Management by Exception
Imagine having many of the mundane repeatable processes transform into a process that handles most of the obvious data updates and error checking, but alerts you to only the few items that really need your attention? One of the most valuable benefits of the workflow approach is the peace of mind that can be attained by knowing that the process will be followed for all items and any that do not “fit” the proper flow, will be put in your task queue for follow up. With The EDGE™:
o Any repeatable process can be quickly modeled and deployed
o All groups or people can be identified for their role in the process
o Each event that triggers the process will do so and notify the people
o Tasks are assigned, delegated, finished and tracked
o Any information needed for a task is delivered with the task
o Any action required is clearly outlined, including exceptions
A process as simple as a checklist of things to do; or as complex as the Real-Time Eligibility Determination against all managed care payers for every registered patient; can be deployed with The EDGE™. Start by considered a few of these.
Revenue Cycle Processes
l Real-Time Eligibility Determination Process
l Claims Editing Process prior to Submittal
l Task assignments for Denial Rework
l Manual posting of claim remittance
l Follow processes for A/R aging
l Worker’s Compensation Processes
l Process for changes based on Payer Changes
l Referring Physician process for proper data entry into HIS
Clinical Processes
l Abstracting medical record keywords to trigger Child Protective Services
l Continuum of Care process modeled for tracking
l Alert notification based on changes in defined measures
¡ Set up automatic warning flags for changes in clinical parameters to signal possible impending worsening condition, could improve patient outcomes and save lives, suffering (and money)
Patient Satisfaction Processes
l Patient Satisfaction Survey process and trigger event
l Information / communication process, timing, checklist
l Patient Pathways for all patient types, timing, reporting
Operational Efficiencies
l Published Outcomes Reporting
¡ There is an ever-increasing amount of published outcomes that are either already required or soon-to-be required by Medicare (CMS) and other third party payers. Such reporting must be accurate in order to receive the full annual pay and is vital for public image.
l Charge Entry, Coding
¡ It is sometimes difficult to properly code and enter charges since different types of data are stored in different forms. If the hospital chart is not complete, the scanning process can be delayed if information is not readily available.
Administrative Processes
l Staffing Processes needing documentation completion
l Capital Project Approval Process
l Online work request form for any department
l Moving data from System A to System B