not have to be removed.  In fact, many providers like to have them available and will associate them to the appropriate complaint(s).  This allows the ICD Code to be selected by clicking the “C” icon under the ICD tab or the Assessment screen on an encounter.

    HPI Complaints screen
    Assigning ICD Code to HPI Complaint
  • 23. My face sheet does not seem to be accurate. Why is my data not carrying forward?
     

    Face Sheet data is chart-level within PrognoCIS.  As such, it is by definition, cumulative and historical.  The way the face sheet interacts with individual encounters, however, may at times give the illusion that the data is not accurate or seems to be missing.  This is due to the time-sensitivity factor of data that is stored at the chart level but is entered at an encounter level.

    The color of the patient band is a visual queue that identifies the status of the face sheet being viewed.  There are 3 possible face sheet levels:

    1.   Charcoal gray WITHOUT any encounter type or encounter date displays when there are no current open encounters.  The face sheet displayed in this scenario will be a complete reflection of all historical activity for the patient; inclusive of all encounters.

    • This is sometimes referred to as a “Face Sheet Encounter” (or a “non-visit encounter”).
    • If you are viewing a face sheet that is charcoal gray with no encounter-level details in the patient band, there will be no impression of data being missing.  This is the complete history of the patient at the chart-level.
    Patient Band-No Enc
    Face Sheet Encounter (i.e.: a non-visit encounter)

    2.   Charcoal gray WITH an encounter type and encounter date displays when the encounter is closed.  The details in the patient band are specific to a visit that occurred in the past and has been signed off by the provider.  This data on the face sheet and on all individual templates is static and in a read-only status.

    • The data viewed on this level of face sheet is static and a reflection of the historical data known as of that encounter date.
    • Data that shows on future encounters may have data that is not reflected on a previous one.  This is because when the 1st face sheet was documented, the future data was not yet known.
    Closed Encounter (Read-only mode)
    Closed Encounter (Read-only mode)

    3.   Light blue with an encounter type and encounter date displays when the encounter is open.  At times, there may be multiple open encounters based upon local preference and system properties.  It is this scenario where it may appear as if data is missing or has not carried forward properly (see Example below for more information).

    Open Encounter (fully editable)
    Open Encounter (fully editable)

    Example:

    1/21 ENC - enter Lithium & close the encounter.  The Lithium carries forward to 1/30 ENC.
    1/30 ENC - the Lithium is shown; enter Lisinopril but leave the encounter open.
    2/10 ENC - the Lisinopril is not showing (because the 1/30 ENC is still open).
    2/20 ENC - If the 1/30 ENC is now closed, the Lisinopril & the Lithium will both be shown.

    When an encounter is started, the face sheet reflects the moment in time when the patient is arrived.  In cases of multiple open encounters, each face sheet may in fact display data at different stages.  As each one has data updated, it will never retroactively update the other past face sheets, and it will not carry forward to future face sheets until both are closed.

  • 24. How do I verify a patient’s insurance eligibility?
     

    PrognoCIS Insurance Eligibility can be implemented within the EMR as well as the Practice Management (Billing) modules.  The required setup is the same for both and requires that you enroll for the feature with your clearing house. Please check with us for a current list of clearing houses which support eligibility before enrolling.

    The clearinghouse communicates with PrognoCIS and performs the benefit checking based on the patient’s demographics and insurance as entered under Patient Register within PrognoCIS.  In addition, the individual insurance company assigned to the patient’s insurance history must have the appropriate electronic payer ID as assigned by the clearinghouse.  This is the trigger that is required in order for the patient’s insurance to be validated and benefits reported back to PrognoCIS.

    Once eligiblity is setup and enabled within PrognoCIS, the verifying of benefits can be done either manually on demand as needed at an individual patient level, or systematically by batch processing for an entire day’s worth of appointments.

    Individual Eligibility Checking – at the Appointment level

    1. Select the appointment from the Appointment –> Schedule.
    2. Click on the Check Eligibility icon (icon_EligiblityCheck-Appointment) in the lower-left of the schedule screen.
    3. Click the OK button to execute the eligibility.
      Note: If it has already been executed, the details will be displayed and can be printed.

    Individual Eligibility Checking – at the Patient Insurance level

    1. Select the patient’s insurance.
    2. Click the Check.. button.
    3. The details will populate under the Details…button which will display with a check mark when it is populated (Eligiblity Buttons on Ins scren).

    Mass Eligibility Checking by batch of the next day’s appointments

    This requires some technical setup, so please contact Bizmatics’ Technical Support or your Project Manager if still implementing.  Once the process is defined to ocurr nightly for you, the eligibility checking will occur automatically overnight for the next day’s scheduled appointments.  Those results can then be viewed when the patient arrives by clicking the appropriate icon on the selected patient’s appointment or from the Home Page.

  • 25. Are there any specific Tablet/Notebook PCs that work with PrognoCIS?
     

    Based on known clients in production, the following models are compatible with PrognoCIS.  Please note that a basic requirement at this time is that the pc run Micrsoft Windows as the Operating System and use Internet Explorer v9 or above as the browser.

    • Hewlett Packard-TX2 Convertible Tablet with Windows 7
    • Toshiba Tablet (as furnished by Bizmatics)
    • Fujitsu Windows Tablet PC Edition
    • Fujitsu Lifebook T4220
    • Fujitsu Lifebook T730
    • Lenovo ThinkPad X61 Tablet 7767
    • Motion C5
    • DakTech’s PlaidSlate (a wireless slate-based pc on the Intel® 945GSE chipset)
    • Toshiba Protege M700
  • 26. What is the logic for auto-defaulting a prescription on an encounter?
     

    PrognoCIS includes various ways to auto-populate a new prescription at the encounter level.  This behavior is based upon the local setting of the system property rx.default.dispensable.fields.blank.

    • If the value is set to Y, then we the dispensable details will be blank (i.e.: nothing will pre-populate).
    • If the value is set to N, then the following conditions determine the auto-population behavior:
      • If there is a value defined in the system property std.patient.chartno, and the drug is included on that chart number, it will auto-populate those default details.  If the same drug has previously been prescribed to the current patient, however, then it will pull the details from the patient's last prescription record and not the default chart specified in this property.
      • If there is no chart number specified in this property or the drug is prescribed within the chart number specified in the property, then the following hierarchy applies:
        1. Doctor Preferred List; if the drug is not defined here, then
        2. Clinic Preferred; if the drug is not defined here, then
        3. Nothing auto-populates, and the user will select details explicitly when creating the prescription order.

    Starting with the Denali version, there is also a new property that can be set to override the above system-default logic.  That property allows an entire prescription to auto-populate based on the same patient's previous prescription.  The property is rx.autocopy.lastenc.drugs.

    When no properties are set to pre-populate based on specific conditions, then the overall system behavior will look at the Attending Provider on the encounter, the Patient's previous prescription history, and the Drug Name as previously prescribed by that provider.

  • 27. Is there a way to register compound names so the prefix & main name are both captialized?
     

    The format of a patient’s name and how it displays in the system and search screens is controlled by a property (prognocis.names.upperlower).

    If the property is set to Y, then all proper names entered into the system will appear with the first letter capitalized and all other letters in lower case – however, this is not the case when a name contains a special format – such as a compound name.

    If the property is set to N, the name will be retained exactly how it is entered by the user.  Thus, the name MacDonald can be stored and displayed as MacDonald – with both the “M” and the “D” as capital letters.

  • 28. Why is the data not saving when I review a face sheet?
     

    Documentation on the face sheet is attached to a patient at the chart level, meaning it is cumulative and historical.  At times, a patient is being seen for a routine follow-up or Post-op check, and thus an entirely new face sheet is not required.  Hence, the Review All feature can be used by a user to indicate the data has been reviewed without having to individually re-document the data.

    This review is executed singularly or colletively, i.e.:

    • Clicking the individual check box in the upper-left of the cell’s title bar, e.g.:FaceSheet Review Single Cell Check box
    • Clicking the All button at the upper-left of the 1st cell, e.g:FaceSheet Review All button

    Users who require this functionality must be assigned at the staff role level under the Face Sheet Settings in system configuration, i.e.:

    1. System –> Configuration –> Admin –> Properties
    2. Select property name facesheet.revby.medtypes.
    3. Valid staff role options are DR, RN, MA, and ST.
  • 29. Does PrognoCIS notify me when a fax fails?
     

    Faxing status can always be tracked via the Tabular Reports; however, in case of a fax that has failed, the system can also send an Alert Message to the user so the report does not have to be manually generated.

    1. System –> Configuration –> Admin –> Properties
    2. Select bizfax.inprocess.offset property
    3. Define the desired number of minutes after a fax fails to alert the user

    Based on the number of minutes indicated in the property, an urgent message will be sent to the sender along with an email to PrognoCIS Support when a fax fails to successfully transmit to the receiver.  This alert is an indicator that the Bizfax utility has terminated or is not able to communicate with PrognoCIS server.

  • 30. How do I delete a template that I no longer need to use?
     

    A template can be deleted from PrognoCIS at any time as long as it has never been used.  Once used, however, the data links the template to the applicable history in the database audit and it cannot be deleted.  It can, however, be inactivated.

    To delete a template that has never been used, simply select it and click the Delete button.

    To inactivate a template that has been used, deselect the Active check box, which will hide it so that it is inaccessible.  However, it is preserved in the background for data integrity in cases where it was previously used.

    FYI: The system will alert you when a template cannot be deleted by displaying an error message in red font indicating where it has been otherwise used in the system, e.g.:

  • 31. How do I create a new encounter without an appointment?
     

    If there is no appointment to arrive but you need to start an encounter, this can be done from any existing encounter or from the patient’s face sheet encounter.

    If there is an existing encounter:

    1. Select the existing encounter
    2. Click the Start/Edit Enc option from the TOC menu
      Note: This option may say Start Encounter if applicable.
    3. Click the add new button
    4. Enter the applicable details (e.g.: Date, Provider, Encounter Type, etc.)
    5. Click the save button

    If there is no existing encounter (i.e.: Face Sheet only displays):

    1. Select the patient
    2. Click the Start Encounter option from the TOC menu
      Note: This opiton may say Start/Edit Enc if applicable.
    3. Enter the applicable details (e.g.: Date, Provider, Encounter Type, etc.)
    4. Click the save button
  • 32. Can I backdate an appointment?
     

    An appointment may be modified as long as it is in a Tentative or Schedule status (meaning it has not been arrived).  However, even in this circumstance, the Date of the Appointment cannot be a previous calendar date – it may only be present or future.

    Once an appointment has been arrived, it becomes an encounter.  An encounter date may be modified – including backwards.

    Thus, if you find that you missed an appointment that must be entered for a past date, the appointment may be created for the present date and arrived, and then the Encounter Date can be modified backwards from the encounter.

  • 33. How do I indicate that a patient has completed an Advance Directive?
     

    There are several options for documenting a patient has an Advance Directive within PrognoCIS.  It is a local preference as to which option will be used in your clinic.

    • Social History
    • Patient Alerts
    • Patient Type
    • User Defined Field
    • Face Sheet Notes

    Social History displays on the face sheet, and thus if a question for Advance Directive is part of the Social History, it will always be visible from the Face Sheet.  There are even properties that allow you to define the response to display in a different color so that it stands out amongst the rest of the Social History details.

    Patient Alerts are attached at the patient level and remain indefinitely until the author removes the alert.  Users can hide alerts posted by other users, however, unless it is hidden, it will always be displayed under the Patient Alerts icon for the patient.  Alerts are free-text, and thus you may document Advance Directives in this manner.

    Patient Type is a user-defined category that can be defined under Group Types at the system level and then assigned to a patient.  Often, this indicator is used to describe a patient population (such as Bad Debt or VIP); however, it could also be used as a way of identifying when an Advance Directive exists for the patient or not.

    User Defined Fields can be defined as needed to display on the Patient Register.  Thus, you may choose to create a unique field to capture Advance Directive status on the Patient Register rather than on the Face Sheet (under Social History).

    Face Sheet Notes are also generalized and customized, thus this is another option.  They are free-text and display on the Face Sheet but are not otherwise specific to an encounter.

  • 34. How do I add a new patient to PrognoCIS EMR?
     
    1. Select Patient –> Register.
    2. Click the Add New icon (icon_AddNewGreen).
    3. Enter desired demographic data.
      Note:  Only the Last Name, First Name, DOB, and Gender are required to save a new patient record.  Other fields are optional.
    4. Click the save button.
  • 35. How do I show a patient payment in the EMR side?
     

    A patient payment can be posted in the EMR side to any encounter using the Copay screen, which becomes enabled as soon as an appointment is arrived.  The payment can be posted including the method of payment (e.g.: Cash, Check, or Credit Card) as well as the amount and how it should be apportioned.  (Note: If you are using the Billing module, apportioning the copayment correctly is important; however, if you are using only the EMR module, it is not required.)

    To post the payment using the Copay screen:

    1. Select the patient’s arrived appointment (i.e.: open encounter).
    2. Click the Copay icon (icon_Copay-Schedule).
    3. Enter the Payment Amount based on method of payment.
    4. Enter the Check/Credit Card details if applicable by clicking the icon_Billing-Apprvd or Deny Status.
    5. Enter the Apportion To details if applicable (i.e.: when Billing module is used).
    6. Click the save button.
    7. To print a walk-out receipt, click the print button.

    Copay screen

  • 36. My Progress Notes are printing the wrong name/address in my letterhead
     

    There are 2 ways to display data on an output template (e.g.: Progress Note, Letter, Procedure Form).

    • Hard-code the information exactly how you want it to print out
    • Use a computer tag to pull the details out of your master files

    If the wrong data is printing in your letterhead, please verify the setup under the output template (Settings –> Configuration –> Templates).  If the data is hard-coded in the template, then you can simply correct the error by typing over with the correct information.  If there is a computer tag (such as [CL_LOGO] or [CL_LETTERHEAD]) then you must verify the contents of the applicable master file.  Typically the prefix CL_ in a tag such as shown here is pulling the data out of the Clinic Location master, record CL, which equals your primary location details.

  • 37. What type of data (benefits information) does the Insurance Eligibility Program provide?
     

    The Insurance Eligibility program is based upon the data that is on file with the clearinghouse for the individual patient’s insurance.  The specific content of the report back to PrognoCIS from the clearinghouse may vary with regards to the specific relationships between the individual payers and the clearinghouse.  In addition, the contents may vary based upon a specific patient’s plan within the payer.

    For example, a patient who has Medicare or Medicaid is either eligible or not.  Perhaps the eligibility is based upon categories such as “Inpatient (Hospitalization)” or “Outpatient” or just “Yes” or “No”.  However, a patient who has Group Health – such as Cigna or Aetna – may have HMO, PPO, POS, Indemnity, HSA, FSA, or any other individual plan.  Some payers offer extended coverages for specific disorders such as Cancer policies.

    Thus, when the eligibility program is executed with the clearinghouse, the information returned into PrognoCIS will depend upon the specific payer and what they are able to provide back through the clearinghouse.

    Sometimes the EB (Eligibility Benefit) details will include deductible, out-of-pocket, lifetime maximum, etc. whereas other times it may simply indicate a rate of payment or percentage.  Sometimes a patient’s responsibility may be provided (e.g.: Copay, 20% billed charges, etc.) and other times not.  The snapshot below shows an actual EB Printout for a group health policy with Aetna Health Plans.

    Eligibility Details

  • 38. My PrognoCIS disappears after I enter my password and my password is correct.
     

    This issue typically occurs when the application is being accessed on a workstation where the Internet Explorer browser settings have not been properly defined.

    Please consult the link for Internet Browser Settings on your Login Page (without logging into the application).  Apply these settings within the IE Tools –> Internet Options on every individual pc or laptop that must access PrognoCIS.

