new employee/user prognocis orientation · new user orientation to prognocis • not intended for...
TRANSCRIPT
4010 Moorpark Avenue, Suite 222 San Jose, CA 95117
www.prognocis.com [email protected] Copyright March 2016 – Bizmatics, Inc.
New Employee/User
PrognoCIS Orientation
Welcome to PrognoCIS EHR/PM The Database
• Cloud-based or Client Server environment determines the type of technical support that may be required based on the scenario
• Internet browser settings apply per each device and user session
• EHR (Electronic Health Record)* and PM (Practice Management) modules share common data at the patient level but are otherwise independent, and users may or may not have access to both sides based on system configuration
Navigating the User Interface • Modules are accessed by Tabs with drop-down menus and Icons or Hyperlinks
• Basic navigation is the same regardless of browser (other than the iPhone App)
• A user may have a single or multiple occurrence of PrognoCIS open at any time, as long as each one is in a unique “New Session” within the browser
User Access • User profiles are based upon primary job classification and determines security rights;
however, additional user roles may be assigned to individuals to expand access.
• Some functionality/icons may come and go based on specific scenarios; hence, one user may see an option that another user does not see
*Patient Portal module shares both EHR & PM data.
New User Orientation to PrognoCIS • Not intended for user training
• Designed as an overview as to the definition and functionality of both EHR and Practice Management to give an idea of the system’s overall purpose for your clinic.
• Covers the basics as to behaviors and standards with regards to User Interface navigation and nomenclature.
• Future workflow-oriented and topical webinars will be forthcoming, and we would love to hear your suggestions! Please submit your requests what you would like to know more about in upcoming months.
• Personal, 1-on-1 user-level training is available in 2/4/8 hour increments remotely as well as on-site in 3 or 5 day packages.
• Tangible PDF version of this webinar can be downloaded from our Resource Center.
• The URL is the address for your data; which is secure and HIPAA-compliant
Login Screen
• Links to technical support, browser settings, sales, industry news, and training pages
Scrolling billboards w/varying content regularly updated
Browser settings
Secure URL https://
Electronic Health Record (Clinical module)
User Profiles Medics Type
• Determines user’s primary Role & thus primary access rights • DR = Providers • ST = Administrative Staff • RN = Clinical Staff • MA = Medical Assistant • Some system properties require the Medics Type to be defined in
order to enable a feature for all users with that specific Role
Role • Each Medics Type corresponds to a user’s primary Role, which determines that user’s initial
access rights of Read, Update, Create, Delete, and Approve for each activity • Custom No Access Roles can be created at a local level to define “Super Roles” as needed
User Roles • Allows you to assign multiple/additional Roles to a user for the purpose of giving her/him added
rights besides those included with her/his primary role • Many roles will include the same permissions as others do or be at a different access level (e.g.:
Doctor & Clinical Staff both include update rights to an encounter; but Admin Staff is read-only)
EHR UI Theme by Profile Type Providers (Medic Type = DR)
• Dual shades of blue with light gray background • Includes Assign To Clinical Staff/MA , which is bi-directional with MA & RN Medic Types • Includes My Preferences hyperlink, which is applicable only for physician logins • Includes clinical, prescription, & limited administrative access by default
Administrative Staff (Medic Type = ST) • Dual shades of gray with white background • No Assign To hyperlink, because they do not attend to patients clinically • Includes full administrative access & limited read-only clinical access by default
EHR UI Theme by Profile Type Clinical Staff (Medic Type = RN)
• Dual shades of purple with light pink background • Includes Assign To Providers hyperlink, which is bi-directional with providers • Includes clinical, & limited administrative access by default
Medical Assistants (Medic Type = MA) • Dual shades of blue with light gray background • Includes Assign To Providers hyperlink, which is bi-directional with providers • Includes clinical, & limited administrative access by default
EHR System Ribbon
• Navigation Icons • - navigate back-n-forth the most recent (up to 20 total) EHR pages accessed • - always returns you to the Home Page from wherever you are in the system
• Menu Tabs • Appointments accesses the scheduling module, including doctors’ availability • Patient accesses the patient-level modules, including demographics & clinical • CPOE is Computerized Provider Order Entry modules (Lab, Radiology, etc.) • Messages module includes internal email as well as scanning and attaching • Report module includes various types of EHR-specific reports • Settings provides access to system-level master files and configuration tables
• System Tray Icons • Shortcuts to general features at the system level or to focused features in a pop-up which
keeps the current screen in the background • Some icons are static while others are situational:
• Static – Compose Message, Take Appointment, Select Patient, Resource Center, Help Topics, Information, Lock, & Logout
• Situational – Meaningful Use, Toggle Billing/EMR, Current Encounter, New Alerts Note: The situation may be due to activity or system configuration (properties).
EHR User Ribbon
• Inbox Messages Table • Hyperlink to entire Inbox displaying all messages of all types and status • Count in black font represents the total number and the red font is the number of unread
messages for each message type, e.g.: • System – alerts/notifications generated by the system based on Supported Events property • User – messages sent by another user or by the patient from the Patient Portal • Telephone – messages sent to you with the designation as Telephone message • ToDo (hyperlink) – messages sent to you by another or by with an assigned Due Date
• Hyperlinks • Assign Staff – lets you define/displays an association between clinicians & providers; content is
bi-directional but the label changes based on User Profile. • Patient Reminder – similar to Call List on the Schedule, this module allows you to call/email
patients regarding upcoming appointments & track those reminders. • My Preferences – specific to providers’ logins only, this allows a provider to create personal lists
of templates and preferred codes specific to his/her encounters only
EHR Home Page Data Display
Patient focused icons
*Admin Properties Home Page home.xxxx.showalldocs (per User Profile level)
• Displays appointments/encounters for the specified filters and date • A property allows a user to see all doctors’ appointments or only those assigned/his own* • Patient-focused icons provide shortcuts to that patient/appointment-specific details • Status reflects the current routing of the patient within that encounter
Patient routing status
• Filters button allows user to display only the applicable appointments within each tab based on the appointment/encounter Provider, Location, Encounter Type, and Status
• allows user to navigate across different dates or to select a specific date on the Appointment tab (Open Enc tab is cumulative so date filter does not apply).
EHR Home Page Data Display (cont’d)
All Open Encounters
Calendar date appointments
Shared Standards/Behaviors EHR/PM
• Field-exit is <TAB> key or mouse click into another field. Data is only retained into the field upon field-exit, and it’s only saved upon clicking the ok or save button as applicable.
Screens
• Check box columns selects a value to be added to or removed from the screen upon clicking the save or ok button in conjunction with the column label, e.g.:
• Del – places a red x in the box and will remove the entry from the screen ( ) • Sel / – places a black check mark in the box and it will add the value to your screen ( )
• - indicates the data/record is visible and available for new/current use
Data/Record Status
• - indicates the data/record is not available for use; however, any references of it are preserved historically for data integrity Note: This typically applies at the master file level.
• - indicates the data/record is visible and available for new/current use
• - indicates the data/record is not available for use; however, any references of it are preserved historically for data integrity Note: This typically applies at the individual data element within a master file level.
• Tabular design is common on many data-entry screens in both EMR & PM • Alternating shades of gray horizontal lines • Selected line will display with an aqua-colored highlight/background • Focused icons will reflect on the selected row only on applicable screens
• Color-coding on Face Sheet/Templates; yellow = carry-forward/history, green = current/today.
Shared Standards/Icons EHR/PM (cont’d) Data-level/Action Icons • - multi-search & select one or more values from a master file • - add a new record to a database the table or master file
• / - search records within a database table or user-defined master file
• - browse directory to attach a file into database table
• - zoom to view the attached record or file
• - navigation arrows advances backwards/forwards one at a time (arrow without the line) or to the first/last (arrow with the line)
• - preview / print / fax / e-send the document
System-level/Feature Icons • - Current Encounter
• - Patient Insurance
• - Legal Documents (e-signature)
• - Patient Register (demographics)
• - Patient Notes
• - Progress Note
• - Select Patient
Hybrid Icons • - auto-complete search/update master file
• - auto-complete single-select set of values
• - auto-complete valid calendar date lookup • - auto-complete approximate calendar date lookup
Default Behaviors Defaults in EHR • Whenever a value defaults, it can be overridden, e.g.:
• Input Template (Vitals, HPI, ROS, Physical, Specialty) – each Chief Complaint lets you assign a single input template per each category which can be overridden at the encounter level by the user using the Template lookup ( ).
• Input Template (HPI, Specialty) – each Encounter Type allows you to define one or more Chief Complaints and/or Specialty input templates, which can be overridden at the encounter level by the user using each respective Template lookup ( ).
• Progress Note – each Encounter Type has a default output template, which can be overridden for each encounter by the provider using the Template lookup ( ).
• Situational – various activities may have defaults that you can change as needed.
Defaults in PM • During PM setup, a Billing Registration is completed for each provider/location/payer,
which results in certain default values being applied during claims creation. • Fee Schedule – U&C is typically used for applying charges; however, Special Fee Schedules may
be created based on location, provider, or payer combinations and be chosen claim-level. • Business Unit – each claim requires an appropriate Pay To entity, which may be the same as
the Rendering Provider (individual) or not (group), and the one that defaults can be changed at the claim-level if applicable by a drop-down pick list.
• EDI Submission – each payer has a submission indicator of EDI or Paper, and when an EDI claim must be forced to paper, this can be done at the claim-level.
Navigating the Schedule
• Search Appointments for • Patient – displays appointments that will be encounters for patients being treated • Others – displays appointments for meetings that are will not become encounters • - executes the defined search of all appointments not arrived or cancelled
- lets you create a new appointment (will default to midnight of current date) • - displays appointment history • - lets you post a patient receipt to Practice Management
• Calendar Filters & Related Functions • Daily – displays appointments for only the date that is selected • Weekly – displays appointments starting with the selected date forward x 7 days • View – displays appointments based upon the specified user-defined custom view • - lets user create a block of time, which will cancel any scheduled appointments • - lets user print the schedule currently being viewed • - lets user duplicate the selected appointments forward to another date • - lets user refresh the calendar being viewed to reflect changes since 1st loaded • - lets user navigate one day backwards or forwards from the selected date
Appointments Call List*
• Service “Due” – these are reminders to the patient that a health protocol is due but has not yet been scheduled, so they call the office to schedule it.
*Corresponds to the Patient Reminders hyperlink on Home Page.
• Appointments – these are reminders to the patient of an appointment that already exists, so they do not forget to keep it.
The Calendar • Allows user to navigate to a different day, month, or year forwards or backwards • The selected date works in conjunction with the filters selected above the viewing area
Appointments Schedule
Easily return to current date
Navigate back or forward
Color coding indi- cates provider work pattern & visit type
Taking an Appointment • You can schedule an appointment for an existing or a new patient • 3 ways to take an appointment, all of which open the Appointment Schedule dialog
Note: The behavior varies as to the “Big 4; i.e.: Date, Time, Provider, & Location).* • Double-click an available slot on the calendar for the desired doctor/location (easiest) • Select the Add New Appointment icon at the top of the Schedule page (select all values) • Select the Take Appointment icon in the System icon tray (defaults to currently selected patient)
Let you overbook a slot, force an appointment when doctor is not available, or add patient to
the wait list
Create New Patient*
Select Existing Patient
*May default or have to be
selected
*To create a new patient, only Name, Gender, & DOB are required.
Working with an Appointment • Double-click the appointment to modify it, which will open the Appointment details dialog.
Note: This is to modify or delete an appointment only; this is not how you cancel one.
Modify/Delete the existing appt, or to
cancel unsaved changes (undo)
Working with an Appointment (cont’d)
• Status – displays the current routing status for the appointment in real-time. Note: To cancel an appointment, change the Status to Cancel by Patient or by Clinic.
• – lets user mark the appointment as Arrived with a single click.
• – lets user assign a routing status as well as assign treatment room and add remark. This data also shows on Home Page & on Encounter Patient Status icon.
• Name – opens Patient Register, which provides access to all demographics, including Employer, Emergency Contact, MU data, Primary Physicians, & Billing summary
• Single-click the appointment on the calendar (which will outline it in red) to select it; the Patient Info Pane in the lower left will populate with action icons for that patient/appointment.
• – provides direct access to patient Alerts, Notes, Billing Notes, Lab & Radiology Orders, Portal Login, Insurance, Encounter, Eligibility, & Legal Documents
• – invokes a user-defined template of patient contact details.
• – copies the appointment to computer clipboard so it can be pasted elsewhere. Note: The appointment will display with a neon green background until pasted.
Arrived Appointments
• – only displays once the appointment is marked as Arrived to enable the user to enter a patient payment for that current visit Copay/Deduct or Self Pay/Visit balance or for a future Advance, or current balance due (for those using Practice Management).
• Once an appointment is marked Arrived, it becomes an encounter and is thus locked and can no longer be modified. Any changes to appointment level data at that point must be done under the Patient Encounter Edit Existing Encounter.
Copay Screen • Payment Amount - enter patient payments for copay or self pay at time of service. • Apportion To - indicate how the money should be applied on the AR side for EOB reconciliation*.
Apportion To only applies for
PM users
Other Scheduling-related Features
• Work Pattern – lets you define each provider’s availability by day of week, location, time of day, and by encounter type if applicable.
• Vacations – lets you define each provider’s scheduled vacations, which work in con-junction with Work Pattern to alert of doctor availability at point of scheduling.
• Appointment Report – provides a catalog of canned reports based on appointment level data, both system-level and locally-defined. Each report pulls from underlying SQL queries to provide a specific data subset. Note: Some encounter-level data may not be available for this level of report.
