ActiveDEFENDER: Accurate Patient
HealthWare Systems' ActiveDEFENDER is designed to manage patient encounter accuracy, not just registration accuracy. There are many opportunities for errors and issues to enter the process AFTER registration is completed. Any solution that stops monitoring the encounter stops enforcing accuracy and leaves the encounter vulnerable to data and documentation deficiencies that can occur during and after the patient visit.
Our comprehensive approach to accurate patient encounter management involves more than just data. It involves making sure that all information is correct within the context of each registration’s unique data, documentation and processing requirements.
All incremental changes and document acquisition steps are tracked to the originator. This allows ActiveDEFENDER the ability to assign responsibility to resolve known issues to the person that created them. An audit trail of each change is maintained to identify where the specific error entered the system. In addition, each user’s errors are tracked and reported by site, department, peer group, and individual. Each user has a report card showing their performance relative to their peers along with their most frequent error types.
Time-sensitive procedures or tasks can be monitored within ActiveDEFENDER to ensure that they are completed by the site-specified deadline. This eliminates surprises and enables staff to prioritize tasks based on approaching deadlines. Incomplete tasks that are approaching their deadline can be assigned escalation policies that automatically notify management.
Deficiency Tracking and Resolution
Deficiency analysis is performed throughout the patient encounter from a financial perspective. Each encounter has specific data and documentation requirements. These can be enforced through the business rules engine. Acceptable timeframes for completing the
performance of specific tasks or the creation/acquisition of particular documents can be built into the monitoring capability of ActiveDEFENDER as well. This ensures that steps are completed accurately and timely to avoid rescheduling, or denials resulting from incomplete documentation or data.
Patient Status Changes
Each time the patient status changes, a work object can be created and routed for review. Patients that go from an outpatient status to inpatient or surgery can be immediately routed to registration staff to ensure that the proper benefit information is acquired.
ED Registration Monitoring
ActiveDEFENDER can monitor ED visits that go through the “quick registration” process to determine if a final registration was ever completed. This avoids the potential to discharge a patient before the full registration is properly entered by registration staff.
2-Day vs. 4-Day Maternity Stays
Each maternity patient visit can be established with “review” flags to ensure that a scheduled vaginal birth that becomes a c-section is properly reviewed for insurance and authorization purposes. If a maternity stay goes into a third day, a work object can be created and routed to the appropriate person or team for review. The same process
can be established for c-sections that extend past the fourth day. By proactively reviewing these encounters, a site can ensure that the appropriate steps are taken to avoid any underpayments or denials.
High Balance Accounts
Daily charges can be imported into ActiveDEFENDER and thresholds established to flag accounts that meet site specified limits. If charges or patient balances exceed the site-specified limit, a work object is created and routed for review.
Utilizing timer-based triggers in our business rules engine, ActiveDEFENDER can flag any patient that was admitted for observation that has not been either discharged or converted to inpatient within the allowable timeframe. Escalation procedures can be included for notifying supervisors when the condition goes unresolved
If the authorized length of stay is provided to the system, the encounter can be flagged prior to exceeding those days. Utilizing timer-based triggers, the system can deliver work objects to concurrent review work queues with escalation procedures for any accounts not resolved in an acceptable timeframe.
Reconciliation RoutinesMultiple data feeds can be configured with ActiveDEFENDER for analysis and reconciliation. The system can identify duplicate or missing entries to produce exception reports and/or work queues for correction.
ActiveDEFENDER includes a complete library of reports for managing encounter issues and exceptions that are interactive. This provides users with the ability to “drill down” into the detail behind the numbers. Most reports include corresponding graphs to represent the same data visually for users. As an added benefit, a complete reports designer is included to allow sites to build custom reports easily without programming expertise.