    After defining these settings, the login should work.  When the password is invalid, the application does not disappear – it simply posts a message of Invalid Password.

  • 39. How do I avoid payment adjustments and demonstrate compliance with the e-presciption incentive program at CMS?
     

    Under the 2012 eRx Incentive Program, an eligible professional must report 10 eRx events between January 1 and June 30, 2012 to avoid a payment adjustment in 2013.  In addition, to qualify for an incentive (bonus) payment, an additional 15 eRx events must be submitted before December 31, 2012.

    For additional information, please visit www.cms.gov/eRxincentive

    “To avoid the 2012 eRx payment adjustment, you must report on a minimum of 10 unique visits via claims from January 1, 2012 through June 30, 2012. Each visit must be accompanied by the eRx G-code (G8553) attesting that during the patient visit at least one prescription was electronically prescribed. Electronically-generated refills do not count and faxes do not qualify as an electronic prescription. New prescriptions not associated with a code in the denominator of the measure specification are not accepted as an eligible patient visit and do not count towards the minimum unique eRx events.”.

    Note: The eRx Incentive Program is NOT THE SAME AS the Meaningful Use Program.  For a comparison of all programs, please visit: https://www.cms.gov/MLNProducts/downloads/EHRIncentivePayments-ICN903691.pdf

  • 40. What is Rx-Hub and how does it benefit me?
     

    Rx-Hub is an automatic feature that Surescripts provides to a provider when he/she is enrolled with them for e-prescribing.  When a provider enters a drug on the prescription screen, the patient’s Prescription Benefit Information (PBI) is displayed in real-time during the office visit.  Surescripts works with the nation’s Pharmacy Benefit Managers (PBMs) and Payers to offer prescribers access to their patient’s Prescription Benefit Information (PBI) in real time during an office visit.

    Prescription Benefit Information

    The patient’s PBI includes eligibility, benefits, and drug formulary as well as lower-cost alternatives (such as generic or alternate drugs) if applicable.  In addition, a patient’s entire medication history across all providers may also be available based upon patient consent.  Having the PBI available in this way enables prescribers to select medications that are on formulary and are covered by the patient’s Drug Benefit.  Collectively, this feature reduces unnecessary phone calls between pharmacies and providers related to drug coverage.

    Within PrognoCIS, the PBI interface is automatic for a certified provider upon entering a drug on the Prescription screen.  If the ordering physician is not certified with Surescripts for eRx, the PBI will not display.  No patient consent is required for this information.

    Medication History

    Another feature of Rx-Hub is a patient’s medication history across providers (i.e.: all drugs the patient has had prescribed regardless of the ordering physician).  This service is made possible by Surescripts’ ability to securely access and aggregate a patient’s medication history from community pharmacies and claim history from payers and PBMs.

    Prescribers who can access critically important information on their patient’s current and past prescriptions are better informed about potential medication issues with their patients and can use this information to improve safety and quality. Medication history can also be used for reconciliation support for patients being treated in an inpatient setting.

    Within PrognoCIS, the interface is automatic in conjunction with enabling e-prescribing for a provider.  However, patient consent is required.  Such consent is documented on the patient’s chart under Patient Register, and if not; it may also be entered direclty via the Prescription screen at the time the prescription is being written.

  • 41. What is required to be setup for e-prescribing in PrognoCIS? Do I always need a VRF (Vendor Request Form)?
     

    The eprescribing feature within PrognoCIS works in conjunction with the industry-known clearinghouse Surescripts.  In order to request prescriptions electronically within the EMR, each eligible provider must enroll for the function with Surescripts, who will assign a unique SPI (Surescripts Provider ID) to the provider.  This SPI is what controls the auto-generated Refill Requests from a pharmacy to a physician.

    The registration and setup of the provider with Surescripts can be handled through Bizmatics for the provider.  Please contact us via your Implementation Project Manager or Technical Support.  Required information is the physician name and demographics as well as his/her NPI and DEA numbers as well as valid fax number in addition to any other applicable licenses or UPIN, PTAN, etc. as required in your state or by local law.

    Providers currently enrolled with another EMR vendor must complete a Vendor Request From (VRF) to transfer assignment into PrognoCIS from the old vendor.  In order to do a complete switchover, Surescripts requires a valid address for each provider’s SPI as stored on their Vendor/Pharmacy Admin Console.  Hence, when completing the VRF, please ensure the address matches completely how the provider was initially setup for eRx to avoid any delay in eprescribing refills within PrognoCIS.

  • 42. How do I reschedule an appointment?
     

    There are 2 ways to reschedule an appointment:

    1. Modify an existing appointment that is currently in Scheduled status.
    2. Work the To Be Rescheduled CalL list for previously cancelled appointments.

    Modify a currently scheduled appointment:

    1. Select Appointments –> Schedule.
    2. Navigate to the desired appointment.
    3. Double-click the appointment.
    4. Change the approriate data.
    5. Click the schedule button.

    Work the To Be Rescheduled Call List of cancelled appointments:

    1. Select Appointments –> Schedule.
    2. Click the telephone icon.
    3. Select To Be Rescheduled radio button.
    4. Click the ok button.
    5. In the upper-left, select the patient name hyperlink to be rescheduled.
    6. Change the appropriate data.
    7. Click the schedule button.
  • 43. How do I block time on the schedule or remove a blocked period?
     

    Typically, the available time slots for appointments are defined under the Appointments –> Work Pattern feature by Provider, Location, and Day of the Week.  At times, however, ad-hoc blocks of time may need to be blocked.

    1. Select Appointments –> Schedule.
    2. Click the Block Time icon.
    3. Enter the Date.
      Note: The date may be data-entered or selected by clicking the calendar icon.
    4. Enter the From time.
    5. Enter the To time.
    6. Enter the Reason.
    7. Click the ok button.

    The applicable time that was blocked will be displayed on the calendar with a solid charcoal gray background.  Any appointments that may be scheduled within the alotted time frame will be automatically moved to the To Be Rescheduled Call List.

    To delete a block:

    1. Select Appointments –> Schedule.
    2. Click the Block Time icon.
    3. Select the check box under the Del column for the block to be removed.
    4. Click the ok button.
  • 44. How do I delete an encounter?
     

    To delete an encounter, it must be returned to a Scheduled status. This requires that there be no encounter-level documentation saved against it. If documentation has been saved, it must be reversed. Once the encounter is empty of new documentation, select Encounter Close  Delete button.

    Notes:
    • The encounter must be totally empty of all new data in order to be deleted.
    • If your system property is enabled to auto-populate ICD from Medical History, you may have to delete ICD code also from the Assessment screen. This will sometimes be the case if you cannot identify any saved documentation and yet the Delete button is disabled.
    • Deleting an encounter will return the status from Arrived to Schedule (i.e.: an open appointment). The appointment can then be deleted, cancelled, modified, or marked as a No Show at your discretion.

  • 45. How do I cancel an appointment?
     

    When the status of an appointment is Tentative or Scheduled, the appointment is not attached to an encounter.  Thus, it may be cancelled at any point until it has been marked as Arrived.   This is done by selecting the appointment on the schedule.

    1. Select Appointments –> Schedule
    2. Navigate to the applicable calendar date for doctor and location.
      Note: This may require user navigation based upon your default view.
    3. Single-click the appointment to be cancelled.
      Note: The appointment will be outlined with a thin red border.
    4. Select the Patient Workflow icon (icon_Patient Workflow).
    5. Choose the appropriate status by clicking the down-arrow (icon_DownArrowPickList).
    6. Click the ok button. Patient Workflow Status Appointment

    Once an appointment has been cancelled, it will no longer show on the Schedule; however, it will be available under the To Be Rescheduled Call List.

  • 46. Does PrognoCIS let me generate PQRS Reports?
     

    Yes. There is some setup involved and security access required, but a menu option called PQRS can be added to the Patient Encounter Table of Contents.  Contact your implementation manager or technical support to have this arranged for your practice.

    For additional information regarding PQRS, please visit this link on the CMS web site: http://cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/pqrs/.

  • 47. How can I make the “New” button available for more than 15 days regarding version release information?
     

    There is a system property called home.newver.notes.days, which is a numerical value that defaults to 15.  This number can be changed to any desired (whole) number of days.

    • Settings → Configuration → Admin → Properties
    • Search for Name → Home Page
    • Search for Tag → home.newver.notes.days

    Admin Properties Home Page

    • Select the property (while highlighted in blue, click it – or double-click it)
    • Enter the desired number of days
    • Click save button

    The NEW balloon gives access to the applicable Release Notes for the upgrade.

  • 48. I cannot update my face sheet – the + icon is not working – why?
     

    In many cases of technical issues, the Internet Explorer browser settings may be the factor.  Always verify that these settings are correctly defined as per the initial setup.  (There is a permanent link to these settings on the PrognoCIS login splash screen.)

    Secondly, the Advanced Settings may need to be restored to their default, i.e.:

      1. Open Internet Explorer window.
      2. Select Tools –> Internet Options.
      3. Select the Advanced tab.
      4. Click the Restore advanced settings button.
      5. If prompted to confirm, do NOT select Delete personal settings check box.
      6. Click the Reset button.

    IE Tools Advanced tabIE Tools Adv Tab Restore Confirm

  • 49. What is the PrognoCIS EHR Certification Number for Meaningful Use?
     

    For registration and attestation w/CMS for EHR Incentive (Meaningful Use), please note that a vendor certification number is required.  To have a unique certification number assigned, please visit:  https://onc-chpl.force.com/ehrcert.  If you are not successful in generating a unique number, plesea use: 30000001SWUGEAS.

  • 50. I have a document I scanned in my Attach Center but cannot attach it to my patient chart. Why?
     

    The most common reasons a document will appear in the Attach Center –> Select list (either scanned or incoming faxes) are as follows:

    1. The file extension of the document is not defined in PrognoCIS as valid.
    2. The size of the document exceeds the maximum allowed (in kilobytes).

    To resolve either of these issues, please verify the system settings under configuration.  This will require you to have admin rights for your user access.

    • Select Settings –> Configuration –> Admin –> Properties
    • Select property name PrognoCIS Parameters

    Property-Prognocis Parameters

    • Verify file extension is defined under prognocis.attach.filetypes.
    • Increase maximum allowed size under prognocis.attach.maxsize.kb.
    • Click the save button.
  • 51. Can a Physician’s Assistant (PA) eprescribe without a DEA Number?
     

    Yes. A Physician’s Assistant (PA) can be enrolled for e-prescribing under his/her NPI Number in the absence of a DEA number.

  • 52. Why does the error “Patient Primary Insurance may not be valid” display on the Schedule?
     

    This message occurs when the primary insurance as listed on the selected patient’s Insurance Register has expired (i.e.: the UpToDate is prior to the Appointment Date).

  • 53. How can I easily check out a patient when the doctor is done? Is there a “check-out” screen in PrognoCIS?
     

    Procedures for discharging patients vary from one practice to another; hence, PrognoCIS is able to accommodate a variety of workflows and scenarios.  With regards to checking a patient out (or discharging) after the clinical part of the visit is completed, the process in your practice will determine which screen or screens and workflows work best for you.

    Patient Status

    When all documentation is completed and the patient is ready for discharge, the status can be set to Ready for Checkout.  This status is then reflected on other screens (such as the Home Page and the Appointment Schedule) for communication to the front desk.   After the checkout is processed, you can then mark the status to Done.  To change the status:

    • Select the encounter and complete all applicable documentation
    • Click the Patient Workflow/Status icon on the encounter screen
    • Select Ready for Checkout
    • Click the ok button

    What you do next depends upon how you answer the following scenarios.  Refer to the applicable headings that follow for additional instructions:

    • Are there orders (lab, radiology, prescriptions, consults, or procedures)?
    • Is there a follow-up appointment required?
    • Does the patient require education or discharge instructions?

    Physician Orders

    There are a couple of different ways to know if the provider has requested orders on a patient (other than being told so by the doctor).  This can vary based upon certain system properties and program features that may or may not be used in your practice.  If you are using the Order Sheetfeature, and the properties are appropriately set, the patient status will reflect the pending order with a status = Process LRDCP (with each upper case letter representing the order that is pending; i.e.: L = Lab, R = Radiology, D = Dispense Drug, C = Consult, and P = Prescription).

    The Encounter Close screen may also be thought of as a “Check-out Screen” of sorts.  Within this screen, there is a Pending Orders Summary, which is a table that displays the number of each order type and status (i.e.: Entered, Approved, or Ordered).  If there is an entry for any order type in this table, the corresponding status will also be reflected as noted above.  Either way, the patient’s status or the pending orders table will indicate during the check-out process if the patient requires any paperwork or requisitions before leaving the clinic.  You can then go the appropriate screen to complete the order and produce the requisition or paperwork if applicable.

    Follow-up Appointment

    If the physician wants to see the patient again in a certain number of days, weeks, months or on a specified date, this Next Follow-upAppointment can be identified and created  during the check-out process.  To view how far forward the physician would like to see the patient again, there are 2 places where this information can be entered and viewed – on the Assessment screen and the Encounter Close screen.  Once the date or time period is known, you can easily create the appointment without leaving the screen you are on.  Simply click the Quick Appointment icon from the system icons, which allows you to create a new appointment ad-hoc.  If the date is not known but a time period is, you may also search for available appointments for the provider, date, and time specified.

    Next, the patient status may be changed from Ready for Checkout to Done.  When the physician closes the encounter, the system will change the status to Complete.

    Patient Education / Discharge Instructions

    If the physician wants to provide the patient with written education or discharge instructions, this may be done directly from the encounter screen during the documentation process at the patient’s bedside, or it can be printed at the front desk from the Home Page using the Checkout Docsicon.  This again is based upon local decision and process as well as how the education materials are defined in your database.

  • 54. Why does my growth chart not print but I can see the points/graph on my screen?
     

    When generating the Growth Chart in PrognoCIS, it interfaces with the Vitals template.  After selecting the desired graph, it will display in the preview window of the EMR.  In addition, if you select the Show Points check box, each point along the graph will also display.

    When printing the Growth Chart, either to a physical printer or to a PDF file, the output may initially not include the graph and/or points.  This is determined by the default settings of your internet browser.  Setting this property may vary depending upon which version of Internet Explorer you are using.

    IE v8.0 Printer Settings

    • Select Tools –> Internet Options
    • Select the Advanced tab
    • Scroll to the Printing section
    • Select the option to Print background color and images
    • Click the OK button

    IE v9.0, v10.0, v11.0 Printer Settings

    • Select File –> Page Setup
    • Select the option to Print background color and images
    • Click the OK button
  • 55. Is there a report to show my Medicaid volume for Meaningful Use?
     

    Yes.  You can run a tabular report by insurance, which will include your Medicaid patients.  To generate the report:

    • Select Report –> Tabular
    • Select Query Name –> Patients with Specific Insurance as Pri or Sec
    • Enter the Period – i.e.: the desired date range for patients to be counted
    • Click OK

    MU Medicaid Volume Report

  • 56. Can I modify or turn off the prompt on Encounter Close to send letter to Referring Physician?
     

    When I close my encounter, I get a pop-up asking me to provide a letter to the referring doctor.  Can I turn that off or change it so it does not always pop-up?

    Enc Close Letters Prompt to User

    This prompt is property-driven, and yes it can be turned off per local preference of the provider.

    • Select Settings –> Configuration –> Admin –> Properties
    • Select property Name Encounter Close Checks
    • Select property Tag as follows
      • enc.close.letterprompt = N to turn off; Y to enable the prompt
        Note:  Prompt occurs automatically when closing an encounter.
      • enc.close.lettermode = F to fax; E to email; P to print
        Note:  Fax/Email is automatic upon answering Yes when prompted.  If set to Print; the letter will print to default printer so it can be mailed via US Mail.
      • enc.close.lettertemplate = define Letter output template to be provided.