• View – lets you create custom calendar views based on provider selection, which can be applied at the Calendar View level for selected location(s)
EHR Patient Menu • Register – the demographic/financial part of the chart; i.e.: DOB, SSN,
preferred pharmacy, address/phone, emergency contact, employer details, meaningful use data, Patient Type (if applicable), Referring & PCPs, and billing details such as attorney and Financial Class if used.
• Resp Person – demographics for the guarantor when not the patient.
• Encounter – the clinical part of a chart based, which includes medical history as well as visit-specific details such as Vitals, HPI, Physical Exam, ROS, and any procedures or orders performed during that visit.
• Review – the historical part of the medical chart, including lab/rad results, progress notes, operative notes, & other pertinent documents such as scans, messages, etc. (Typically this is a read-only feature.)
• Letters Out – lets you correspond electronically via fax, email, or encrypted file with any patient, physician, or other health care agency with regards to a patient’s chart. This module also includes the meaningful use Summary of Care requirement.
• Letters In / Transcribe – allows incoming correspondence to be imported/attached.
• Growth Chart – contains pediatric growth charts defined by CDC and WHO for
• Clinic Forms – clinical, financial, or other type of patient-level questionnaire or document that can be used as a flowsheet or tracking tool for relevant to one or more encounters or idependent of any encounter, such as Surgery Scheduling or Insurance Precertification.
Patient Register • Demographics, contacts & employer, MU data, PCPs, attorney & Financial Class, etc. • Links to preferred pharmacy, insurance, case management, patient alerts & notes, siblings,
appointment history, legal documents, user access, and patient portal access
Demographics tabs
Pharmacy and Siblings
Patient focused icons
Chart # unique to each patient
Patient’s other doctors
Patient Encounter • Once an appointment is marked Arrived, it becomes an Encounter • All clinical interactions with a patient and the staff (MA, RN, Provider) is documented via the encounter
screen using the face sheet, input templates, and/or input forms Chart # unique to each patient
3 Types of Encounters • Open – as indicated by a blue ribbon, an open encounter is active for the Enc Date shown and is
100% documentable – both at the face sheet and at the template level. All data entered is considered to be effective as of that visit date as for its source.
Notes: • There is a system property that limits the number of open encounters*. • An open encounter may be modified, or a new (additional) encounter may be started. • Always ensure you are documenting the correct Enc Date if multiple open encounters allowed.
*Admin Properties Encounters encounter.max.open
• Closed – as indicated by a charcoal gray ribbon, a closed encounter is locked for the Enc Date shown and cannot be documented – it is entirely read-only, including face sheet.
• Face Sheet – as indicated by a tan ribbon, is face sheet only; meaning there is no visit associated with it. This means for there is no encounter (open or closed) for the current system date.
•
Note: Every chart has at least a Face Sheet Encounter even when the patient has no appointments. It is the cumulative medical history for the patient, which can be entered in advance for new patients if applicable and carries forward for future appointments.
The Encounter Screen • User-specific search memory (up to 10 patients) + multi-criteria search options • Customizable TOC menu displays on left-hand side of encounter screen • Customizable Face Sheet menu allows up to 9 face sheets per encounter • Access to patient’s visit history and medical records review
Input Templates
Search options
Patient-level Links
History of encounters
Face Sheet • Default face sheet (seen above) is applicable for all encounters at all times • Up to 8 additional customized face sheets based on specialty, encounter type, or gender*
*Admin Properties Facesheet Layout #+ facesheet.navigate.all
Any confirguration of 9 squares (3 x 3)
read-only data*
Input Templates Vitals, HPI, Specialty, Clinic Forms • Can have multiple templates on the same encounter • A template can have one or more category of questions, tasks, procedures • User enters the appropriate response or action, which then displays on the relevant
output template, such as the Progress Note or the Procedure Form (Op-Note)
ROS, Physical, Social History • Single template per encounter • A template can have one or more organ systems, each of which contains specific aspects
to be examined during the visit
Standards/General Behaviors • Accessed via the Encounter TOC menu along left-hand side of encounter screen • Element design can include default values in conjunction with system properties such
as auto-copy and auto-select to improve efficiency of data entry/documentation • The Result Type and Report Sentence of each element is what dictates the format and
syntax of the output on Progress Note/Procedure Form • All templates include a Notes section at the bottom which accepts dictation/free-text
narratives • Macros/Smart Text narratives may be pre-defined for all Notes fields in the Phrases
master
Input Templates (cont’d) • The Result Type of an element determines the field color/icon & how the user populates it as well as
how it displays on the output as regards sentence case, data expression, etc. • The check box must be selected ( ) in order to be included in the output. Even if a value displays
in the field, if it is deselected ( ), it will not be included on the Note.
White fields accept data
entry (even to select a value)
Yellow fields auto-populate or are system
calculated
Gray fields require you to use the icon to select a value Each category
can be selected All/None with
1 click
Double-arrow head displays
conditional sub template
Output Templates* Progress Notes, Procedure Forms • HTML Tags dictate format and syntax of the data as well as its location on the output • Progress Note defaults from Encounter Type • Procedure Form defaults from Specialty Template • System-generated and automatically displayed on Document List by Encounter Date
Letters, Emails • PrognoCIS Tags (_TAGNAME_) pulls data from within the patient chart based on suffix
defined by user on the template • HTML Tags dictate format and syntax of the data as well as its location on the output • Template picklist via Letters Out screen; can attach Forms and Progress Notes if needed • Email address is required under Patient Register if applicable
Others • Lab and Radiology requisitions/orders • Prescriptions
Note: Can be customized per state-specific (watermarked) stationery as applicable. • Legal Documents for e-signature from patient • Mailing Labels • PDF Fillable Forms
*Admin Output Templates Forms Letterhead applies to all
Output Templates (cont’d) • The content that displays on any output is contingent upon the mapping of the applicable
tags (HTML, PrognoCIS) on the template design in conjunction with the Report Sentence syntax for each individual element/bullet contained within the applicable input template.
• Output may also be hard-coded based on local needs and scenarios in conjunction with the system-generated output.
The literal sequence in which the tags are defined in the design of the template mirrors the data flow on the actual output.
Labels/data outside of the HTML brackets [ ] will appear in output exactly as defined in the design of the template. Be sure to spell correctly.
Formatting may also be defined, such as font style (bold, italics, underlined) or color, etc..
Provider Assessment, Plan, E&M, and Orders • E&M – allows the provider to view the summary of what has
been documented in comparison to the applicable MDM in order to select the appropriate E&M CPT Code.
• Assessment – reflects the ICD and CPT/HCPC codes to be billed for the visit as well as doctor’s assessment & plan narratives
• Prescription – lets the provider request prescriptions by paper or electronically for standard or controlled substance drugs as well as view analytical data nationwide for medications and patient specific eligibility or formulary details Note: This a required Core Objective of meaningful use for all eligible professionals.
• Lab/Radiology Order – lets the provider request labs or order diagnostics tests by paper or electronically. Note: This is a required Core Objective of meaningful use for all eligible professionals.
• Lab/Radiology Result – lets the provider view results for labs and x-rays ordered that have been received electronically or scanned/attached to the patient’s chart. These may be individually reviewed or compared in matrix format for health analysis.
• Education – shows the EHR-generated education required to be given to the patient. Note: This is a required Core Objective of meaningful use for all eligible professionals.
Letters Out • Allows you to correspond electronically or print hard copy medical records • Pre-defined templates or ad-hoc letters; ability to attach from Document List as needed
MU Core Objective
Document List
Letters templates
Transmission options
Growth Chart • Interacts with child’s Vitals as applicable • Includes industry-standard CDC and WHO charts, gender-specific for the patient
Clinic Forms • Independent of or in association with one or more encounter; patient-specific • Electronic worksheet based on local needs • Supported Event #75 allows users to be notified when updates are made; a Zoom link to
the Clinic Form is included with the System Notification in user’s Inbox
Very useful with pre- certification and
authorization tracking.
EHR CPOE Menu • Rx / Refill – invokes a patient search and opens the Prescription
screen. If the patient selected has an open encounter, it will open that encounter’s Prescription screen; but if there is no open encounter, the Refill Rx screen launches.
• Lab Order – lists all labs that have been entered up until a result is posted to it. Valid statuses are E, A, O (Entered/Approved/Ordered).
• Lab Results – lists all labs that have been ordered including those with a result posted as well as those pending a result.
• Lab/Radiology eSend – allows the user to mass-transmit a batch of tests to the vendor via bi-directional interface if applicable. This requires technical setup per vendor specs.
• Radiology Order – lists all tests that have been entered up until a result is posted to it. Valid statuses are E, A, O (Entered/Approved/Ordered).
• Radiology Results – lists all tests that have been ordered including those with a result posted as well as those pending a result.
• Lab/Radiology Review – displays unread test results that are pending doctor’s review. Note: This corresponds to colored bubbles that appear in the upper right for providers under their own user logins.
EHR Messages Menu • In – contains all messages generated by the system or by users and
patients to the user who is logged in. The system alerts/notifications are triggered by the Supported Events property.
• Out – contains a copy of all messages the user has sent to another.
• Compose – allows the user to create a new message to a user/patient. Note: This will overtake the existing screen and become the active one causing you to exit whatever you are currently doing. The Compose icon in system tray lets you do so in a pop-up w/o losing active screen.
• Attach – opens the Attach Center on your server, which includes a cumulative list of incoming scans that need to be attached to the patient’s respective charts. This is also referred to as “bulk scan and attach” and requires technical setup before you can use it.
• Scan – with the appropriate setup, this option allows the user to scan a document or image directly to a patient chart without having to go into the Attach Center first. It also allows you to attach an external document into PrognoCIS.
• Amendment – facilitates an audit of requests for changes made by the patient to either clinical or demographic data where the doctor does not initiate the change. The option includes an approval utility by the doctor before the amendment is made. Note: This is outside the context of a patient encounter.
Note: Messages are shared between EHR and Practice Management, including items you may want to attach (such as Clinic Form for pre-certifications) or assigned tasks (to a provider or clinical staff).
EHR Report Menu • Tabular – system-level reports based on various conditions and data
sets; all based on a date range specified by the user. Tabular reports can be exported to Excel or equivalent DB for local purposes.
• Patient – reports generated at an individual patient level
• Encounter – reports based upon encounter-level data or scenarios
• Graphs (Metrics/Tests/MIS) – reports in graphical format as to the output
• Review Encounter – a screen for licensed MD to review all encounters from subordinate NP/PA providers whose encounters are flagged as Ready for Review for the sake of closing them.
• PQRS Report – for those not using PrognoCIS PM, this report lists all PQRS encounters and applicable QDC details for Medicare-B billing.
• Audit Trail – provides various queries for productivity type reports based on system or user activity and objects.
• Meaningful Use – detail and summary reports based on calendar year and EHR certifi- cation period used for attesting to CMS for meaningful use; includes both Stage 1 and Stage 2 years prior to 2015 as well as Modified Stage 1 & 2 for 2015 – 2017. Note: The data on these reports are the equivalent of the MU Dashboard icon in the system icon tray.
Practice Management (Billing module)
PM UI Theme by Profile Type Billing Staff (Medic Type = BL)
• Launches PM module directly • Dual shades of blue with light gray background • Includes full billing/collection & limited EHR administrative access by default
Note: By default Medic Type BL will not include EHR access.
PM System Ribbon
• Navigation Icons
• allow you to navigate back-n-forth the most recent (up to) 20 pages at a time • always returns you to the Home Page from wherever you are in the system
• Menu Tabs • Patient accesses the scheduling & demographics modules shared with EHR • Claims enables the biller to process and track all charges to ensure they are billed • Remittance is where all payments and credits are posted (electronic or manual) • AR/Follow-up provides tools for managing/tracking all Accounts Receivables • Messages module includes internal email as well as scanning and attaching • Report module includes system and user-defined billing/collection reports • Settings provides access to system-level master files and configuration tables as well as
user-level processes such as batch assignment and file downloads
• System Tray Icons • Shortcuts to general features at the system level or to focused features in a pop-up which
keeps the current screen in the background • Static – Select Patient, Compose Message, Resource Center, Help Topics, Information,
Lock, & Logout • Situational – Dashboard, Toggle EMR/Billing, New Alerts
PM User Ribbon
• Productivity Tables • Ready To Send – shows count and dollars of all unsent claims in status “S”
Note: These claims have been scrubbed and are ready to be sent to clearinghouse or printed. • Not Posted – shows dollars for all insurance EOBs/ERAs + patient payments for outstanding
balances that need to be applied against the applicable buckets (status “E” not “P”) Note: These should be applied before statements are generated.
• Collection Today – shows dollars physically collected (entered) for current system date Note: These are typically used to balance to daily deposits and will reset to 0 at midnight.
