Centricity Business Functionality by chenmeixiu


									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              Visit level appointments and insurance concepts are built into the system to
Management                    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 pro-
                              actively notify staff of outstanding tasks and automatically prioritize critical
                              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               Enterprise Wide Scheduling (EWS) can accommodate scheduling rules
Scheduling                    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

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

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   Based on timing of the receipt of registration information, there is an
Eligibility (270/271)     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

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         Opportunity exists to post a simple copay real time instead of having lag.
(included with BAR)         Opportunity for improvement exists to generate a system created receipt.
                            Check-In and posting of copay to a credit invoice can provide batch audit
                            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              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   Referring Practice Online is a web-based physician portals offer cost-
                            effective methods for improving customer service, communication and

Scope of Patient Financials Deployment

Solution                  Scope and Benefits
                          Standard implementation of TES, no charge splitter will be deployed. All
Transaction Editing
                          charge entry and inbound charge interfaces will go through TES.
System (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      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
                          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.

                          Standard implementation of the PCS application.
Paperless Collection
                          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              Standard implementation of Occupational Medicine and Case
Medicine/Case             Management provides organizations the ability to produce company
Management Module         statements.

Anesthesia/Radiation      The Centricity Business Anesthesia/Radiation Billing Module handles the
Module                    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

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           The Enterprise Task Management functionality will improve the automation
Management                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    The electronic exchange of claims and remittances via a connection to the
Remittance (835/837)      eCommerce clearinghouse. Refer to the software schedule for the specific
                          details regarding payers and volume.

                          The Credit Card Module provides a direct connection between BAR, your
Credit Card Module
                          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       DBMS is a report writer utility to extract queries of data that are not part of
System                    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.

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                    GE Healthcare Benefits
                            Converts registration demographics and insurance information from a
Registration Conversion
                            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

                            Allows for the import of patient registration and patient-level insurance
Registration/ADT Inbound
Interface                   information into the Centricity Business database.

                            Allows for the import of professional charges into the Centricity Business
Inbound Batch TES
Charge Interface
                            Allows for the export of professional charges from the Centricity Business
Outbound Batch BAR
Charge Interface


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