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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 D:\840970129.doc 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 D:\840970129.doc 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 D:\840970129.doc 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 D:\840970129.doc 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. D:\840970129.doc 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 D:\840970129.doc 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. D:\840970129.doc