• Outstanding Claims – shows a cumulative total of all dollars billed but not yet paid in full
• Inbox Messages Table • Hyperlink to entire Inbox displaying all messages of all types and status • Count in black font represents the total number and the red font is the number of unread
messages for each message type, e.g.: • System – alerts/notifications generated by the system based on Supported Events property • User – messages sent by another user or by the patient from the Patient Portal • Telephone – messages sent to you with the designation as Telephone message • ToDo (hyperlink) – messages sent to you by another or by with an assigned Due Date
PM Claim Data Display
*Admin Properties Billing Parameters create.claims.condition
• Displays appointments/encounters for the specified filters and date • Status columns allow the biller to account for every appointment/encounter billing-wise in
conjunction with system property and encounter status*. • Patient-focused icons provide shortcuts to that patient/claim-specific details
Patient focused icons
Patient routing status/EHR
Claim status for that visit
• Filters options allows user to display only the applicable appointments within each tab based on the appointment/encounter Provider and/or Location
• allows user to navigate across different dates or to select a specific date
PM Claim Data Display (cont’d)
All Open Encounters
Calendar date appointments
PM Claims Menu • Edit Claims – includes every CMS-1500 claim (electronic or
paper) generated from EHR or from scratch, regardless of status, via a search-and-select screen based on user filters
• Unprocessed – lists all claims that have been generated but not yet sent out the door, whether paper or electronic; scrubbed or unscrubbed. Note: This is a biller’s worklist and should be empty at the end of each working day.
• Penalty Invoices – includes every Self-pay invoice for non-care related charges, such as missed appointments, bounced check, or administrative/medical records fees; regardless of status; generated automatically or from scratch
• New – lets you create a new claim or penalty invoice with or without a visit in EHR as long as the patient has a chart #.
• Send – lets you submit all scrubbed claims electronically by single batch to the clearing-house or print paper CMS-1500 in one batch, which updates status to Billed.
• Processed – lists all claims that have been billed at claim level or charge code level and allows you to create custom filters by which to analyze billed claim data.
• Returned/Rejected – lists claims that have been billed but returned by the clearinghouse or the payer unprocessed to be fixed and resubmitted. Note: These claims are in a Billed status but are not going to appear on any EOB unless you resubmit it according to the reason for which it was sent back to you.
PM Remittance Menu • EOB/ERA – includes every insurance remit (electronic or paper) that
has been entered into the system, regardless of Posting status
• Misc Credit – lets you manage credits outside of a remittance or receipt transaction (per property); often for the sake of creating a future refund to patient or insurance
• Patient Payment – lets you view/create patient payments whether collected at time of service (EHR Copay) or after the fact (PM) as well as manage patient credits (Advance bucket for self)
• Refund – lets you create a refund entry for patient or insurance to offset a credit when applicable if it cannot be transferred or recouped
• Returned Checks – lists entries of bounced checks to correspond with penalty invoices if applicable (based on Special Billing Charge setup and local workflow)
• Other Payment – includes specialty payment transactions such as Employer, Collection Agency, and Capitation receipts
• Unallocated – lists all electronic (and manual) EOBs that have been entered but not yet applied (Posted) to the insurance buckets
• Processed – lists all insurance remits that have been applied/posted
• Write-off – facilitates write-off transactions both at an insurance or patient level, singularly or bulk
• Transfer Pat Credit – lets you move a patient credit to another patient if applicable
PM AR/Follow-up Menu • Patient Account – displays the entire transactional history of any
patient including claims, payments (insurance & patient), write-offs, statements, etc. In addition, there are multiple shortcuts and links to details as applicable to all activity within Accounts Receivable.
• Denied – lets you manage claims flagged via EOB Entry as a denial from insurance that the cashier does not take corrective action on during payment posting process.
• Assigned Tasks – lets you create custom worklists by user or other category to define productivity and accountability/trending of A/R issues and ensure appropriate action is taken.
• Payment Plans – lets you create payment plans for a patient who cannot pay entire balance in full, including payment cycle, amount, and frequency.
• Outstanding Letters – lets you generate demand/collection letters to a patient/guarantor based on balance due, financial class, and payment plan status.
• Outstanding – lists all claims that have been billed until they have a zero balance; regardless what bucket the balance remains due.
• Send To Collection – lets you assign patient balances to collection agency, which performs an internal write-off within A/R for tracking purposes.
• Disputed – lets you manage payments flagged via EOB Entry to dispute with insurance.
Patient Account Screen
Patient Bucket Bal Due + Adv $
not applied
Claims Table Track claim
activity at claim level
Payments Table Track payment
activity at claim level
Activity Table Track all activity
at claim level
Activity Table • At a claim level, this lets you expand/collapse each charge row as to payment and write-off
activity for transactional trouble-shooting
PM Messages Menu • In – contains all messages generated by the system or by users and
patients to the user who is logged in. The system alerts/notifications are triggered by the Supported Events property.
• Out – contains a copy of all messages the user has sent to another.
• Compose – allows the user to create a new message to a user/patient. Note: This will overtake the existing screen and become the active one causing you to exit whatever you are currently doing. The Compose icon in system tray lets you do so in a pop-up w/o losing active screen.
• Attach – opens the Attach Center on your server, which includes a cumulative list of incoming scans that need to be attached to the patient’s respective charts. This is also referred to as “bulk scan and attach” and requires technical setup before you can use it.
