FBCS Patch 29 Overview CPRS Bi-Directional Communication

1. FBCS Patch 29OverviewCPRS Bi-Directional Communication

2. Patch 29 Overview • Primary Purpose • Enhancement Functionality • Other Enhancements • Defect Repairs • Questions & Answers

3. Primary Purpose • New bi-directional interface between CPRS and FBCS Authorization in real time • Allows user to stay apprised of significant events of an eligible consult’s approval and scheduling process • Allows for permission-based updates to consults via FBCS Authorization • Allows for the improved flow and data capture of Non-VA claims processing information.

4. Home Page • Worklist expanded to display additional consults and consult information • “Service Name” column renamed from “Consulting Service” • Three new consult grid columns: • Last Action Taken: displays last CPRS action on consult • Action Date: displays date of last action taken on consult • Read: checkbox to annotate the last action was read • Re-arranged consult-related action buttons for easy access • Moved Suspended Authorizations to it’s own page within FBCS Authorization.

5. Home Page

6. Home Page – Suspended Auths Suspended Authorizations tab has been moved from the home screen and is now available on the application ribbon • Upon clicking the Suspended Authorization tab the user will get a screen displaying all suspended authorizations for that user. The suspended authorization functionality has not changed. • The user can take a shortcut completing the authorization by just double-clicking the authorization they select and the authorization will open

7. Home Page – Additional Consults • Per current functionality FBCS will display all Pending and Active consults identified as Fee Services within the GMRC Consult Management Menu • Now with Patch 29, in addition to Pending and Active, FBCS will display Fee Services consults that have had certain actions or status updates applied.

8. Home Page – Additional Consults • The below actions/events will add the consult to the FBCS worklist. • CM (Comment) • ER (Edit/Resubmit) • CT (Complete Request) • CX (Cancel or Deny Request) • DC (Discontinue Order) • FR (Forward Request) • SC (Schedule) • SF (Significant Findings) • Consults with captured consult actions will not be removed from the worklistuntil a user Hides the consult.

9. Home Page – Additional Consult Details • FBCS will update the consult in the worklist with the status or action changes as they occur and reflect this activity in the new columns Last Action Taken and Action Date

10. Home Page – Additional Consult Details • Consults for patients that have multiple Pending and Active records listed will continue to bold in the worklistfor easy reference, they will remain bolded until the consults’ statuses have been updated to something other than Active or Pending thus no longer meeting the criteria. • *Utilizing the Refresh button will draw more consults with a Pending or Active status and/or consults that have had recent actions performed upon them to the list

11. New Consult Statuses – Read/Unread User can specify whether a listed consult has been reviewed by flagging it as Read/Unread • Flag is viewable by all users who have access to the worklist and consult • If a new action is performed to a consult that is marked as “Read”, upon refreshing the grid, the consult will now be reverted to “Unread”. Users may also manually switch the status. • For example, the last action on the below consult was SCHEDULED, the user reviews and marks it as Read. The consult then receives a COMMENT action and upon refresh the new action flag now indicates “Unread”

12. New Consult Statuses – Read/Unread • Flagging a consult as Read does not remove the consult from the worklist. • Reviewing may not always lead to Hiding the consult therefore this distinction can assist in annotating the consult has been encountered by a clerk in FBCS.

13. Consult Action Buttons Consult-related action buttons provide existing and new functionality are arranged to the right of the worklist.

14. Set Patient Button New “Set Patient” button loads the highlighted patient in the consult grid as the active patient

15. Set Patient Button Once you select “Set Patient” the system will select the patient and load all other Authorization tabs with that patient’s details. This mimics the functionality of manually searching and selecting for the consult’s patient.

16. Print Consult The Print Consult button works just as before. Your computer will still need to be connected to a VistA printer and the consult will print upon selecting the print consult tab. Only one consult can be printed at a time.

17. Hide Consult The “Hide Consult” button will continue to remove the consult from the grid, however, if actions are performed on the consult, it will reappear in the grid. Consults will not be able to be reactivated from the Hidden Consults list if no action has taken place after 90 days.

18. Commands Button • “Commands” button holds existing consult commands, such as Create Authorization • As well as features new consult commands, such as Linking Consults to CT Records and Consult Actions More on the new features later in the presentation

19. Creating Authorizations To create an authorization from a selected Consult, click the “Commands” button and choose “Create Authorization” If the consult is an Inpatient consult, the user will be prompted to create a notification or CT record per regular functionality and site implemented preferences.