    Enc Close Letters Property for Doctor

  • 57. How to remove the ability to add new complaints directly from Encounter HPI
     

    Typically, clinical users who have update permissions to Encounter –> HPI also have the ability to create new complaints “on-the-fly”, directly from an encounter. Hence, if upon searching for a complaint, it is not found, the user clicks the ” + ” icon to add a new one. This links to the system default “Basic HPI” template and allows the user to document the visit accordingly.

    HPI Disable Add Complaint

    At times, it is not practical for all users to have this ability, so it can be removed.  This is a role-specific permission, however, and not just an individual user permissions.  New complaints can still be added at the system-level under Settings –> Configuration, even if this ability is disabled.

    To disable a Role’s ability to add new complaints directly from within Encounter –> HPI,

    • Settings –> Configuration –> Admin –> Role
    • Select the applicable role (i.e.: Medical Assistant, Nurse, etc.)
    • Scroll to Configuration –> Workflow heading
    • Deselect C, U, D permissions (leaving only R – Read Only)
    • Save the change

    Role Disable Add Complaint

  • 58. Can my nurses or medical assistants approve prescriptions for me – including controlled substances?
     

    Yes.  This is accomplished by a combination of user permissions as well as a system property that can be configured to give non-providers approve rights for prescriptions.

    To simply approve a prescription, regardless of drug type, the user must first be given rights to save/approve prescriptions.  Select Settings –> Configuration –> Admin –> Role.  For applicable roles (e.g.: Nurse, Medical Assistant), in addition to Read access, you must also assign the ability to Update, and Approve.

    Rx Approve CPOE under Role

    For controlled substance access, In addition to the save and approve permissions, you must also select  Settings –> Configuration –> Admin –> Properties –> Prescription Parameters –> rx.allow.dea.drugs.approve and set value to Y.  (Note: This property must be set by Bizmatics.)

    FYI: the user must also have basic update permissions to an encounter and not be blocked access for the individual patient.

  • 59. Can I send text messages to remind patients about their appointments?
     

    Yes. Effective with version 2, build 11 of PrognoCIS EMR, the ability to send text message to patient cells phones is a feature.  Please contact your sales representative to have this feature added, and it will be implemented immediately for your practice!

    For more information, please review the Text Reminders User Quick Guide.

  • 60. How do I use Pharmacy Search effectively and have local pharmacies only?
     

    E-prescribing providers have access to all pharmacies nationwide via the Pharmacy Search in PrognoCIS.  PLEASE NOTE: when the search is invoked, the default display is indexed by pharmacies geographically; regardless of the Pharmacy Type.  This is a technical requirement from Surescripts, who provides e-prescribing functionality for PrognoCIS users.  If you attempt to search by pharmacy name, city or state, the search may appear to be inaccurate for this reason.

    To easily locate the desired local pharmacies, first set the index to filter out the non-retail pharmacies by entering the word Retail in the Type Name field.  Once the search refreshes to show retail only, search on any of the other desired fields.

    Pharmacy Search

    One other convenience is to import only the desired local pharmacies so they are accessible via the Clinic Preferred button on the prescription screen.  This requires administrative rights to Settings –> Configuration but only has to be done once.

    • Select Settings –> Configuration –> Vendors –> Pharmacy.
    • At least one pharmacy must exist.  If not, click the add new button to create a dummy one.  If so, then select that pharmacy.
    • Click the import button at the bottom of the screen.

    Pharmacy Import

    • Set the filters on the search screen as outlined above.
    • Select the check box to the far left of each desired pharmacy.
    • Click the ok button.  All selected pharmacies will import.

    To use the imported pharmacies from the prescription screen of the encounter, click the Pref Pharm button and select the Clinic Pharmacy icon.

    Pref Pharmacy Search

  • 61. Error occurred while…"Fetching Data" or "Saving Record" –> how do I fix these errors?
     

    Because PrognoCIS operates in a web-based environment, Internet Browser settings apply at the individual workstation level for each user.  Often the temporary cache of cookies and temporary internet files need to be manually cleared out to prevent errors when attempting to save data or access records.

    If an error prompts such as “Error occurred while fetching data” or “Error occurred while saving record”, usually if you clear your Temporary Internet Files and delete Cookies from your browser, once you log back in the error will be resolved.   Depending on what browser and version you use, the exact steps may vary; however, most browsers typically have a choice labeled as “Internet Options” or “Settings” under which there are options to clear these temporary files.  This will have to occur on each individual computer that receives these types of errors.

  • 62. Custom face sheets per doctor specialty
     

    In cases of practices with multiple providers of different specialties, a face sheet can be customized to be specialty-specific by properties and Provider setup parameters.

    Settings –> Configuration –> Admin –> Properties

    • facesheet.navigate.all     –> set value to N
    • facesheet.1.specialty      –> set value to Specialty Code (e.g.: OB, Pain, Fam Med)
    • facesheet.1.visittype       –> set value to (leave it blank; define nothing)
    • facesheet.1.inactive        –> set value to N

    Settings –> Configuration –> Medics –> Specialty

    Define applicable specialties and note the Code, which is a unique number that can be up to 10 digits long and is alpha-numeric.  This code for the doctor’s matching specialty is what you must define in the property noted above.

    Settings –> Configuration –> Medics –> Providers

    Associate the applicable specialty to the provider.

    Only providers who are logged in with the Specialty designated will view the face sheet in addition to all other standard face sheets that are active.

  • 63. Payment adjustments begin in 2015 for non-compliant meaningful use providers
     

    Payment Adjustments Begin 2015 for Non-MU Compliance

  • 64. Encounter Types Reserved for System Use Only
     

    The backbone of every appointment/encounter in PrognoCIS is the encounter type, which controls certain default behaviors of the encounter.  When defining encounter types under Settings –> Configuration, a 2-digit code is required that must be unique for each one.  For some encounters, which are reserved for internal/system use only, the 2-digit code is locked and hence cannot be assigned by a user when creating local encounter types.  This list defines those reserved for system-only use.

    DB  -  Dummy Billing
    DE  -  Dummy Encounter
    DL  -  Dummy Lab
    DR  -  Dummy Radiology
    FS  -  Face Sheet
    FZ  -  Face Sheet History Only
    RR  -  Refill Request
    SR  -  Surescripts Refill Request
    XX  -  Merged Patient

    Any other 2-digit combination of alpha-numeric codes may be used when defining local encounter types.

  • 65. What version of Internet Explorer and Adobe Reader should I use?
     

    PrognoCIS is compatible with most browsers and versions of Adobe Acrobat Reader; however, as techonlogy advances some third parties are not always compatible with each other at the same time.  Hence, there may at times be conflicts with versions of browsers and Adobe Reader.  When in doubt, please consult the most recent Hardware/Software Requirements Specifications checklist on our Resource Center or contact Technical Support for more information.

    • Internet Explorer v10 requires Adobe Acrobat Reader 10 or 11
    • Internet Explorer v9 requires Adobe Acrobat Reader 9
      NOTE:  Bizfax workstation must have this combination –> Neither IEv10 nor Adobe X works with faxing functionality at this time.
    • Internet Explorer v8 and earlier requires Adobe Acrobat Reader 9.
  • 66. What are the limitations of using compatibility view in my browser?
     

    If your Internet Explorer browser is set in compatibility view as per the version number, then some features of EMR may not work properly.You need to turn it off. Please note that each version of PrognoCIS and of Internet Explorer has different configuration combinations.

    If you choose to enable Compatibility View when it is required, some of the limitations you will face include:

    • Documents in Preview Pane will be cut off
    • Links will not display in right location on screen
    • Some buttons will not work properly or at all
    • Schedule time increments will not display correctly
    • Draw Tool will not be available
    • Some pop-ups may not be invoked
    • Microsoft updates compatibility setting everytime they do a patch

    Please remember to use PrognoCIS properly, all workstations must have their internet browser settings properly configured per the version they are using.

  • 67. Patients get alerts & message service error when confirming text reminders
     

    AT&T processes all text messages between PrognoCIS and patients.  There is a 2-hour time limit with AT&T for automated replies.  This error occurs for a patient when they respond to the text more than 2 hours after it was delivered.

    TextResponseFailure-1

    Here is the AT&T response from Technical Support when we inquired:

    TextResponseFailure-2

  • 68. Is my state enabled for EPCS (Electronic Prescribing Controlled Substances)?
     

    As of June 2015, 49 of the 50 states in USA + Washington, DC allow the electronic prescribing of controlled substances.  EPCS are processed through PrognoCIS via the Surescripts clearinghouse.  To know your state’s status, please visit:

    http://surescripts.com/products-and-services/e-prescribing-of-controlled-substances

  • 69. Can I track user activity via date/time stamp of documentation or changes made?
     

    Yes.  All user activity at an encounter level is tracked in the system Audit Trail.  This activity can be captured as part of the Progress Note or as an independent (custom) output template.  There are unique tags within the software that pull this data based on the section.

    To create a custom template, for example, follow these easy steps:

    • Select Settings –> Configuration –> Output Templates
    • Select Forms or Progress Notes
    • Click add new
    • Assign a Template Name
    • Choose desired data by clicking the Select Tag + icon

    LU Tags

    •  Search for Tag Name ENC_LU
      Note: 
      This equates to Encounter Last Updated and displays the activity via date/time stamp and user.

    LU Tags (2-ALL)

    The output can be organized/formatted as per local preference following standard output template and HTML standards.  The following example shows the output content based upon the specific tags as indicated by the color-coding in the sample.

    LU Tags (3-Output vs Tags)

  • 70. In what states is a supersiving MD required for mid-level provider eRx?
     

    Per Surescripts requirements, mid-level providers such as Nurse Practicioners and Physician Assistants in the following states require a Supervising MD for all electronic prescriptions submitted:

    • Alabama
    • Georgia
    • Illinois
    • Kansas
    • Louisiana
    • Massachusetts
    • Missouri
    • Nebraska
    • New Jersey
    • North Carolina
    • Oklahoma
    • Pennsylvania
    • South Carolina
    • Tennessee
    • Texas

    If you are a mid-level provider in one of these states and write electronic prescriptions through PrognoCIS, please consult the Configuration Guide for setting up a Supervising Provider in your user profile.

  • 71. Acronyms, File Types, and Definitions relevant to EMR/PM (Billing) terminology
     

    Common Acronyms

    AMA = American Medical Association
    ANSI = American  National Standards Institute
    CMS = Centers for Medicare and Medicaid Services

    CPT = Current Procedural Terminology
    CQM = Clinical Quality Measures
    EDI = Electronic Data Interchange
    EHR = Electronic Health Record
    EOB = Explanation of Benefits
    EMR = Electronic Medical Record
    ERA = Electronic Remittance Advice
    eRx = Electronic Prescribing

    ICD = International Classification of Diseases
    HCPCS = Healthcare Common Procedure Coding System
    MAC = Medicare Administrative Contractor
    MU = Meaningful Use
    NCCI = National Council for Compensation Insurance
    NCD = National Coverage Decision
    NCH = National Claims History
    NEC / NOC = Not Elsewhere Classified / Not Otherwise Classified
    NOS = Not Otherwise Specified
    NPI = National Provider Identifier
    NQF = National Quality Forum
    PMS = Practice Management System
    PQRS = Physician Quality Reporting System
    QDC = Quality Data Codes

    EDI File Types

    835 = electronic file of payment data as processed by a payer and sent through a clearinghouse to PrognoCIS.  The payment and adjustment data is then interfaced into PrognoCIS at the individual claim level.
    837 = electronic file of claim data as generated on PrognoCIS and transmitted through a clearinghouse to a payer.  The charges are then processed by the payment and either returned, rejected, paid, or denied.  There are two versions of 837 = 837I and 837P.
    837-I = Institutional Claims (paper equivalent is UB-04) and applies for facility billing.
    837-P = Professional Claims (paper equivalent is CMS-1500) and applies for professional (Provider) billing.
    999 = electronic file of claim status data generated by the clearinghouse and transmitted to PrognoCIS as an acknowledgment of having received the claims transmitted in the 837.
    The contents of the 999 may be a failure or a success and are populated at the claim level in the railroad track icon to reflect the status of the claim once it has been processed in PrognoCIS up until it is accepted by the payer.  Thus, there may be multiple 999 records per claim.
    TA1 = electronic file of claim-level rejections from the payer as transmitted to PrognoCIS through the clearinghouse and posted to the Returned Claims screen.
    277 = electronic file of charge-level rejections from the payer as transmitted to PrognoCIS through the clearionghouse and posted to the 277 Status screen.
    270 = electronic message sent from PrognoCIS Insurance Eligibility module through the clearinghouse to request benefit information for the claim’s payer based on the date of service.
    271 = electronic message returned back to PrognoCIS through the clearinghouse with the benefit information effective for the date of service and the patient based upon the insurance information entered.

    Definitions of Terms

    CPT =  a 5-digit number assigned to every medical, surgical and diagnostic service, test, or procedure performed by a medical provider.  CPT codes are associated to charges in a Fee Schedule and are used by insurers to determine the amount of reimbursement that a practitioner will receive.
    HCPCS = a 5 digit number assigned to every medical, surgical and diagnostic service, test, or procedure performed by a medical provider.  There are 2 sets of HCPCS – level I are identical to CPT codes while level II HCPCS are typically use by medical suppliers and represent services that may or may not be passed through a physician’s office.
    ICD = a number assigned to every injury, illness, or disease assessed by a provider’s examination to identify the patient’s condition.  ICD codes may be a 3, 4, or 5 digit number.
    Clearinghouse = a third party entity who acts as an agent between the billing vendor or PMS and insurance companies.  A clearinghouse is typically an alternative to direct billing and is often the only available option in cases where insurances do not provide direct billing or online solutions.  Please consult the FAQ for list of current clearinghouses that are available to users of PrognoCIS.

  • 1. In what scenarios will a “Dummy Billing” claim be created?
     

    ‘Dummy Billing’ claims are created by the system in the following scenarios:

    • No Show
    • Appointment Cancelled by Patient
    • Bounced Check (CoPay entry)
    • Bounced Check (Patient Receipt entry)
    • Claims → New
  • 2. How do I send my electronic claims (EDI)?
     

    EDI claims may only be transmitted from PrognoCIS to your clearinghouse provided all applicable setup has occurred.   Please refer to your Implementation Manager at PrognoCIS for further details if you have not already submitted your Billing Setup & Registration Checklist to us.

    Claim Details screen

    • Select the applicable claim
      • Claims → Edit
      • Home Page → Claim Details icon
    • Verify the accuracy and completeness of the claim
    • Select Ready to Send check box
    • Click the save button

    Send Claims screen

    • Select Claims → Send Claims
    • Select the applicable tab
      • EDI-Pri - primary claims with primary insurance balance outstanding
      • EDI-Sec - secondary claims with primary payment posted
    • Select the check box beside each validated claim to be transmitted
    • Click the Process button

    Notes:

    • All claims that are validated for transmission will be indicated by a green highlight and status code of 99.
    • An orange “Processing…please wait” status box will display while the batch is generating.  This message will go away once the batch has successfully created and transmitted to the clearinghouse.
    • Claim status can be tracked via the Track Status icon on the Claim Details screen.
  • 3. How do I print my paper claims (CMS-1500)?
     

    Paper claims may be printed in two different ways within PrognoCIS – similarly to the EDI claims under the Claims → Send Claims menu or directly from the Claim Details page.  A paper claim can be printed on a standard CMS-1500 form (i.e.: preprinted red-and-white form purchased independently of PrognoCIS) or to plain white paper where PrognoCIS will also print the overlay format with the data.  This is property-driven and must be setup with your Implementation Manager at PrognoCIS.

    Send Claims screen

    • Select Claims → Send Claims
    • Select the applicable tab
      • Pri-CMS - primary claims with primary insurance balance outstanding
      • Sec-CMS - secondary claims with primary payment posted
    • Select the check box beside each claim to be printed
    • Click the Process button

    Claim Details screen

    • Select the applicable claim
      • Claims → Edit
      • Home Page → Claim Details icon
    • Verify the claim has already been billed
    • Click the printer icon
    • Select the applicable CMSoption (Primary, Secondary) radio button and click ok

    Print CMS1500 from Claim Page

    Notes:

    • The option to print a CMS1500 directly from the claim will only be available once it has intially been printed/billed.
    • An orange “Processing…please wait” status box will display while the batch is generating.  This message will go away once the batch has successfully created and printed to the designated printer.
    • Claim status can be tracked via the Track Status icon on the Claim Details screen.
    • Please refer to your Implementation Manager at PrognoCIS for further details if you have not already submitted your Billing Setup & Registration Checklist to us.
  • 4. How do I create a CMS1500 for patient who has paid me so he can be reimbursed from the insurance?
     

    Often the patient will pay the provider and then seek reimbursement from his insurance company.  In this case, it is common that the insurance company will require a CMS1500 claim form that includes all of the appropriate codes and credentials.

    To create a CMS1500 for a patient, the following must occur:

    • The check box in the ’Patient’ column must be selected on each line-item (charge).
    • Applicable insurance should be added for that particular patient.
    • Make sure that ‘Accept Assignment’ drop down value is set to ‘Not Assigned’.
    • Click the printer icon on the Claim Details page and select the CMS1500 for Patient option.
    • Click ok button.

    Note: Similarly, EDI claim for patient can be sent by clicking the print option on claim and choosing option ‘Send Patient EDI’.

  • 5. How can I make the “New” button available for more than 15 days regarding version release information?
     

    There is a system property called home.newver.notes.days, which is a numerical value that defaults to 15.  This number can be changed to any desired (whole) number of days.

    • Settings → Configuration → Admin → Properties
    • Search for Name → Home Page
    • Search for Tag → home.newver.notes.days

    Admin Properties Home Page

    • Select the property (while highlighted in blue, click it – or double-click it)
    • Enter the desired number of days
    • Click save button

    The NEW balloon gives access to the applicable Release Notes for the upgrade.

  • 6. How can I quickly resend a secondary claim for a specific insurance?
     
    • Under the Claims tab, select either
      • Claims Center, or
      • Outstanding Claims
    • Click the Select Filter button and define the desired criteria, e.g.:
      • Secondary Responsibility = Y
      • Insurance Name = enter the applicable secondary insurance name for which claims are to be resent
      • Click the ok button
    • Select the check box for each claim that is to be resent
    • Click Resend arrow (icon_Resend Claims).

    The selected claim will be sent the same way they were originally (i.e.: EDI or CMS).

  • 7. Why does the error “Patient Primary Insurance may not be valid” display on the Schedule?
     

    This message occurs when the primary insurance as listed on the selected patient’s Insurance Register has expired (i.e.: the UpToDate is prior to the Appointment Date).

  • 8. What EDI Clearinghouses are supported by PrognoCIS Billing module?
     
  • 9. Acronyms, File Types, and Definitions relevant to EMR/PM (Billing) terminology
     

    Common Acronyms

    AMA = American Medical Association
    ANSI = American  National Standards Institute
    CMS = Centers for Medicare and Medicaid Services

    CPT = Current Procedural Terminology
    CQM = Clinical Quality Measures
    EDI = Electronic Data Interchange
    EHR = Electronic Health Record
    EOB = Explanation of Benefits
    EMR = Electronic Medical Record
    ERA = Electronic Remittance Advice
    eRx = Electronic Prescribing

    ICD = International Classification of Diseases
    HCPCS = Healthcare Common Procedure Coding System
    MAC = Medicare Administrative Contractor
    MU = Meaningful Use
    NCCI = National Council for Compensation Insurance
    NCD = National Coverage Decision
    NCH = National Claims History
    NEC / NOC = Not Elsewhere Classified / Not Otherwise Classified
    NOS = Not Otherwise Specified
    NPI = National Provider Identifier
    NQF = National Quality Forum
    PMS = Practice Management System
    PQRS = Physician Quality Reporting System
    QDC = Quality Data Codes

    EDI File Types

    835 = electronic file of payment data as processed by a payer and sent through a clearinghouse to PrognoCIS.  The payment and adjustment data is then interfaced into PrognoCIS at the individual claim level.
    837 = electronic file of claim data as generated on PrognoCIS and transmitted through a clearinghouse to a payer.  The charges are then processed by the payment and either returned, rejected, paid, or denied.  There are two versions of 837 = 837I and 837P.
    837-I = Institutional Claims (paper equivalent is UB-04) and applies for facility billing.
    837-P = Professional Claims (paper equivalent is CMS-1500) and applies for professional (Provider) billing.
    999 = electronic file of claim status data generated by the clearinghouse and transmitted to PrognoCIS as an acknowledgment of having received the claims transmitted in the 837.
    The contents of the 999 may be a failure or a success and are populated at the claim level in the railroad track icon to reflect the status of the claim once it has been processed in PrognoCIS up until it is accepted by the payer.  Thus, there may be multiple 999 records per claim.
    TA1 = electronic file of claim-level rejections from the payer as transmitted to PrognoCIS through the clearinghouse and posted to the Returned Claims screen.
    277 = electronic file of charge-level rejections from the payer as transmitted to PrognoCIS through the clearionghouse and posted to the 277 Status screen.
    270 = electronic message sent from PrognoCIS Insurance Eligibility module through the clearinghouse to request benefit information for the claim’s payer based on the date of service.
    271 = electronic message returned back to PrognoCIS through the clearinghouse with the benefit information effective for the date of service and the patient based upon the insurance information entered.

    Definitions of Terms

    CPT =  a 5-digit number assigned to every medical, surgical and diagnostic service, test, or procedure performed by a medical provider.  CPT codes are associated to charges in a Fee Schedule and are used by insurers to determine the amount of reimbursement that a practitioner will receive.
    HCPCS = a 5 digit number assigned to every medical, surgical and diagnostic service, test, or procedure performed by a medical provider.  There are 2 sets of HCPCS – level I are identical to CPT codes while level II HCPCS are typically use by medical suppliers and represent services that may or may not be passed through a physician’s office.
    ICD = a number assigned to every injury, illness, or disease assessed by a provider’s examination to identify the patient’s condition.  ICD codes may be a 3, 4, or 5 digit number.
    Clearinghouse = a third party entity who acts as an agent between the billing vendor or PMS and insurance companies.  A clearinghouse is typically an alternative to direct billing and is often the only available option in cases where insurances do not provide direct billing or online solutions.  Please consult the FAQ for list of current clearinghouses that are available to users of PrognoCIS.

  • 10. Where do I enter the description that is required for NOC codes for my EDI claims?
     

    NOC (Not Otherwise Classified) codes are billable; however, per ANSI-5010 specs, a qualifying description is also required to be sent in the EDI file segment SV101-7).  This is not currently a requirement of paper claims billed on a paper CMS-1500.

    In PrognoCIS, on the claim details screen, the description can be entered directly into the Comments field on each applicable charge row.

    NOC FAQ

    This is applicable to both CPT and/or HCPCS codes that are categorized as Not Otherwise Classified (typically such codes may be identified with a “99″ and/or the word “General” or “NEC” in the description).  If there are multiple NOC code charges on the same claim, each individual code requires its own individual Comment to be entered.

    NOTE:  This is not the same as NDC codes which are still required for dispensable drugs as applicable.  NDC codes are still entered under the red flag icon on the charge row.

  • 11. Why can’t I delete a line-item from my claim? The delete check box is not there for my Special Billing Charge.
     

    When trying to delete a charge row from a claim, but the Del check box is missing, deselect the Ready to Send check box. Once that is unchecked, the Del check box will be enabled and should appear on the charge line so it can be deleted.

    This is especially true in cases of Special Billing Charges.  These are automatically flagged as Billed status because they are billed to the patient.  Hence, the Del check box is not applicable on the charge row.  If there are other charges present that will be submitted to the insurance, theReady to Send check box remains enabled so those charges may be correctly billed.  To otherwise remove the patient charge row; since they are already considered to be billed, the claim will have to be reopened so those items can be deleted.

    Charge Row on claim can't be deleted

  • 12. Is PrognoCIS compatible with Ansi 5010?
     

    Yes.  As of our December 24, 2011 release of v2b6, all EDI communications within PrognoCIS are Ansi-5010 compliant.  All users should be using v2b6 as of January 1, 2012 in order for all of their EDI transmissions to be in the 5010 format.  Ansi-5010 replaces version 4010 and is applicable for all EDI transaction in EMR (Surescripts eRx, Insurance Eligibility) and Billing (Claims, Remittances/EOBs, Eligibility).

    Please note that these changes are not just limited to PrognoCIS; rather, they are applicable for the entire healthcare industry.  We cannot guarantee that there will no problems; as problems can occur with any update of this magnitude. Please understand that any such issue may not be within the jurisdiction or result of an issue with PrognoCIS.  Clearinghouses, payers, and other third party processing agencies may also have issues as they likewise transition.  Although there are multiple parties involved, we will make all efforts to address them quickly as they are reported.

    The response time from clearinghouses and payers has been slow in the past few weeks due to high volume of 5010 transitions.

  • 13. How does PrognoCIS handle the Global Period (or Global Days) for a procedure?
     

    The global period (or global days) for a procedure impacts how often the clinic will receive reimbursement for a procedure.  The number of days is defined within the CPT Master under Settings –> Configuration.

    Once such a CPT Code has been billed, a system-generated alert will automatically be created for the patient indicating the CPT Code and the applicable global period.  This alert will then pop-up for the scheduling staff when booking an appointment. This allows the office to decide if they are going to go ahead with the appointment although it will not be billable.

    Global Days Defined to a CPT Code

    Global Periods-CPT Days Defined

    CPT Code with a Global Period is Billed

    Global Periods-Claim Billed CPT

    Scheduler is Alerted Automatically if Global Period Applies

    Global Periods-Alert

  • 14. How do I verify a patient’s insurance eligibility?
     

    PrognoCIS Insurance Eligibility can be implemented within the EMR as well as the Practice Management (Billing) modules.  The required setup is the same for both and requires that you enroll for the feature with your clearing house. Please check with us for a current list of clearing houses which support eligibility before enrolling.

    The clearinghouse communicates with PrognoCIS and performs the benefit checking based on the patient’s demographics and insurance as entered under Patient Register within PrognoCIS.  In addition, the individual insurance company assigned to the patient’s insurance history must have the appropriate electronic payer ID as assigned by the clearinghouse.  This is the trigger that is required in order for the patient’s insurance to be validated and benefits reported back to PrognoCIS.

    Once eligiblity is setup and enabled within PrognoCIS, the verifying of benefits can be done either manually on demand as needed at an individual patient level, or systematically by batch processing for an entire day’s worth of appointments.

    Individual Eligibility Checking – at the Appointment level

    1. Select the appointment from the Appointment –> Schedule.
    2. Click on the Check Eligibility icon (icon_EligiblityCheck-Appointment) in the lower-left of the schedule screen.
    3. Click the OK button to execute the eligibility.
      Note: If it has already been executed, the details will be displayed and can be printed.

    Individual Eligibility Checking – at the Patient Insurance level

    1. Select the patient’s insurance.
    2. Click the Check.. button.
    3. The details will populate under the Details…button which will display with a check mark when it is populated (Eligiblity Buttons on Ins scren).

    Mass Eligibility Checking by batch of the next day’s appointments

    This requires some technical setup, so please contact Bizmatics’ Technical Support or your Project Manager if still implementing.  Once the process is defined to ocurr nightly for you, the eligibility checking will occur automatically overnight for the next day’s scheduled appointments.  Those results can then be viewed when the patient arrives by clicking the appropriate icon on the selected patient’s appointment or from the Home Page.

  • 15. What type of data (benefits information) does the Insurance Eligibility Program provide?
     

    The Insurance Eligibility program is based upon the data that is on file with the clearinghouse for the individual patient’s insurance.  The specific content of the report back to PrognoCIS from the clearinghouse may vary with regards to the specific relationships between the individual payers and the clearinghouse.  In addition, the contents may vary based upon a specific patient’s plan within the payer.

    For example, a patient who has Medicare or Medicaid is either eligible or not.  Perhaps the eligibility is based upon categories such as “Inpatient (Hospitalization)” or “Outpatient” or just “Yes” or “No”.  However, a patient who has Group Health – such as Cigna or Aetna – may have HMO, PPO, POS, Indemnity, HSA, FSA, or any other individual plan.  Some payers offer extended coverages for specific disorders such as Cancer policies.

    Thus, when the eligibility program is executed with the clearinghouse, the information returned into PrognoCIS will depend upon the specific payer and what they are able to provide back through the clearinghouse.

    Sometimes the EB (Eligibility Benefit) details will include deductible, out-of-pocket, lifetime maximum, etc. whereas other times it may simply indicate a rate of payment or percentage.  Sometimes a patient’s responsibility may be provided (e.g.: Copay, 20% billed charges, etc.) and other times not.  The snapshot below shows an actual EB Printout for a group health policy with Aetna Health Plans.

    Eligibility Details

  • 16. Why is my claim dropping to paper when it is supposed to go electronically?
     

    The insurance master in PrognoCIS determines alot of behavior for how a claim is processed based on the payer that is assigned.  This includes whether or not to send the claim electronically or drop it to a hard-copy, paper claim.  The claim will reflect the status of the payer at the moment it is created; thus, if a payer gets updated after the claim has been created, it is possible that the claim will be handled differently than you expect.

    For example, Aetna is typically an electronic payer.  However, based on your setup, if the insurance master has not been correctly defined to reflect that, it is possible for you to get a claim for Aetna that drops as a paper claim.  In order to fix this so it can be billed EDI, you will have to modify the insurance record for the payer and then recalculate the claim in PrognoCIS to refresh it.

    Updating Insurance Master

    • Settings –> Configuration –> Masters –> Vendors –> Insurance
    • Select the applicable payer (e.g.: Aetna)
    • Enter (or verify) the EDI Payer ID
      Note: This is a 5-digit number assigned to the payer by the clearinghouse.
    • Select (or verify) the EDI Clearinghouse
      Note: 
      This will reflect the clearinghouse(s) you are setup for based on the Billing Registration Setup Form you provided during implementation.
    • Select (or verify) the EDI Claim Filing Code.
    • Click the save button.

    Recalculating the claim

    • Select the unbilled claim
      Note: The Paper Ins Form check box will be selected and grayed-out.
    • Click the re-calc button
      Note: The Paper Ins Form checkbox will refresh as de-selected, which indicates that the payer has updated and will now go EDI instead of paper.
    • Click the save button
  • 17. My PrognoCIS disappears after I enter my password and my password is correct.
     

    This issue typically occurs when the application is being accessed on a workstation where the Internet Explorer browser settings have not been properly defined.

    Please consult the link for Internet Browser Settings on your Login Page (without logging into the application).  Apply these settings within the IE Tools –> Internet Options on every individual pc or laptop that must access PrognoCIS.

    After defining these settings, the login should work.  When the password is invalid, the application does not disappear – it simply posts a message of Invalid Password.

  • 18. Error occurred while…"Fetching Data" or "Saving Record" –> how do I fix these errors?
     

    Because PrognoCIS operates in a web-based environment, Internet Browser settings apply at the individual workstation level for each user.  Often the temporary cache of cookies and temporary internet files need to be manually cleared out to prevent errors when attempting to save data or access records.

    If an error prompts such as “Error occurred while fetching data” or “Error occurred while saving record”, usually if you clear your Temporary Internet Files and delete Cookies from your browser, once you log back in the error will be resolved.   Depending on what browser and version you use, the exact steps may vary; however, most browsers typically have a choice labeled as “Internet Options” or “Settings” under which there are options to clear these temporary files.  This will have to occur on each individual computer that receives these types of errors.

  • 19. Does PrognoCIS manage EDI Files for claims and payments (837 and 835) incoming and outgoing?
     

    PrognoCIS PM (“The Billing Module”) fully supports EDI processing of healthcare claims (837) and payments (835) files.  Whether Professional (837-P) or Institutional (837-I), claims are routed through a clearinghouse based on a provider’s enrollment via a secured FTP connection between PrognoCIS and the clearinghouse.  A user can process a single claim or multiple claims at any time of day per local need.  The system has the capability to batch the claims as one combined file for all payers or as a single batch per payer based on user preference.

    Electronic Remittance Advice files (ERAs or 835) are likewise downloaded via a secured FTP connection between PrognoCIS and the clearinghouse.  Such downloads can be scheduled to automatically download as soon as the clearinghouse makes them available. Such processes can be scheduled to execute hourly based on local preference.  Once downloaded into PrognoCIS, the user can validate the data and post it so that is applies to the account as applicable.

  • 20. Does PrognoCIS use any other tool for EDI validation and management?
     

    PrognoCIS has built-in algorithms to validate all 837 claim files.  Prior to submission, a claim must pass three levels of validation at the system level – (a) Claim Save, (b) Claim Ready to Send, (c) Send Claims.  In addition, the user has the flexibility to create localized, custom scrubber checks as needed.  All validations and success or failure status is tracked from claim creation through payment posting.

    Similarly, 835 payment files are verified for valid (matching) claims while being processed and PrognoCIS logs the results which the user can review for any anomalies.  In addition, the system generates human-readable reports, which allows the user to review as needed and take appropriate action.

  • 21. Does PrognoCIS receive Acknowledgment Reports (such as 997/999) and how are transactions tracked?
     

    Yes, PrognoCIS receives and generates acknowledgment reports from the clearinghouse, which provide front-end returns or rejections from the clearinghouse or the payer.  It is imperative that these reports be worked consistently because they are showing as Billed in PrognoCIS but have not been successfully received by the payer to process.

    Such reports (known as 997, 999, or 277) are uploaded from the clearinghouse and updated into PrognoCIS to reflect the transaction status.  Such status is tracked at the claim level under the railroad track icon and can be viewed at the system level under Claims –> Returned/Rejected.   The applicable status reflects whether or not the claim has been accepted or rejected, which may require correction by the user or may simply be informing you it has already been processed.

  • 22. How does client know what file type they will receive from the payer?
     

    All transactions are routed through a clearinghouse, which requires enrollment.   When implementing Electronic Remittance Advice Posting in PrognoCIS, the client does their own enrollment with the applicable clearinghouse.  The industry standard for remittance files is Ansi-835, and most major payers accommodate this format.  However, if for any reason the payer does not support 835, the user can manually create the remittance in PrognoCIS.  In this case, the system has the provision to scan the EOB and attach it to the Remittance screen.

    Regarding 835 files, if the payment mode specified is any one of the following, the system will process them:

    • ACH – Automated Clearing House
    • CHK – Check
    • NON – Non Payment Data
  • 23. Did PrognoCIS utilize any EDI Mapping Tool to incorporate payment posting into PMS?
     

    PrognoCIS has a built-in algorithm which maps and applies all 835 data into the PMS structured data correctly.  In addition, PrognoCIS produces a human-readable EOB report similar to the Remit Easy-Print format produced by Medicare.  The automatic Log File tracks all data from the 835 and how it is applied internally and the Remittance Error Report highlights anomalies.

    Note:  In case where clarifications are required, we refer to the Medicare Remit Easy Print.

  • 24. What is PrognoCIS 835-Expectation Management & Reporting when 835 cannot be applied?
     

    PrognoCIS provides the following reports/screens to aid users with managing their Accounts Receivables and Payment Exceptions:

    • Claims –> Returned/Rejected – displays claims that have been returned back to the user via 997, 999, or 277 report from clearinghouse or payer
    • AR/Follow-up –> Disputed – displays payments the cashier has flagged as needing to be disputed perhaps due to not having paid correctly, etc.
    • AR/Follow-up –> Denied – displays charges that have been denied by the payer via Denial Reason within the remittance advice/EOB
    • AR/Follow-up –> Assigned Tasks – displays a user-generated work list by internal assignment queues for managing trends and productivity
  • 25. What is the meaning of the colors/Tracking Status on Outstanding Claims screen in PM?
     

    Within the Practice Management module, collectors and billers can work their open balances under the AR/Follow-up --> Outstanding tab.  This customizable screen displays open balances within the user's specified filters and parameters in a table that includes colors and tracking status numbers.

    In the lower left of the screen, there is a Legend button, which defines all of the Tracking Status Numbers and what they mean.  These are typically assigned by the clearinghouse in the EDI Acknowledgment reports and/or ERA files.

    LegendButton-OutstandingClaims

    The various Amount font colors and their meanings are as follows:

    • Black font indicates the Total Charges billed when there has been at least a partial or a full payment
    • Red font indicates there has been no payment at all and the full Total Charges are still outstanding
    • Blue font indicates the current claim balance due
    • A mint green-colored background indicates an EDI and not a paper CMS claim.

    GreenEDIBackground-OutstandingClaims

  • 26. How do I add Ordering Provider to a claim?
     

    When a Payer requires the Ordering Provider for a service, you have the option of adding it at the claim level or at the charge level.  The preference may be payer-specific.  There is no harm in putting it in both places; but it is a local decision.  When the Referred-By Provider is associated to the encounter (see EMR TOC --> Encounter --> Edit Existing screen), it will auto-populate at the claim level.

    Claim-level Ordering Provider is entered under the i-button on the claim.  (Note:  The label = Referring Provider.)
    i-Button_ReferringProvider

    Charge-level Ordering Provider is entered under the CMS Flag icon on the specific charge row.
    CMS-Flag-OrderingProvider

  • 1. How do I create a user login or reset a password?
     

    Once a user exists, a User ID/Password can be assigned. To create a new user first, please refer to the FAQ entitled: “How do I add a new user to the system?”

    Select Settings  Configuration  Admin  Login Details.
    • Select the User Type from the pick list
    • Click binocular to select the desired employee
    • Specify a unique User ID
    Note: System auto-generates one if you prefer to keep it.
    • Click the box to Auto-generate (optional) … OR …
    • Enter desired Password twice (optional)
    Note: Passwords must be 8-10 digits, alpha & numeric.
    • Click OK
    If the user has an email address on file (Patient Register), an email will be auto-generated to the patient. The email will include an encrypted PDF attachment that contains the login details. The password to unlock the PDF is the patient’s Date of Birth by default.
    The password assigned (whether auto-generated or manually) will be good for 1 use only and immediately expires upon first use. The user can then change the password (which will not expire).
    Note: There is a property within the system settings (optional) if you would prefer passwords to expire.

  • 2. Why can’t I view my faxes that I’ve attached to my Document List in Internet Explorer?
     

    Note: This article applies to Internet Explorer only.

    Faxes are stored as *.TIF files. In order to view these, you must have a TIFF Viewer application.  If you do not have one already, you can download one for free from the internet.

    • Access www.alternatiff.com
    • Select the option to Install into IE (in the upper right of screen)
    • The screen will prompt that it is successfully installed
    • Click on the “click here” link to register
    • Complete the registration for your practice

    This must be done on each individual workstation/laptop and must also be registered once it is installed.  This will then allow you to view these files and provide the alternatiff tool bar of icons for resizing/repositioning/etc within the Document List.

  • 3. I can’t log into PrognoCIS from my pc but everyone else in the office is logged in okay
     

    This usually means the Internet Explorer options have not been properly defined on the specific pc that is having the problems.  This is not related to the user id, unless you are actually getting an error that the User ID is Invalid.

    Define these settings as follows:

    • Open Internet Explorer
    • Select Tools → Internet Options
    • Follow the settings as documented under Browser Settings
      Note: The Browser Settings is a hyperlink on the Login Page.  You can also request a copy from Technical Support or download them directly from the hyperlink.
  • 4. How do I add a new user to the system?
     

    This is a permission that must be assigned to your User Role. If you have this permission, the employee can be added under the most appropriate category based upon the role required within EMR.

    Create the User Record:

    • Select Settings → Configuration → Masters → Medics
    • Select the appropriate category for the user
      • Provider → MD, DO, PA, ARNP
        Note:  Providers require a license; if you are adding a new provider to your practice, it may require the purchase of an additional license.
      • Resource → non-licensed professionals or entities who require a schedule
      • Medical Assistant → MA, PT
      • Clinical Staff → Nurses, Technicians, Therapists, etc.
      • Admin Staff → IT, Receptionist
        Note: Typically, these users do not require clinical access to a patient chart.
      • Biller → Billers and collectors (N/A for EMR only)

    Assign a Login to the User:

    • Select Settings → Configuration → Admin → Login Details
    • Select the User Type
    • Select the User Name
    • Assign a User ID
    • Assign a Password
    • Click the ok button
  • 5. How does the data exchange between my PMS & PrognoCIS flow when something changes?
     

    PrognoCIS works in conjunction with numerous PMS systems (i.e.: AdvancedMD, Medial Mastermind, Avisena, etc.).  In all cases where a PMS is used, the source of demographic and scheduling data it primarily the PMS.  The interface then feeds the data via the HL7 interface into PrognoCIS.  There is no limit to the number of times such a data exchange can occur.

    NOTE:  In such cases, it is STRONGLY RECOMMENDED that all data corrections to demographics or scheduling data be performed only on the PMS and not directly into PrognoCIS.  Unless the PMS does not provide a scheduling feature, you will typically not be trained on the PrognoCIS internal scheduling and demographic functions except on an as-needed basis.

    The following points summarize the specifics with regards to transaction and data flow regarding demograhpics, appointments, and assessment (Billing) information.

    1. Patient Demographics are entered in the Practice Management System (PMS) and flows over into PrognoCIS EMR for synchronization.

    2. Scheduling Data is entered in the PMS and flows over into PrognoCIS EMR Appointments Schedule module for synchronization.  Only in cases where the PMS does not offer a Scheduler will it be necessary for you to enter appointments directly into PrognoCIS.

    3. Billing Information (ICD / CPT / HCPCS/ Modifiers) can be entered into PrognoCIS under the Assessment screen on the encounter.  This information then flows back over to the PMS for billing. The biller can edit this information during the billing process within the PMS.  If the changes made are related to this assessment data, however, it will not be reflected in PrognoCIS.  If such changes to the coding are required, it may be preferred to delete the claim from the PMS and make such changes in PrognoCIS Assessment so it will flow back to the PMS again.  This is strictly based on local practice, as the billing information does not synchronize from the PMS back into PrognoCIS.

    Typically, a bi-directional Interface for Patient Demographics and Scheduling data is not available.  It is best practice for you to maintain data entry control in ONLY ONE SYSTEM.

    There is NO LIMIT on how many times a patient record can be updated. Every time it is updated on the PMS, it will flow over to and synchronize in PrognoCIS EMR. Please note, however, when it comes to appointments, once it has been marked as ARRIVED in PrognoCIS, there are typically no further updates accepted for that record.  Once an appointment is arrived, it becomes an ENCOUNTER in PrognoCIS, which has numerous other dependencies within the EMR that are not part of a PMS synhronization.

    The Scheduled Process for the Interface

    The flow of demographics and scheduling information to EMR is actually under control of the Practice Management System.  Since the PMS is pushing the information to EMR, any update done to the demographics section will trigger a Data Transfer Request from the PMS to EMR.  In case of AdvancedMD PMS, PrognoCIS pulls the information from AdvancedMD at a regular interval; thus, and update performed on any patient record is automatically included and syncrhonized into PrognoCIS in the next cycle.

    As for the billing Information flow from PrognoCIS EMR to the PMS, the data is typically generated when a user closed the encounter. (On an as-needed request, there is an option to generate the data transfer into the interface when the data entry occurs under the Assessment screen while an encounter can be open OR closed.)

  • 6. Are there any specific Tablet/Notebook PCs that work with PrognoCIS?
     

    Based on known clients in production, the following models are compatible with PrognoCIS.  Please note that a basic requirement at this time is that the pc run Micrsoft Windows as the Operating System and use Internet Explorer v9 or above as the browser.

    • Hewlett Packard-TX2 Convertible Tablet with Windows 7
    • Toshiba Tablet (as furnished by Bizmatics)
    • Fujitsu Windows Tablet PC Edition
    • Fujitsu Lifebook T4220
    • Fujitsu Lifebook T730
    • Lenovo ThinkPad X61 Tablet 7767
    • Motion C5
    • DakTech’s PlaidSlate (a wireless slate-based pc on the Intel® 945GSE chipset)
    • Toshiba Protege M700
  • 7. How do I talk to a person in Customer Service and get some technical support?
     

    There are various ways of contacting the Technical Support department to speak with a live person.  In addition, you may also get answers to your questions/issues right here on the Resource Center or by directly submitting a Support Ticket to the Engineering Department without first speaking with somebody.

    • Resource Center –> Live Chat
      • Monday – Friday,  24 hours each day
      • Saturday & Sunday,  6:00am – 5:00pm PST
      • After-hours on weekends, an email will be generated to the On-Call Rep
    • Resource Center –> Create a Support Ticket
      • Under 'Manage Support Cases' link, create a case.
      • A Case # will be assigned within the tracking database once it is generated
      • Use the Case # when doing any follow-up inquiry
    • Telephone: (408) 873-3032 toll free- (800) 552-3301

      • Monday – Friday,  round the clock
      • Saturday-Sunday, 6:00am to 5:00pm PST
    • Email: techsupport@bizmaticsinc.com

    Please remember the Resource Center is on-line and accessible 24/7.  In addition to the links to Technical Support, the Resource Center also includes training videos, FAQs, and User Quick Guides, which may also answer many of your questions.

  • 8. What type of scanner shall I use for OCR Scan feature?
     

    Please visit our page at: http://store.card-reader.com/t-bizmatics.aspx to review hardware options.

  • 9. I cannot update my face sheet – the + icon is not working – why?
     

    In many cases of technical issues, the Internet Explorer browser settings may be the factor.  Always verify that these settings are correctly defined as per the initial setup.  (There is a permanent link to these settings on the PrognoCIS login splash screen.)

    Secondly, the Advanced Settings may need to be restored to their default, i.e.:

      1. Open Internet Explorer window.
      2. Select Tools –> Internet Options.
      3. Select the Advanced tab.
      4. Click the Restore advanced settings button.
      5. If prompted to confirm, do NOT select Delete personal settings check box.
      6. Click the Reset button.

    IE Tools Advanced tabIE Tools Adv Tab Restore Confirm

  • 10. Does PrognoCIS interface with external instruments/machines like EKG, Vitals, Diagnostic, etc.?
     

    Yes. There are some standard interfaces that already exist (i.e.: Welch-Allyn, Midmark); however, models vary and thus each new installation typically requires customization. In addition, not all models are compatible. Therefore, if you are interested in such an interface, contact our Technical Support Team or your Implementation/Project Manager at Bizmatics.  When contacting us, please note the following requirements:

    Requirements for Custom Interface:

    1. Name and type of the machine/instrument
      1. The specific model
      2. USB, non-USB, serial, wireless, etc.
      3. Vitals, Diagnostic, EKG, etc.
    2. Manufacturer
    3. Manufacturer’s Specs
    4. If manufacturer specs are not available, then provide the manufacturer’s phone, address, and web site

    The Process:

    1. Time is a factor that we frequently cannot control.
    2. Compatibility of PrognoCIS and the machine’s architecture must be determined.
    3. Engineering must review the manufacturer’s specs and requirements.
    4. Engineering will contact the manufacturer directly if necessary.
    5. If it is deemed to be a doable interface, the program plan will be developed and communicated to you.
    6. If a customization charge is applicable, it will have to be approved before the development will begin. If it is intended for general use, it will be scheduled for general release based upon client demand.
  • 11. I have a document I scanned in my Attach Center but cannot attach it to my patient chart. Why?
     

    The most common reasons a document will appear in the Attach Center –> Select list (either scanned or incoming faxes) are as follows:

    1. The file extension of the document is not defined in PrognoCIS as valid.
    2. The size of the document exceeds the maximum allowed (in kilobytes).

    To resolve either of these issues, please verify the system settings under configuration.  This will require you to have admin rights for your user access.

    • Select Settings –> Configuration –> Admin –> Properties
    • Select property name PrognoCIS Parameters

    Property-Prognocis Parameters

    • Verify file extension is defined under prognocis.attach.filetypes.
    • Increase maximum allowed size under prognocis.attach.maxsize.kb.
    • Click the save button.
  • 12. Why does my growth chart not print but I can see the points/graph on my screen?
     

    When generating the Growth Chart in PrognoCIS, it interfaces with the Vitals template.  After selecting the desired graph, it will display in the preview window of the EMR.  In addition, if you select the Show Points check box, each point along the graph will also display.

    When printing the Growth Chart, either to a physical printer or to a PDF file, the output may initially not include the graph and/or points.  This is determined by the default settings of your internet browser.  Setting this property may vary depending upon which version of Internet Explorer you are using.

    IE v8.0 Printer Settings

    • Select Tools –> Internet Options
    • Select the Advanced tab
    • Scroll to the Printing section
    • Select the option to Print background color and images
    • Click the OK button

    IE v9.0, v10.0, v11.0 Printer Settings

    • Select File –> Page Setup
    • Select the option to Print background color and images
    • Click the OK button
  • 13. I am having trouble viewing the training videos
     

    Please clear out your browser cookies.  The exact process will vary depending upon the type and version of browser you are using.  For example, if you are using Windows Internet Explorer v9, the steps are as follows:

    • Select Tools –> Internet Options
    • Select General tab
    • Select Browsing History –> Delete
    • Select the check box(es) for types of files to be cleared
    • Click the Delete button

    You may also be able to go directly to the Delete Files from Tools menu.  Other versions of IE may have different menu choices or labeling.

    Clearing temporary internet files and cookies will often reset any browser memory issues that seem to be application issues.

  • 14. Does PrognoCIS notify me when a fax fails?
     

    Faxing status can always be tracked via the Tabular Reports; however, in case of a fax that has failed, the system can also send an Alert Message to the user so the report does not have to be manually generated.

    1. System –> Configuration –> Admin –> Properties
    2. Select bizfax.inprocess.offset property
    3. Define the desired number of minutes after a fax fails to alert the user

    Based on the number of minutes indicated in the property, an urgent message will be sent to the sender along with an email to PrognoCIS Support when a fax fails to successfully transmit to the receiver.  This alert is an indicator that the Bizfax utility has terminated or is not able to communicate with PrognoCIS server.

  • 15. What internet browsers work with Version 3 upgrade?
     

    As of March 2014, PrognoCIS released version 3 of both Electronic Medical Records and Practice Management.  With this upgrade, older versions of Microsoft Windows OS (such as XP) and Internet Explorer (versions 6-8) are no longer compatible with PrognoCIS.

    The following internet browsers are compatible with PrognoCIS V3.B2:

    • Internet Explorer version 9 in Compatibility View off
    • Internet Explorer version 10 in Compatiblity View off
    • Internet Explorer version 11 in Compatibility View off
    • Safari for Mac & Desktop
    • iPad, iOS version 5.0, 6.0
  • 16. What version of Internet Explorer and Adobe Reader should I use?
     

    PrognoCIS is compatible with most browsers and versions of Adobe Acrobat Reader; however, as techonlogy advances some third parties are not always compatible with each other at the same time.  Hence, there may at times be conflicts with versions of browsers and Adobe Reader.  When in doubt, please consult the most recent Hardware/Software Requirements Specifications checklist on our Resource Center or contact Technical Support for more information.

    • Internet Explorer v10 requires Adobe Acrobat Reader 10 or 11
    • Internet Explorer v9 requires Adobe Acrobat Reader 9
      NOTE:  Bizfax workstation must have this combination –> Neither IEv10 nor Adobe X works with faxing functionality at this time.
    • Internet Explorer v8 and earlier requires Adobe Acrobat Reader 9.
  • 17. Why won’t the training videos play on Resource Center?
     

    Some older versions of PrognoCIS in combination with older versions of Internet Explorer require the browser to be executed in Compatibility View.  The training videos, however, do not work in Compatibility View; and hence the browser settings must be modified accordingly to play them.  Effective with PrognoCIS Version 3, Build 2, December 2014, Compatibility View is no longer required for EMR and hence the settings will not need to be individually modified to play the videos.

    Prior to V3B2, if you are having issue within your Internet Explorer browser, please verify your settings per version of IE or download Google Chrome for viewing videos while using IE for PrognoCIS.

    For more information, refer to the User Quick Guide PrognoCIS User Training Videos.

  • 18. What are the limitations of using compatibility view in my browser?
     

    If your Internet Explorer browser is set in compatibility view as per the version number, then some features of EMR may not work properly.You need to turn it off. Please note that each version of PrognoCIS and of Internet Explorer has different configuration combinations.

    If you choose to enable Compatibility View when it is required, some of the limitations you will face include:

    • Documents in Preview Pane will be cut off
    • Links will not display in right location on screen
    • Some buttons will not work properly or at all
    • Schedule time increments will not display correctly
    • Draw Tool will not be available
    • Some pop-ups may not be invoked
    • Microsoft updates compatibility setting everytime they do a patch

    Please remember to use PrognoCIS properly, all workstations must have their internet browser settings properly configured per the version they are using.

  • 19. Patients get alerts & message service error when confirming text reminders
     

    AT&T processes all text messages between PrognoCIS and patients.  There is a 2-hour time limit with AT&T for automated replies.  This error occurs for a patient when they respond to the text more than 2 hours after it was delivered.

    TextResponseFailure-1

    Here is the AT&T response from Technical Support when we inquired:

    TextResponseFailure-2

  • 20. My PrognoCIS disappears after I enter my password and my password is correct.
     

    This issue typically occurs when the application is being accessed on a workstation where the Internet Explorer browser settings have not been properly defined.

    Please consult the link for Internet Browser Settings on your Login Page (without logging into the application).  Apply these settings within the IE Tools –> Internet Options on every individual pc or laptop that must access PrognoCIS.

    After defining these settings, the login should work.  When the password is invalid, the application does not disappear – it simply posts a message of Invalid Password.

  • 21. Error occurred while…"Fetching Data" or "Saving Record" –> how do I fix these errors?
     

    Because PrognoCIS operates in a web-based environment, Internet Browser settings apply at the individual workstation level for each user.  Often the temporary cache of cookies and temporary internet files need to be manually cleared out to prevent errors when attempting to save data or access records.

    If an error prompts such as “Error occurred while fetching data” or “Error occurred while saving record”, usually if you clear your Temporary Internet Files and delete Cookies from your browser, once you log back in the error will be resolved.   Depending on what browser and version you use, the exact steps may vary; however, most browsers typically have a choice labeled as “Internet Options” or “Settings” under which there are options to clear these temporary files.  This will have to occur on each individual computer that receives these types of errors.

  • 1. Do e-prescriptions count in Core Measure 1 – CPOE?
     

    Yes.

    Core Measure 1 (CPOE) is applicable to all prescriptions written regardless how that prescription is actually transmitted to the pharmacy.  Thus, whether or not a prescription is faxed, e-prescribed, printed through PrognoCIS, or handwritten, as long as the drug details for the prescription are enterd into the structured data of PrognoCIS, it is counted towards Core Measure 1.

    NOTE:  Core Measure 4 considers only e-prescriptions that are permissible; thus the two measures will have different numerator and denominator results.

  • 2. If all of my denominators for Clinical Quality Measures = 0, do I still have to report CQM?
     

    Regarding Clinical Quality Measures as an individual measure (Core Measure 10), please note there are a total of 44 individual measures defined.  Attestation requirements are that each eligible provider must attest to a minimum of 6 out of these 44 up to a possible maximum of 9 (from the same 44).

    As concerns a denominator = 0, the only clarification to note is with regards to the 3 CQM defined as Mandatory Core Clinical Quality Measures.  In case of these 3, if the denominator = 0, the EP must simultaneously report on the corresponding Alternate Core Clinical Quality Measures (up to 3).  If the denominator of the alternate measures is 0, that is acceptable with no further requirement.  If the denominate of the original mandatory core measures is > 0, there is no need to report on the alternate ones at all.

    The remaining requirement of Core Measure 10 – CQM is to also report on any 3 other (additional) Clinical Quality Measures, and for those there is no minimum requirement  Thus, 0 is acceptable with no further requirement.

    In all cases where the denominator value = 0, the eligible provider must key the 0 into the attestation system, and if applicable, report on the additional measures as well.

    For additional information, please consult the FAQs published by CMS at this link:  informationhttps://questions.cms.hhs.gov/app/answers/detail/a_id/10145/p/21%2C26%2C1139%2C1155.

    See also FAQ entitled: Is there an exclusion for Core Measure10 – Clinical Quality Measures when none of them apply to me?

  • 3. Does the Referral Letter I order from Encounter Close screen count for Menu Set 8 (Summary of Care Record)?
     

    No.  Ordering a Letter to Referred-to Physician from the Encounter Close screen does not allow you to attach the patient’s Summary of Care Record.  Thus, it will not be counted in the numerator for Menu Set 8.

    To comply with Menu Set 8, please follow the training steps outlined in the Meaningful Use webinar (summarized here for your convenience):

    1. Encounter –> Assessment –> Consult button –> order the desired referral by type
    2. Encounter –> Order Sheet –> Consults tab –> select the referred-to specialist
    3. Letters Out –> Attach –> FHR
      1. Save the referral letter with the attached FHR to the patient
      2. Print, Fax, Email, or Download the Referral Letter + FHR documents
  • 4. How do I count numerators/denominators when I attest since I use multiple certified EHR systems?
     

    Scenarios:

    1:  I attested for meaningful use last year using an EMR system that I no longer use then converted over to PrognoCIS.  When I attest this year, some of my data is on the old system and the rest of it is in PrognoCIS.

    2: I work in another office that uses a different EMR system.  Do I have to attest twice – once for each system?

    Answer:

    For all measures with a numerator / denominator requirement, the numbers compiled by each individual EHR system are to be added together and reported as 1 combined total in a singular attestation for the current certified EHR being used.  Although many measures are mandated to be a % of “unique patients seen”, in the case of multiple EHR systems, this is not possible.  Hence, CMS makes the provision for you to simply add the total numbers from each system into 1 combined total to be reported during attestation.

    For more information, see http://www.hitechanswers.net/meaningful-use-objectives-multiple-certified-ehrs/.

  • 5. Why does my meaningful use dashboard show zero (0) or the numbers are just not changing?
     

    When generating the ARRA Dashboard for meaningful use, the system remembers the criteria from the last time it was ran.  This includes the physician and the From/Up-to Date range.  When the numbers on your dashboard are not changing, or if they are showing 0, sometimes the most common reason is that the incorrect doctor and/or date range has been recalled from memory or just not changed for the valid data you are seeking.

    After verifying the provider and date range are accurate, if the numbers still show 0 or are not changing, the second thing to look at would be to verify the patient is not marked as Exempt from Reporting.  This is a flag on the Patient Register –> Other Info tab.  By default, dummy and test patients should have this flag set so they are excluded automatically; however, for some reason, a real patient may have had this option selected by mistake.

    If the patient is not exempt from reporting, and the date range/provider entered are correct, then the reason can vary based upon the individual meaure.  See topics for the specific measure for additional information.

  • 6. What is the PrognoCIS EHR Certification Number for Meaningful Use?
     

    For registration and attestation w/CMS for EHR Incentive (Meaningful Use), please note that a vendor certification number is required.  To have a unique certification number assigned, please visit:  https://onc-chpl.force.com/ehrcert.  If you are not successful in generating a unique number, plesea use: 30000001SWUGEAS.

  • 7. Which version of HL7 is used for Meaningful Use interfaces to state immunization registry?
     

    For stage 1 of Meaningful Use (2011 edition), which covers reporting periods from 2011 thru 2013, PrognoCIS uses HL7 v2.3.1.

    For stage 2, which begins January 2014, we will support HL7 2.5.1.

  • 8. Is there a report to show my Medicaid volume for Meaningful Use?
     

    Yes.  You can run a tabular report by insurance, which will include your Medicaid patients.  To generate the report:

    • Select Report –> Tabular
    • Select Query Name –> Patients with Specific Insurance as Pri or Sec
    • Enter the Period – i.e.: the desired date range for patients to be counted
    • Click OK

    MU Medicaid Volume Report

  • 9. Meaningful Use Hardship Exemption Payment Adjustment 2015
     

    Eligible Professionals who do not successfully begin demonstrating meaningful use compliance by October 1, 2014 will be subject to payment adjustments of up to 1% per year beginning with 2015 for five years, for a total deduction of Medicare reimbursements of 5%.

    The deadline for first-time attesters is as follows:

    • Quarter 3 of calendar year 2014 (July 1 – Sep 30, 2014) reporting period
    • Attestation no later than October 1, 2014

    CMS Resources:

    Application for hardship exception, must be completed by July 1, 2014
    http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/HardshipException_EP_Application.pdf

    Requirements to qualify for hardship exception
    http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_HardshipExcepTipSheetforEP.pdf

  • 10. Can I skip a year or withdraw from attesting for Meaningful Use?
     

    CMS Timeline/Payment Details: http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Participation-Timeline.html

    FAQ: https://questions.cms.gov/faq.php?faqId=9220
    Q:
    If an eligible provider fails to meet meaningful use during a participation year under the Medicare program, can he/she continue to participate and earn incentives?
    A: An EP that participates in the Medicare EHR Incentive Program and does not meet MU for one participation year is highly encouraged to continue to attest and earn incentive payments for future participation years. If a participating provider does not successfully attest for a given year, he/she will not be eligible to receive an incentive payment for that year; however,  attesting and receiving an incentive payment for a future participation year is based on the provider’s ability to meet MU during that year and is not based on success or failure in a previous year.

    When a provider continues to participate and submit attestation information in subsequent years, the progression through the stages of MU will continue to follow the CMS-established timeline of meeting the MU criteria of each stage for two program years regardless of whether he/she demonstrates MU in each consecutive year.

    For example, if an EP demonstrates Stage 1 criteria for the 1st payment year, but does not meet the Stage 1 criteria in the 2nd payment year, the EP will receive an incentive payment for the 1st year but not for the 2nd year. When the EP proceeds to attest for the 3rd payment year, he/she may be eligible to receive the associated incentive payment if MU is met; however, since the EP has completed the 1st and 2nd program years, the EP will be expected to demonstrate the stage 2 meaningful use criteria to receive payment in the 3rd year, even if he/she did not meet the Stage 1 criteria in the 2nd year.

    If a provider registers to participate in the EHR Incentive Program for the first year but chooses to withdraw their attestation, the provider may have the opportunity to start over and “repeat” their first year of participation in the Incentive Program if a CMS post payment or prepayment audit has not been initiated. If the provider withdraws their attestation during or after a CMS audit has been conducted, the provider forfeits the ability to reattest as a Year 1 participant and must attest as a Year 2 participant in the next year. Once the provider has withdrawn and the audit has been initiated, the progression along the EHR Incentive Program timeline has begun and the provider would need to meet MU along this schedule in order to earn the associated incentive payments.

    FAQ: https://questions.cms.gov/faq.php?id=5005&faqId=7737
    Q:  If I participated in the Medicaid Electronic Health Records (EHR) Incentive Program last year, am I required to participate in the following year?
    A:  No.  Medicaid providers are not required to participate in consecutive years of the EHR Incentive Program.  Providers who skip years of participation will resume the progression of Meaningful Use (MU) where they left off.  All providers are required to meet two years of Stage 1 in their first two years of MU  and then proceed to Stage 2, regardless of not participating in consecutive years.

    Notes: 

    • There is an exception to that general rule for providers who demonstrated MU in 2011, as Stage 2 did not begin until 2014.)
    • EPs who wish to maximize their incentive payments must qualify for an incentive payment for six years.  They can begin receiving payments no later than 2016 and may not receive payments after 2021.
  • 11. Meaningful Use Concierge Service provides 1-on-1 assistance/training to achieve meaningful use
     

    Please contact us at (408) 873-3032 or by email at mu@bizmaticsinc.com to learn about or to request our new personal Meaningful Use Concierge Service.  This service has multiple packages available for you and your staff and will provide direct assistance and even personal follow-up and hand-holding through the entire 90-day reporting period to help you achieve meaningful use in your practice.

    To order this service directly, please download and complete the MU Concierge Services Form from the User Quick Guides section and return it to our corporate offices.

  • 12. Why are SNOMED codes required for Encounter Types?
     

    SNOMED Codes are assigned at the Encounter Type level under Settings –> Configuration –> Clinic –> Enc Types.

    Enc Type SNOMED

    Starting in calendar year 2014, all stages of Meaningful Use require a SNOMED Code to be assigned to encounters in order to comply with certification for certain measures including Clinical Quality Measures (NQF).

  • 13. Do Labs/Radiology count when ordered for an Exempt Encounter Type?
     

    Yes.  Starting with 2014, it is mandatory to assign a Meaningful Use indicator to all encounter types within EMR, including those that are Exempt.

    Within PrognoCIS, lab and radiology orders are created/stored at a patient level and are not encounter-dependent (even when ordered in conjunction with an encounter).  Hence, if a EP (Eligible Professional) orders a lab or radiology during the meaningful use reporting period in conjunction with an encounter that is otherwise exempt, the lab and radiology can still be counted within MU Totals for respective measures.

  • 14. Payment adjustments begin in 2015 for non-compliant meaningful use providers
     

    Payment Adjustments Begin 2015 for Non-MU Compliance

  • 15. Do my Refill Request encounters affect my Meaningful Use compliance?
     

    Refill Request encounters are not counted in any of the measures except for Core Measure 1 – CPOE and Core Measure 4 – ePrescription.

  • 16. I record vitals for my patients on every visit, why is my dashboard still showing red?
     

    Core Measure 8 – Vitals History requires 4 specific vital signs to be recorded, e.g.:

    • Height
    • Weight
    • BP
    • BMI

    If any of this information is missing, the patient will not be counted in the report. There are properties at the system level that must be defined to capture the specific test codes you are answering on your Vitals template for these 4 questions.  Please verify the following parameters are properly defined:

    • vital.height.testcode
    • vital.weight.testcode
    • vital.bp.testcode (Note:  If you choose to record Blood Pressure as 2 separate values, both test codes must be defined as a comma-delimited list.)
    • ensure real patients are not flagged as “Exempt from Reporting” under Patient Register (Note: It is recommended that dummy patients be flagged as such so they are excluded).

    In addition, please be aware that the BMI is calculated by the system; however, it still requires the user to select the check box for the question so the system knows to apply the calculation.  If this is not done, although the system calculates and displays the BMI value on the template, the report will not recognize it.

  • 17. Why are my Clinical Summary numbers not increasing?
     

    First of all, Core Measure 13 is applicable only for office visit encounters, as identified by the presence of a CPT Code that indicates E&M services were provided on the visit.  In addition, the summary must be provided within 3 business days from the Encounter Start Date (i.e.: Date of Service).

    Applicable CPT Codes are either hard-coded or based upon a system property, e.g.:

    • System property = arra.ov.cpt.codes
    • 99212, 99213, 99214, 99215, 99201, 99202, 99203, 99204, 99205 = default CPT codes (Note:  If you use any other codes, define all codes used in your clinic.)
    • CPT code must be present on the encounter Assessment –> CPT tab

    The Clinical Summary can be generated in the following scenarios:

    • Click the MU Summary button on Encounter Close screen
      • Note: If it is past 3 business days, this button will be disabled.
    • A pop-up will prompt the user to print the summary when
      • The physician marks the encounter complete/signs off on it.
      • If the Patient Portal is enabled but there is no email address on the Patient Register
      • Note:  If the summary was previously printed manually using the MU Summary button, the pop-up will not display.
  • 18. I am clicking the “H” icon on Current Medications but my Medication Reconciliation number is not increasing.
     

    Menu Set 7 – Medication Reconciliation applies only to NEW PATIENTS.  This means that if the patient’s first encounter within your PrognoCIS database falls within the reporting period, that is the only encounter for which you must reconcile the medications.

    Clicking the “H” on any other encounter does not have any negative impact; however, it does not count towards your meaningful use numerator for this measure.

    Note:  If you use an Encounter Type in your facility called “New Patient”, unless it is the patient’s first encounter within PrognoCIS, it will not be considered for this measure.  The Encounter Type is not a consideration whereas the encounter date and the fact that it is the patient’s first visit are the factors involved.

  • 19. What is the last date for Medicaid Incentive Program?
     

    You must contact the individual State to confirm the last date under their program.  The Medicaid Meaningful Use program is issued at the individual state level; thus, each state may follow different time lines based on their activation.

    You may also refer to the link provided by CMS for the status of and contact information for each state’s program: https://www.cms.gov/apps/files/statecontacts.pdf.

  • 20. How do I identify specific patients that are not compliant for my different Meaningful Use measures?
     

    There are various Tabular Reports that itemize the patients who are outside of the range for specific measures, e.g.:

    • (CS-01) List of paients without Prescription
    • (CS-03) List of patients without PMH
    • (CS-05) List of patients without Current Medications
    • (CS-06) List of patients without Medication Allergies
    • (CS-07) List of patients without Demographic Details
    • (CS-09) List of patients more than 13 years old Without Smoking Status
    • (MS-06) List of patients without Education Material
    • (MS-07) List of patients Medication Reconciliation Not Done
  • 21. I prescribe DEA-class drugs frequently but cannot send them electronically. Will that affect my ePrescription totals?
     

    The measure for ePrescriptions applies to only permissible drugs; thus, DEA-class drugs (i.e.: controlled substances) are not included in Core Measure 4 – ePrescriptions.

    The denominator is calculated based upon the number of drugs prescribed that are eligible for e-prescribing; meaning they are not a controlled substance.  If those eligible drugs are then actually transmitted electronically, they will be counted in the numerator.  Such a permissible drug may be prescribed and thus counted in the denominator overall; however, if no or a non-participating pharmacy is selected, it will be excluded from the numerator.

    To be counted for measure 4, the drug must be eligible (i.e.: non-DEA controlled substance) and a participating pharmacy (i.e.: eRx label) must be selected on the prescription.  The prescription must be completed by clicking the eRx icon on the Prescription screen.

  • 22. Will I pass meaningful use with so many red thumbs-down on my dashboard instead of green thumbs-up?
     

    Demonstrating compliance of meaningful use is based upon the attestation results you report to CMS at the end of the reporting period. Within PrognoCIS, the dashboard that displays the red thumbs-down and green thumbs-up icons is to be used as an encounter-level gauge; however, please remember that not all measures will apply to every encounter.

    In cases where an encounter does not apply to an individual measure, a red thumbs-down will display. This does not necessarily mean that you are failing meaningful use.  It simply means that specific encounter does not meet the criteria the measure is recording.

    For example, Core Measure 1 requires that a provider enter prescriptions into the structured data of the Prescription screen and complete the prescription within the EHR.  If the patient does not have a prescription that day, then you will get a red thumbs-down.   If the patient does have a prescription, it should be green thumbs-up.  It may show as a red thumbs-down, however, if you have not completed the prescription or only partially entered it.  So in this example, the red thumbs-down may be valid or may require you to correct the encounter.

    Other measures may not be applicable either based on the specific criteria for each.  For additional information, please see the Meaningful Use/PQRS category under User Quick Guides or the Training Videos.

  • 23. What is the deadline for attesting 2011 Meaningful Use?
     

    Although the 90-day reporting period for demonstrating meaningful use ends on December 31, 2011, providers actually have until February 29, 2012 to file their attestation with CMS.

    For all applicable dates published with regards to meaningful use, please visit the CMS web site at the following link:
    https://www.cms.gov/EHRIncentivePrograms/01_Overview.asp#TopOfPage

  • 24. I work in multiple states and qualify for Medicaid program – can I attest in both states?
     

    No. Per CMS, an eligible provider may only receive one incentive bonus regardless of multiple qualifications.

  • 25. If I attest under Medicare for 1st year, can I then switch to Medicaid in a subsequent year and vice versa?
     

    A provider can switch between the programs ONLY ONCE after receiving the incetive money for the first year. For example, if a provider attested for Medicare in 2011 and received money for the same year, then he/she can switch to Medicaid ONLY once in the subsequent remaining years of participation within the meaningful use program.

  • 26. Is zero (0) numerator/denominator acceptable for 2nd year of attestation under Clinical Quality Measures?
     

    As of current information from CMS (January 2012), yes – 0 is an acceptable value for any CQM numerator or denominator.

  • 27. Some measures are not being counted on my Meaningful Use Dashboard – why is that?
     

    The ARRA Dashboard has two tabs of data which represent current statistics of compliance based upon the provider and date range specified when generating it.  There are two tabs of data that display – the Core Measures tab and Menu Set Measures tab.

    Core Measures include all 15 required measures.  To be fully compliant, each eligible provider must register a value in the green area of the gauge (if numerator/denominator values are required) or with a green thumbs-up indicator in the “At least once” table.  The only exception is for any measure that you are eligible for the exclusion.  By virtue of the exclusion criteria, these measures may show in the red area of the gauge or by a red thumbs-down indicator in the table.

    Menu Set Measures include 10 possible measures; however, each provider is only required to report on 5 of the 10.  Because of this, it is possible that at least 5 of these measures will show in the red area of the gauge (if numerator/denominator values are required) or by a red thumbs-down indicator in the “At least once” table.  In addition, of the 5 measures chosen to report under Menu Set, if you qualify for the exclusion, showing in the red is also valid based on the exclusion criteria being satisfied.

    When totals are not registering as greater than 0 (i.e.: are showing in the red), it may be valid.  To be confident you are not in danger of a failed attestation, please verify:

    1. Core Measures are satisfied (i.e.: in the green) except where you qualify for and are taking the exclusion.  In case of such exclusion, it is acceptable to show in the red even under the Core Measures tab.  WIthout exclusion, all 15 should be green.
    2. Menu Set Measures are satisfied as per requirement (i.e.: 5 of the possible 10 should be in the green).  In cases where one of the five selected for attestation is in the red, provided you qualify for the exclusion, this is acceptable and is the only situation where more than 6 “red” values is acceptable.  Without exclusion, only 5 should be red whereas the other 5 must be green.

    Note:  One of the 5 selected Menu Set measures must be #9 or #10 but cannot be both.  Thus, one of these should be red while the other one is green in all cases except where the selected one is excluded.  In only that situation will both measures be in the red.

  • 28. What is the correct process for Immunization Registry Data Submission?
     

    First of all, please verify if the eligible provider (EP) has performed any immunizations and documented these within PrognoCIS during the reporting period.

    If no, then at the time of attestation, the EP has to select the exclusion where it says “EP has not done immunization during 90 days”.  Nothing else is required.

    If yes, then the following steps apply:

    • EP must confirm with the state if the state is ready to accept immunization registry file electronically from an EHR technology.
    • If the state is not ready, then EP has to select the exclusion where it says “state is not ready to accept electronic file” and nothing more is required.
    • If the state is ready, then
      • EP has to share one sample file with the state to verify and confirm on the format.  Please contact Bizmatics’ Implementation Manager or Technical Support reprsentative for assistance as required.
      • The test file does not have to include live immunization data.  The transmission of actual patient information is not required for the purposes of a test. The use of test information about a fictional patient that would be identical in form to what would be sent about an actual patient would satisfy this objective.
      • Once the test file is shared with the state, the EP has to wait for the confirmation from the state regarding the file format and then complete the attestation.
      • In case the state is taking time to verify such a test (due to the long que of pending test cases, then the EP can select the exclusion where it says that the state is not ready.
      • In case the test file fails, or the state provides feedback of missing or invalid data format, this does not negate compliance as to attestation.  It is strongly suggested you save the test results and state feedback in event of audit and it is okay to attest to the affirmative.

    Note:  Please see the Immunization Registry Status by State FAQ help topic for additional information.

  • 29. What are the requirements of the Medicaid EHR Incentive program instead of Medicare?
     

    Though in many cases, the Medicaid requirements may mirror those of the Medicare program, CMS does not define the criteria for individual Medicaid programs.  These are authored by and administered by each individual state.

    To get the information on Medicaid requirements, plesae contact your state directly, or view the following link at CMS:https://www.cms.gov/apps/files/statecontacts.pdf, which will list each state and its current status as of CMS awareness

  • 30. Menu Set Measures Checklist for Compliance (MU Dashboard red and green indicators)
     

    There is a total of 10 Menu Set Measures defined by CMS as criteria within Meaningful Use.  All 10 measures are included on the ARRA Dashboard and Tabular Report within PrognoCIS; however, only 5 are required to demonstrate meaningful use compliance.

    There is no user interface within PrognoCIS to identify the 5 measures that the client chooses to report.  These are identified to CMS during the attestation. Some measures are time-sensitive, meaning there is no way to retroactively receive credit once the reporting period has ended.

    ARRA Dashboard Requirements:

    • ONLY THE CHOSEN 5 measures need to be compliant
      • A green thumbs-up will display on the dashboard for features that must be tested at least once
      • Numerators that require a minimum % must display within the green area of the gauge on the dashboard
    • The 5 measures NOT CHOSEN may display as red thumbs-down, which is ok, because those are not required for attestation.
    Menu Set Measures of Meaningful Use
    Menu Set Measures of Meaningful Use

    Measure-specific Reminders:

    • Measures 1 & 3 are totally “free” for all providers and do not require any specific minimum % of patients nor that a test of the feature be excecuted.
      • Drug Formulary is a feature included with ePrescription and the patient’s informaiton is automatically provided when entering a prescription drug.
      • Tabluar Reports can be generated on demand based on specified conditions
    • Measure 2 – Lab Results will usually exceed the minimum requirement IF an HL7 Lab Results interface is implemented within the practice.
      • If there is no HL7 interface, this measure can still be met manually by entering individual results for each lab test ordered
      • Faxed/scanned results attached to the patient’s Document List do not count
      • Measure 2 can be selected as one of your 5 out of 10 and excluded if you do not perform lab tests during the reporting period.
    • Measure 4 - Patient Reminders requires a valid email address for the patient under Patient Register –> Address tab.
      • Measure 4 can be selected as one of your 5 out of 10 and excluded if you do not see patients under age 5 or over age 65
      • Time-sensitive measure, which means the appointment for which the reminder is being sent must be within the reporting period.
    • Measure 5 – Timely Access to Electronic Health Information
      • 100% ”free” to any practice who has implemented the Patient Portal, verify:
        • The patient has an email address on Patient Register
        • The patient has been given a User ID/Password to the portral
          Note:  It is not a requirement that the patient actually login and use the portal; however, to be compliant, you must give them that access.
      • Not available to any practice who has NOT implemented the Patient Portal
    • Measure 6 - Patient Education is one of the easiest measures to comply with – especially for any clinic who provides patient education in any form, e.g.:
      • Requires only 10% of all unique patients seen within reporting period receive education as indicated by the system.
      • Education requirement must be defined in the Education Master based on the Type and Trigger, i.e.:
        • Settings –> Configuration –> Clinic –> Education
        • File = generates the material to be printed within PrognoCIS during the encounter and given to the patient.
        • Brochure = indicates verbal or pre-printed education was given to the patient during the encounter.
      • The user must click the OK button to indicate the education was provided.
      • Time-sensitive measure, meaning it cannot be retroactively applied outside of the reporting period.  .
    • Measure 7 - Medication Reconciliation is only applicable to new patients seen within the reporting period.
      • Measure 7 applies when the patient’s 1st visit within PrognoCIS occurs within the reporting period.
      • User must click the “H” icon inside the Current Medications cell of the face sheet when applicable.
        • Medication History will display IF the patient’s consent is indicated on the Patient Register –> Other Info tab.
        • Warning message to manually reconcile medications if no consent on file to view actual history at Surescripts.
      • Clicking the “H” icon on existing patients will not affect your numbers for this measure.
    • Measure 8 – Summary of Care Record is only applicable in conjunction with patients who are referred out for a Consultation, as indicated on the encounter by:
      • Assessment –> Consult button
      • Order Sheet –> Consult –> Referred-to Provider/3rd Party
      • Letters Out –> FHR attachment
      • Print, fax, email, or downloaded the Letter Out & FHR to an electronic file
    • Measure 9 (Immunization Registry Data Submission) or 10 (Syndromic Surveillance Data Submission) must be chosen as 1 out of the 10 required menu set measures.
      • You can select either measure but you cannot select both (even if you do both immunizations and/or syndromic cases).
      • Whichever one is chosen must be tested within the reporting period unless the exclusion applies and is being taken during attestation.
        • The test requires assistance of PrognoCIS Technicians.
        • Contact Technical Support or your Project Manager as applicable.
      • Regarding measure 9 (Immunization Registry Data Submission), please see related FAQ/Help Topic for list of active states with such a provision.
      • For clients who can exclude both measures, it is a matter of preference which one is selected and excluded.
  • 31. Core Measures Checklist for Compliance (MU Dashboard red and green indicators)
     

    There is a total of 15 Core Set Measures defined by CMS as criteria within Meaningful Use.  All 15 measures are MANDATORY and are included on the ARRA Dashboard and Tabular Reports within PrognoCIS.

    ARRA Dashboard Requirements

    • Numerators that require a minimum % must display on the dashboard with the needle within the green area on the gauges.
    • A green thumbs-up will display on the dashboard for features that must be tested at least once or have the feature implemented during the reporting period.
    • Exclusions that are applicable and taken during attestation are still considered to be compliant and will be indicated by red indicators instead of green.
      Note: Only excluded core measures should ever be “in the red” – either the gauges or the “Tested at least once” section of the dashboard.

    Core Measures of Meaningfu lUse

    Measure-specific Reminders:

    • Measure 1 – CPOE applies to the prescription module only of the CPOE functions.
      • All drug details for the prescription must be entered into the individual data fields on the prescription screen (e.g.: Drug, Strength, Frequency, Dose, etc.)
      • The prescription must be fully completed within the EMR
        • Update the drug to the prescription
        • Save the prescription to the patient chart
        • Complete the prescription by either printing, faxing, or eRx.
          Note: The method of completion is NOT part of the measure.
      • A red thumbs-down icon on the Encounter Dashboard means:
        • There was no prescription at all on this encounter.  In this case, it is ok to show as red because only prescriptions written on the encounter qualify for this measure.
        • A prescription was started and/or saved but was not completed.  In this case, the user must correct the encounter in order to comply and show as a green thumbs-up on the Encounter Dashboard.
    • Measure 2 – Drug Interaction Checks is totally “free” and does not require any specific minimum % of patients.  The feature is automatically enabled with meaningful use properties.
      • Compliance is based upon the feature being enabled – not whether or not indications actually exist.
      • Users may set the severity level property to limit how often the Prescription Alerts display when applicable and what user actions can be taken.
    • Measures 3 (Problems), 5 (Current Medications), and 6 (Drug Allergies) are similar in the requirements (80%) and method of compliance, i.e.:
      • Data is entered through the Face Sheet –> PMH, –> Current Medications, or –> Allergies.
      • If there is no data to record, the user must select the check box that indicates “No Known” in order to be counted in the numerator as compliant.
      • The cell should not be left unanswered in order to receive credit.
      • This information is chart-level; yet it is also reflected on the Encounter Dashboard:
        • None of these measures should have a red thumbs-down.
        • Once it has been entered, it will reflect on every encounter for that patient as a green thumbs-up.
    • Measure 4ePrescription of permissible prescriptions.
      • The denominator does not apply to drugs classified with a DEA Class (indicator will display on the screen) controlled substance.
      • Numerator takes into account the selection of the pharmacy and whether or not the prescription is completed electronically.
        • If a pharmacy is not selected at all or the Pharmacy chosen is NOT eRX enabled, it will not count as a compliant prescription.
        • If the selected pharmacy IS eRX enabled, then the system forces you to send the prescription via the eRx icon, and thus it will be counted in the numerator as compliant.
      • A red thumbs-down icon on the Encounter Dashboard means:
        • There was no permissible prescription on this encounter.  In this case, it is ok to show as red because it is not part of the measure.
        • There is a permissible prescription, however, it has not been completed via eRx – either because:
          • No pharmacy selected, or
          • The selected pharmacy is not eRx-enabled.  In this case, the icon cannot be changed to green unless you rewrite the prescription and choose an eRx enabled pharmacy when completing it.
    • Measure 7 – Demographics requires that 5 specific fields be captured at the chart level.
      • All 5 fields (DOB, Gender, Language, Race, Ethnic Group) are required for a green thumbs-up.
      • If only 1, 2, or 3 elements is missing, it will be a red thumbs-down.  (None of these measures should have a red thumbs-down.
      • This information is chart-level; yet it is also reflected on the Encounter Dashboard:
        • None of these measures should have a red thumbs-down.
        • Once it has been entered, it will reflect on every encounter for that patient as a green thumbs-up.
    • Measure 8 – Vitals Signs applies for patients 2 years and older.
      • All 4 fields (Height, Weight, BP, BMI) are required for a green thumbs-up.
      • User must data-enter the height, weight, and blood pressure onto the Vitals template from the encounter.
      • User must explicitly select the BMI check box to receive credit in the numerator.  (Note: PrognoCIS automatically calculates the BMI, however, the user must select the check box so it is counted in the compliance report.)
      • All applicable test codes must be defined under Configuration –> Admin –> Properties –> Vitals.
      • Many specialties qualify for the exclusion for this measure, and if that is the case, then a red thumbs-down is ok.  To exclude, the provider must be able to justify that these specific vital signs are not required to render same quality of care for the patient’s condition.
    • Measure 9 – Smoking History applies for patients 13 years and older.
      • All applicable test codes must be defined under Configuration –> Admin –> Properties –> Vitals.
      • If client has different SH templates (i.e.: Adult SH, Pediatric SH, Mental Health SH, General SH, etc.), make sure it is the same question on all templates or that all questions used are defined in the property.
      • This data is stored at chart-level and should thus never be red thumbs-down.  Once it has been entered, it will always show as green thumbs-up.
    • Measure 10 – Clinical Quality Measures
      • This measure has two parts to the attestation.
        • Initially, you will answer YES that CQM is available within your EHR.
        • In addition, you must report numerator/denominator values for at least 6 individual CQMs with a possible maximum up to 9 CQMs.
          • 3 CQMs are mandatory core measures (NQF0028, NQF0013, NQF0421) which must be reported.
          • 3 CQMs are alternate core measures, which only have to be reported when applicable (CMS will prompt during the attestation).
          • 3 CQMs are provider’s choice out of the remaining 38 measures.
      • As phase 2 and 3 of meaningful use is implemented by CMS, additional education will be made available by PrognoCIS.
      • 0 % is OK (for 1st year of participation with no penalty).
    • Measure 11 – Clinical Decision Support Rule is basically a “free ” measure; however, providers are required to implement at least 1 rule that is relevant to your specialty or patient population
      • Such expressions are created under Settings –> Configuration –> Workflow –> Expressions.
      • Each EP can use his/her own discretion when creating support rules baesd on local workflow and patient population
    • Measure 12 – ePHI provided upon request
      • PHI must be provided electroncially but be in a human-readable format.
      • If patient does not explicitly request records to be given electronically, the exclusion applies and can be taken during attestion.  In this case the gauge will display as 0% with the needle in the red area on the dashboard.
      • If compliance is required due to patient request for electronic copy of PHI:
        • Both the denominator and numerator are based upon user data-entry.
        • PrognoCIS has no way to discern qualifying patients for the denominator since it is based on a request and is not directly tied to patients seen during the reporting period.
        • The numerator will be 100% for providers who have implemented the patient portal in their practice and issued email addresses to patients.  The request will still have to be keyed into PrognoCIS to count in the denominator.
    • Measure 13 – Clinical Summary
      • Required for all encounters billed as an office visit based on the presence of a CPT (E&M) code on the Assessment –> CPT tab.
        • The office visit codes must be defined in the system.
        • Standard codes (i.e.: 99201-99205 and 99211-99215) are hard-coded.
        • If using non-standard codes, they must be defined under System –> Configuration –> Admin –> Properties –> ARRA.
      • Printed from the Encounter Close screen.
        • MU Summary button allows user to manually print the summary at-will.
        • If not manually printed, doctor will get a pop-up to automatically print the summary while closing the encounter.  The pop-up will not occur when:
          • The portal is implemented.
          • The summary has already been printed manually.
          • The system date is more than 3 days past the date of service.
          • There is no E&M office visit CPT code present on Assessment.
          • The encounter type is defined as exempt in system properties.
      • The numerator will be 100% for providers who have implemented the patient portal in their practice and issued email addresses to patients.
      • Time-sensitive measure
        • Must be fulfilled within 3 days of the encounter DOS
        • Cannot be retroactively fulfilled.
    • Measure 14 – Electronic Exchange of Key Clinical Information
      • The feature must be tested within the reporting period on either dummy patient or real patient
        • The test can consist of actual or fictional patient data
        • Patient Review –> Patient XML = export
        • Patient Review –> CCD/CCR = import
      • Time-sensitive measure
        • Test must be executed once during every reporting period.
        • Cannot be retroactively fulfilled.
    • Measure 15 is totally “free” for all with no user action required.
  • 32. I have multiple providers in my practice. Does each one have to perform an individual test of Menu Set 9 Immunization Registry?
     

    According to CMS guiidelines and definition of Menu Set 9 – Immunization Registry Submission, in a shared physical setting for multiple providers, the test with the state immunization registry is required only once per EHR Technology – not once per provider.

  • 33. None of the Clinical Quality Measures apply to me – am I exempt from reporting CQM?
     

    As per CMS FAQ, please review the fianly ruling outlining requirements of reporting Clinical Quality Measures: https://questions.cms.hhs.gov/app/answers/detail/a_id/10144/kw/clinical%20quality%20measure.

    In the event that none of the 44 Clinical Quality Measures applies to an EP’s patient population, the EP is still required to report 0 denominators for all six (3 mandatory core + 3 alternate core) CQM. If all of the remaining CQM included in Table 6 of the final rule also do not apply, the EP is still required to report on at least three of the additional CQM of his/her choosing (other than the six core Clinical Quality Measures).  If the EP reports zero values for these 3 additional measures, then for the remaining ones, the EP will also have to attest that all of them – as calculated by the certified EHR technology – likewise have a value of zero in the denominator.

    Bottom line:  Every EP is required to try to find at least three menu set CQM for which the denominator is not zero.  If not, then the EP must still choose three and report the 0-value denominator.  Simultaneously, the EP must accompany such “zero denominator reporting” with an attestation that all of the other menu-set CQM also have a 0-value denominator. A zero report in the menu-set is not sufficient without such accompanying attestation.

    To view the final rule for the Medicare and Medicaid EHR incentive programs, please visit: http://edocket.access.gpo.gov/2010/pdf/2010-17207.pdf.

    For more information about the Medicare and Medicaid EHR Incentive Program, please visit http://www.cms.gov/EHRIncentivePrograms.

  • 34. If my 1st years attestation is rejected by CMS, do I lose the incentive dollars?
     

    For first year of particpation in the meaningful use program, a rejected attestation does not necessarily mean the provider is penalized.  For instance, if an attestation is submitted for a period of October 1, 2011 – December 31, 2011 and it rejects by CMS, it does not mean the provider loses the maximum $18,000 benefit.  The provider will not receive the bonus on the basis of 2011; however, thus he/she will have to declare 2012 as his/her first year of particpation.  (There is no penalty for this scenario.)

    However, benefit dollars are disbursed only as a result of a successful attestation.  Thus, if an attestation is rejected, the provider must submit again.  Each attestation submitted must be reported for a different 90-day reporting period.  As long as the deadline has not expired, a provider may attest mutliple times for a different, unique 90-day period.  As long as one is successfully accepted by CMS, the provider is eligible to receive the maximum benefit.

    Note: The information in this FAQ is applicable for 2011 and 2012 for first year participants.

  • 35. Immunization Registry Status by State
     

    The following list summarizes status of state data submission for immunization registries, a requirement of meaningful use (Menu Set Measure 9).  This information is effective March 2012.

    In Production:

    •   Florida
    Certified:

    •   Virginia
    •   New Jersey
    •   Illinois
    •   Washington
    •   Michigan

    Active / In Process:
    •   Georgia
    •   Maryland
    •   Nevada
    Not Available at the State Level:
    •   California
    •   North Carolina
  • 36. Do Meaningful Use guidelines apply to all encounters of a patient?
     

    Of the 25 measures of meaningful use defined by CMS, some are applicable at the patient level regardless of the number of indivdiual encounters for that patient.  Others are dependent upon specific encounters for a patient.  To understand exactly which encounters are included, it depends upon the verbiage within the definition by CMS.

    The following measures are all based upon unique patients seen within the reporting period.  These criteria apply at the chart-level; thus, if a patient has 5 encounters within the reporting period, the eligible provider is required to document the data on only at least 1 of those 5.  It is not necessarily required on all 5 encounters (though there is no penalty if that is the case).

    Core Measures:

    • CS-01 – CPOE Prescription
    • CS-03 – Problem List
    • CS-05 – Medication List
    • CS-06 – Medication Allergy List
    • CS-07 – Demographics
    • CS-08 – Vitals History
    • CS-09 – Smoking History
    • CS-12 – Electronic Patient Health Information (Note:  Though not based upon patients actually seen within the reporting period, this measure is chart-level in conjunction with the patient requesting the information.)

    Menu Set Measures:

    • MS-05 – Timely Electronic Access
    • MS-06 – Education Resources

    In addition, some measures do apply at the encounter level and are determined by specific aspects of those criteria.

    • CS-13 – Clinical Summary for each Office Visit
      • Applies only to encounters that are billed as an office visit (e.g.: CPT Code that indicates E&M services rendered)
      • If the patient has multiple office visits within the reporting period, each one is counted
    • MS-07 – Medication Reconciliation
      • Though based at the chart level, this actually applies only to new patients.
      • The criteria is counted on only the first encounter for the patient when that first visit occurs within the reporting period.
    • MS-08 – Summary of Care Record
      • Based upon each individual encounter that results in a referral or consult request to another care provider
      • If the patient has multiple visits within the reporting period that result in a consultation/referral, each encounter will be counted