Download 1.1 Scope of Functionality

1.1 Scope of Functionality
Below is a brief summary of the scope of the Centricity Business functionality, by application suite
that will be deployed as part of the implementation.
Scope of Access Management
Application/Module
Scope and Benefits
Ambulatory Visit
Management
Visit level appointments and insurance concepts are built into the system to
eliminate appointment/insurance errors. There is also automated task
management, electronic work lists and built-in intelligence eliminating the
need for unnecessary manual tasks. System alerts and reminders proactively notify staff of outstanding tasks and automatically prioritize critical
issues.
Appointments can be linked to visits. Numerous appointments/visits can be
created to match up to the physician if a patient being seen for more than
one reason.
Registration
Standard implementation of registration
Major focus will be how insurance is currently assigned and needs to be
designed in the application for future use.
GE Healthcare FSC’s will need to be designed with flexibility to assign the
appropriate plan for payment of outpatient activity.
Co-pays vary with the visit; depending upon what the particular
appointment is for.
Advanced Web
Web-based design provides an intuitive graphical user interface and the
ability to customize the presentation of information to match the unique
workflow needs of each type of user. Users can also access information
across the Internet or Intranet as necessary.
The online pre-arrival process fosters information collection before the
patient comes in for service. At every point of patient-staff interaction,
streamlined workflow results in less wait time and capturing accurate
information up front means cleaner, faster billing and collections.
Enterprise Wide
Scheduling
Enterprise Wide Scheduling (EWS) can accommodate scheduling rules
based on Location, Location Category, Appointment Type, Appointment
Type Category, Prerequisites and SQL. This would allow for more
appropriate matching.
Flexible enough to allow basic Appointment Types while allowing
departments and physicians to have more specific appointment types. The
standards developed will be organization-wide decisions during install
design phase and prior to system build.
With EWS, Master Schedules can be standardized within departments.
Templates can be set up for changes to provider’s schedules without
changing the Master Schedules.
Changes to Master Schedules and Daily Schedules are fairly simple within
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Application/Module
Scope and Benefits
Centricity Business, allowing this task to be assigned to a central staff as
well as specific staff at the department/site levels.
EWS contains an on-line Wait List that allows users to add a patient to the
Wait List for a provider at the time of appointment scheduling. It also alerts
users that there are patients on the Wait List when another patient cancels.
EWS Advanced Work Flows in the Web has the flexibility to be able to
perform Centralized Check In as well as Departmental Check In.
Advanced Web Rules
Implement consistent and automated appointment conflict checking rules.
This feature accommodates scheduling rules based on Location, Location
Category, Appointment Type, Appointment Type Category, Prerequisites
and SQL. This will allow for more streamlined scheduling.
Advanced Web Sets
Allows users the ability to schedule a group (or set) of appointments for a
single patient at one time.
Call Center Module
This message tracking system resides as a function in the Enterprise Wide
Scheduling system, with integration points into the registration, appointment
and chart tracking databases. Messages are stored in a custom database
and message access is controlled through Security Plus. Flexible setup
options allow the module to be tailored to meet specific, organizational
needs.
Address Corrector
Improve address accuracy input to new system to eliminate bad address
cleanup on the back-end.
Open Referrals
Improve referral integration, monitoring and tracking process. Provides
functionality including standardized referral types, and referral queue and
tracking functionality. Internal physicians can also be tracked as referring
physicians if the client chooses to set this up.
Enterprise Index
Identifies duplicate patients with a weighted patient matching algorithm;
lowers and may eliminate existing duplicate patients for registration
database records success. This will lower the need to perform manual
work to merge duplicate patient records.
eCommerce – Interactive
Eligibility (270/271)
Based on timing of the receipt of registration information, there is an
opportunity for improved eligibility information for verification prior to the
patient arriving for the appointment. If the patient has already been seen,
there is an opportunity for improved eligibility information for verification and
re-assignment of insurance as necessary. The improved levels of real time
benefit checking will help reduce denials.
Interactive Eligibility provides access to Eligibility Verification
information at the point of service, ensuring compliance with patients' health
and receiving pre-authorization during patient pre-arrival process or at the
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Application/Module
Scope and Benefits
time of patient arrival.
An integrated electronic eligibility check and response can be achieved via
the eCommerce connection directly from Centricity Business and with
results displayed along side registration data incorporated into the
registration workflow and pre-arrival/post arrival worklists.
Refer to the software schedule for the details about payors and volume.
Encounter Form Generator
Allows for creation of custom encounter forms, labels, and based on service
analysis report results over time, specific encounter forms per physician
based on typical CPT, ICD 9 use.
Front Desk features
(included with BAR)
Opportunity exists to post a simple copay real time instead of having lag.
Opportunity for improvement exists to generate a system created receipt.
Check-In and posting of copay to a credit invoice can provide batch audit
controls.
Patient responsibility balances can be collected at the same time as
payment applied across two transactions:
a) the credit invoice for the copay
b) a payment at the account level for the patient’s current
outstanding balance.
Using standard features prompted within these various applications can
increase copay and other front desk revenues.
Patient Online
Referring Practice Online
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Provides online "24/7" self-service tools for scheduling appointments,
renewing prescriptions, inquiring about and paying bills, finding relevant
health and wellness information.

Customized and branded for each organization

Adds critical functionality to "information-only" web sites

Helps attract and retain patients

Enhance patient-physician communications

Reduces operating costs
Referring Practice Online is a web-based physician portals offer costeffective methods for improving customer service, communication and
access.
Scope of Patient Financials Deployment
Solution
Transaction Editing
System (TES)
Scope and Benefits
Standard implementation of TES, no charge splitter will be deployed. All
charge entry and inbound charge interfaces will go through TES.
Increase use of real time TES edits based on setup and evaluation.
Improve work file assignment and sorting for better use of wordlists.
Billing and Accounts
Receivable
Standard implementation of BAR.
Access to demographic and financial data
Allocates copay
Automatic charge capture via TES
Claims production and management in preparation for eCommerce
services.
Supports electronic claim submission
Supports remittance posting
Rejection Subsystem
Identifies reimbursement variances
Statement Generator:
Allows for creation of statements
Increased data accuracy
Tracks billing and collections
Standard and ad hoc reports, online queries, mailing labels, form letters,
and claim and receipt edit lists.
Paperless Collection
System
Standard implementation of the PCS application.
The use of collections and follow-up processes and organization will be a
standard model.
PCS and DBMS (Database Management System) reports will be used to
organize follow-up activities.
Occupational
Medicine/Case
Management Module
Standard implementation of Occupational Medicine and Case
Management provides organizations the ability to produce company
statements.
Anesthesia/Radiation
Module
The Centricity Business Anesthesia/Radiation Billing Module handles the
full range of anesthesia billing requirements including non-time based
charges, concurrency calculations and warnings, payer specific modifiers
and reduction percentages for concurrencies. In addition relief teams are
accommodated with Centricity Business Anesthesia with a system option
to default either the starting provider, ending provider or the provider who
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Solution
Scope and Benefits
spent the most time on the case as the billing provider.
Payer Contract Module
Separates payer contracts from the charge master. Rules based
functionality helps identify underpayments and overpayments and creates
rejections and flags variances when payments are being posted.
Enterprise Task
Management
The Enterprise Task Management functionality will improve the automation
and workflow for claims follow-up activity. The product allows for tools that
automate and streamline claims management and production. This can
help to accelerate reimbursement and maximize staff productivity.
eCommerce – Claims and
Remittance (835/837)
The electronic exchange of claims and remittances via a connection to the
eCommerce clearinghouse. Refer to the software schedule for the specific
details regarding payers and volume.
Credit Card Module
The Credit Card Module provides a direct connection between BAR, your
banking partner and the credit card transaction companies.
Using a credit card server, the Credit Card Module connects your GE
Healthcare system to a host process that routes funds between leading
financial networks and your bank. When your patients choose to pay with
a credit card, the transaction is managed as a cash payment, without
going to a separate credit card program.
From the GE Healthcare desktop, the payment is automatically recognized
within BAR (or wherever charge entry activity takes place). It shows up
instantly in your bank account and is received and credited within seconds;
eliminating the manual charge entry of credit card receipts and
reconciliation associated with a manual charge entry process. It reduces
the number of bills to send, and decreases the need for back end
collection efforts.
Database Management
System
DBMS is a report writer utility to extract queries of data that are not part of
the standard reports set.
Security Plus
Security/Web Security allows customers to determine roles and rights of
end users with access to specific points in the horizontal and vertical tool
bars, menu pathways etc.
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Scope of Business Intelligence
Solution
GE Healthcare Benefits
Informatics
The Informatics solution has three major components – data
extraction and load, distribution of data through the dashboard
functionality, and detailed analysis and reporting.
The data extraction and load can be accomplished as frequently as
once per day. Data is extracted from the live system via an extractor
tool and loaded onto a separate SQL server and database via a
loader tool. The SQL database closely resembles the database
structure from the live source system.
Using the system tools, the data is transformed into specific data
views for the dashboard that spans the high-level business reporting
needs. Some of the data views may be specific business metrics that
are routinely followed. Automated alerts may also be distributed to
designated resources as these metrics reach specific values.
Once the high-level data has been reviewed, more detailed analysis
and reporting may be required which the Informatics tool provides for.
The ability to drill through to the detail from the high-level is an
integral part of the solution as is the ability to format a specific query
and report.
Scope of Conversions and Interfaces
Solution
Registration Conversion
Registration/ADT Inbound
Interface
Inbound Batch TES
Charge Interface
Outbound Batch BAR
Charge Interface
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GE Healthcare Benefits
Converts registration demographics and insurance information from a
legacy system to Centricity Business. Efforts to clean up duplicate patient
records should be undertaken before files are cut and testing begins. The
purpose of a conversion is to transfer data from one system to another; it
is not intended to do duplicate record and database cleanup as part of the
conversion processing. While there is duplicate checking logic inherent in
the conversion to note when duplicates have occurred, and drop a record
if it doesn’t meet the matching criteria, the conversion is not intended to
clean up a database. Database cleanup needs to be addressed prior to
testing.
Allows for the import of patient registration and patient-level insurance
information into the Centricity Business database.
Allows for the import of professional charges into the Centricity Business
database.
Allows for the export of professional charges from the Centricity Business
database.
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