20. Creating Authorization 7079 • If the consult is an Outpatient consult, a new Create 7079 window will appear with some data pre-populated, per existing functionality. • This functionality has been augmented to include parsing and auto-population of consult details onto the 7079. • The data will populate from a consult when one is either selected from the homepage worklist or manually selected via the Create/Edit 7079 form.

21. Creating Authorizations The list below details what 7079 form fields are affected. • DX Code 1 – Populated with Provisional DX from consult. Cannot be edited upon population. • Reason for Referral – Populated with Justification for Non VA Care from the consult. Can be cleared if necessary. • Remarks – Several consult fields are populated to Remarks and are placed at the beginning of the field above any other populated text. Can be edited if necessary. • Accident Related – Populated as checked IF the selected consult has a noted Third Party Liability as “Yes • *Note: when editing a 7079 users must review already populated data to determine if values should be cleared or edited before auto population of the above fields takes place.

22. Consult Data Capture – 7079 Population Provisional Diagnosis • Provisional Diagnosis will auto-populate into the DX 1 field • Will populate if already blank and is not editable once populated unless initially saved

23. Consult Data Capture – 7079 Population Justification for Non VA Care • Auto-populated into Remarks field • When present, will also populate a new Supplemental Data field labeled “Reason for Referral” • Users may access additional options in this field via a picklist. • If “Other” is chosen FBCS will populate the consult’s accompanying text to an additional free text field.

24. Consult Data Capture – 7079 Population Remarks • Many consult fields will auto-populate into the 7079 Remarks • FBCS identifies and parses data from the following consult fields: • Type of Service & procedure • Chief Complaint • Non-VA Care Justification Reason • This data is accessible in Remarks for editing

25. Consult Data Capture – 7079 Population Third Party Liability Status • YES/NO data will update the Accident Related field • Accident Related checkbox can be edited if necessary

26. Viewing Consult Details To aid in easy reference, the consult details can now be viewed and copied while working on a 7079 or 7078.

27. Updating Consults via the 7079 form It may be necessary to apply an action to a consult while working against a 7079. This can be accomplished by clicking the Consult Actions button from within the form. A list of permissible and available actions will be presented.

28. Updating Consults via the 7079 form Only actions available for the consult and user will be illuminated. Updates made in this form will reflect in the Homepage upon automatic and/or manual refreshing of the worklist. These actions will update CPRS in real-time.

29. Auto-hide Consults • Checkbox added to indicate whether the consult should be hidden when the 7079 or 7078 is saved. • Allows the user to hide the consult when saving, rather than manually having to go back to the consult grid to hide. • Consult grid is a shared list and will be hidden for all users who can view the consult.

30. Updating Consults via FBCS • Applying actions to Consults is also available from the Home Page. • As previously mentioned this is available via the “Commands” button

31. Commands for Consults – Consult Actions • “Consult Actions” can apply real-time updates to consults • Mimics CPRS action activity • Roles and permission required in CPRS are required in FBCS to apply action • The following actions can be taken/updated against a consult in FBCS Authorization: 1. CM (Comment) 2. ER (Edit/Resubmit) 3. CT (Complete Request) 4. CX (Cancel or Deny Request) 5. DC (Discontinue Order) 6. FR (Forward Request) 7. SC (Schedule) • 8. SF (Significant Findings)

32. Updating Consults via FBCS Schedule a Consult

33. Updating Consults via FBCS Cancel a Consult

34. Updating Consults via FBCS Edit/Resubmit a Cancelled consult

35. Updating Consults via FBCS Discontinue a Consult

36. Updating Consults via FBCS Forward a Consult

37. Updating Consults via FBCS Add Significant Findings

38. Updating Consults via FBCS Administratively Complete a consult

39. Updating Consults via FBCS Adding Comments to a consult • Free text field to add comments to the selected consult. • Alerts can be sent to the ordering provider

40. Consult Data Capture Consult Comments &Clinical Tracking Records • Added comments may also be added to a linked Clinical Tracking (CT) record automatically. These will be saved and can be retrieved as Existing Comments of a CT Record. Conversely CT comments can be added as a “Comment” to the consult record in CPRS

41. Linking a Consult & Clinical Tracking Record A Clinical Tracking record can be linked to a selected consult for reference and comment exchange. The “Commands” button provides two options: • