Automated Workflow for HealthCare Providers — Eliminating the Complexity of Existing Systems and Processes
Healthcare is a complicated industry. Within any different facility or department there may be one or more paper-based processes and/or information systems that must be managed in order to insure that patients are provided the appropriate care, the care is authorized by payors and that the care is documented and processed appropriately for reimbursement.
This can mean that healthcare workers must bounce between multiple systems, both electronic and paper-based, to complete their work. This leads to massive inefficiencies as multiple systems much be checked and rechecked throughout the process to insure that all appropriate steps have been taken for each and every patient encounter.
HealthWare Systems' ActiveQ solves for many of the most complex issues in healthcare today. ActiveQ is a highly configurable workflow engine designed to automate the delivery of information to the appropriate facility personnel within various work processes. ActiveQ eliminates much of the switching back and forth between applications to insure tasks are being completed appropriately.
ActiveQ is able to incorporate work flow items from multiple discrete data sources: data elements that are present in the different information systems (registration systems, clinical systems); data elements that exist in the other databases (scanned or imported); and data elements that are imported into ActiveQ from other programs (reports, data files, etc.). With ActiveQ, items can be completed, tagged for later completion, forwarded to another user for completion or distributed for completion by multiple other users.
Pre-Arrival and Patient Status Management
The Pre-Arrival and Patient Status Management workflow manages the entire pre-arrival process in order to financially and clinically clear a patient prior to providing services. The system provides proactive identification of status changes on the account that require follow-up and review. By capturing all documentation such as pre-authorizations, medical necessity, ABNs, insurance eligibility, and patient estimates in a single repository sophisticated deficiency management and workflow ensure that each and every encounter is managed completely.
Using our advanced business intelligence engine, we can verify that all steps are complete BEFORE the patient presents. Daily activities are prioritized to ensure that all steps are completed and all documentation prepared. Documents are held in queue pending the patient’s arrival at which time they can be delivered to the desktop of the registrar regardless of where the patient presents. All of this can be accomplished regardless of the facilities existing systems for patient registration/scheduling, eligibility, medical necessity, etc.
Financial Assistance/Charity Workflow
This solution consists of a financial screening component that is initiated during registration (alternative at bedside or during discharge planning). The “quick screen” is used to determine the likelihood that the patient will qualify for one or more financial assistance programs. It uses a tiered weighting system to find the best reimbursement sources for the hospital.
The sequence of questions is adapted to the various state and local programs that the facility participates in. In addition, questions are added or modified to incorporate the facility’s financial assistance policy as well.
As the user navigates through the interview process, an interactive help system provides question-specific assistance to the end user. Tools for calculating resources and assets are provided within the quick screen tool as well.
Upon capturing the patient’s responses, an inquiry is sent to one or more data sources to predict the likelihood that the patient qualifies for assistance. The combination of the patient’s responses and these results will cause the system to produce recommendations regarding what programs are best suited for this patient.
All team members participating in follow-up activities (i.e. further interviews, application form completion, etc.) either utilize our workflow tools directly or provide ongoing updates to the patient folder so that there is a single repository for all activity. This enables all participants to share the information collected.
If a patient is unable to qualify for benefits for the primary reimbursement source, their work object can be routed to another team for review. Since all information is shared, the next team can make decisions without having to repeat steps or bother the patient for redundant information.
This workflow provides a “paperless” solution for efficiently managing all of the disparate data and documentation requirements associated with pre-surgical testing. It uses many of the powerful data capture, deficiency analysis, communication and workflow solutions from ActiveWARE to manage the process.
Utilizing this solution healthcare facilities can:
- Reduce delayed, rescheduled, cancelled procedures
- Reduce duplicate documentation, unnecessary and “stat” tests
- Improve communication with referring physicians and 3rd party testing organizations
- Improve physician and patient satisfaction
- Improve patient safety
- Have a dramatic positive financial impact on surgical operations
Historically, information that was faxed had to be logged, immediately reviewed by a clinician and maintained in a paper chart. With ActiveFAX integrated into the process, referring physicians, primary care physicians and 3rd party testing facilities simply continue to fax information as they always have.
By utilizing ActiveFAX, the facility can convert all faxed communication to electronic documentation which can then be incorporated into automated workflows for completion of all pre-encounter activities. Some key features and benefits of this solution include:
- Complete audit trail of all faxed communication without handwritten logs
- Electronically reject faxes back to originator, from any workstation, for clarification or to indicate that fax is incomplete or illegible
- Electronically manage abnormal test results and clearances
- Comprehensive search capability for locating faxed information based on any number of search categories/indexes
- Provide access to multiple clinicians/departments without making copies
Discharge Not Final Billed
The DNFB workflow is built using the ActiveQ workflow engine as well. The DNFB workflow creates workflow objects utilizing data from three (3) discrete data sources: data elements that are present in the ADT, data elements that exist in the electronic patient folder (scanned or imported), and data elements that are imported into the system from other 3rd party or hospital information systems (reports, etc.).
Typically, the existing DNFB report is received daily and each line item on the report is processed to determine how the work object should be created and assigned. Work objects are assigned based on configurable criteria. For example:
Coders: Any account that is new and has been determined to contain sufficient information for coding is routed to a coder. Existing accounts previously assigned to an associate for review, but have since been corrected and are now ready for coding, will also be assigned to coders for final review/coding.
Associates: Each department has assigned specific associate(s) to be responsible for completing/gathering missing information for specific accounts. Accounts will appear on each associates list that either have a hold code and/or are missing physician orders (or other required documentation). Associates locate missing information and forward accounts to coders for coding and release to billing.
For all accounts in the DNFB workflow, associates can click the account and view the corresponding documents stored in electronic patient folder (EPF). The initially displayed documents are configurable and associates may be given the ability to access all documents in the EPF. Accounts can be sorted by multiple criteria (dollar value, aging, etc.) and reports can be run on the same criteria. Associates can also add notes to accounts, forward accounts and/or distribute accounts for other associates for comment/follow up.
Finally, escalation policies and procedures can be enforced to ensure that all work objects are completed in an acceptable timeframe. If an object is delayed beyond established thresholds, it can be escalated to the appropriate manager for review and resolution.
- Refund Workflow
- Void Refund Workflow
- Stop Payment
- Customer Service
- New Insurance
- Payment Research