• Scan – with the appropriate setup, this option allows the user to scan a document or image directly to a patient chart without having to go into the Attach Center first. It also allows you to attach an external document into PrognoCIS.
Note: Messages are shared between EHR and Practice Management, including items you may want to attach (such as Clinic Form for pre-certifications) or assigned tasks (to a provider or clinical staff).
PM Reports Menu • Billing* – system-level reports that reflect billing-level activity on claims
with a Billed status. System reports cannot be modified; however, they can be saved into a custom report and modified if needed.
• Aging – displays outstanding AR by Patient, Insurance, Employer, or Collection Agency in aging buckets of 30-day increments
• Collection* – system-level reports that reflect payment activity on claims both from insurance and patients. System reports cannot be modified; however, they can be saved into custom reports & modified.
• Summary – provides an overview of pertinent AR buckets, with each on also providing details if needed via the hyperlink.
• Statement – allows you to manually generate demand statements for a single or multiple patients/guarantors and include ad-hoc message.
• Distribution – provides a summary of posted payments by provider, intended to assist clinics in determining salary to be paid to those providers who are employees of the clinic
• Ledger – allows you to manually generate demand ledger for an individual or multiple patients for a specific date period.
• Tabular – system-level reports based on various conditions and data sets for specified date range, which can be exported to Excel or equivalent DB for local purposes.
*Users can modify or create custom layouts for Billing & Collection Reports.
PM Reports Management • Financial Analysis – provides comparisons of billing
and collection data at the intervals specified for the date range specified; e.g.: days within the month or months within the year, etc. Also includes Fiscal Year comparisons at the practice or provider level. Note: Users can customize these Layouts.
• Dashboard – displays up to 9 user-definable snapshots of financial-related data which provides a real-time glimpse of various activities for productivity or overall accounts managements. Note: By default, the dashboard may be empty or display dummy data for your clinic; contact Technical Support or your Implementation Manager with your requirements.
• Statistics – includes various canned queries of data sets and provides claim counts and dollar values for each one; e.g.: Total Billed, Total Unprocessed, Total Sent to Primary only, AR by Buckets, etc.
• Graphs – provides graphical output of billing, collection, and payer mix data based on defined queries.
PM Settings Menu • Configuration – provides access to system properties and master
files that control behavior and functional access to the system. Note: Users require appropriate administrator permissions.
• Claim Batches – lets the user create batches under which claims will be processed. If using batches for billing, a claim cannot be marked Ready To Send without assigning a batch number to it. The prefix can be pre-defined or set by user when creating the batch.
• Receipt Batches – lets the user create batches under which all pay- ments and write-offs will be processed. Batch numbers, by default,
will have a prefix based on the User ID (her/his initials). This can be overridden by the user when creating the batch.
• Fee Schedule – contains all fee schedules for the clinic, which is used to apply dollars to charge codes on the claim (Billing Schedule) or adjustments on the EOB Entry screen (Allowed Schedule). Fees are associated to codes (CPT, HCPC, Special Charges, Items).
• Scrubber Checks – allows you to create custom edits that will stop a claim from going out with incorrect data and forcing the biller to correct it then mark Ready to Send.
• Scheduled Process – contains parameters for queries (or “jobs”) that will execute auto- matically based on PrognoCIS Server setup and generate output for the user under
• Download Files – stores the files generated by the system via Scheduled Processes as well as any aging report or CMS1500 claim that is printed, for the sake of reprinting.
Using the New Release Shortcut
Login as a valid user to your database
Click the New icon ( ), which remains visible for 30 days following an upgrade
The version-specific Release Notes will launch by default in a separate window
If there are technical difficulties with accessing or viewing the Release Notes, please contact Technical Support at (880) 552-3301, or (408) 873-3032, PST
Version Build Release Notes
Using the Help Topics
Login as a valid user to your database
Access the System Help icon ( )
Click Release Notes
Select the applicable version (Help
retains all version Release Notes)
Resource Center
Home Page a Resource Center
Self-log Cases
Support Teams by eMail: • Technical Support: [email protected] • Meaningful Use: [email protected] • Training: [email protected] • Sales/Marketing: [email protected] • Accounting: [email protected]
Live by Phone
On-line Chat
Self Train
Public webinars
Resource Center (cont’d)
Home Page a Resource Center
Launches Video Library
Videos by Module include topics that match the menu tabs
and module names within the application
Vides by Workflow lists topics based upon role in the clinic
(which may also exist under the “by Module” column)
Webinar Videos are recorded versions of public webinars and
have not been edited as the training videos have been
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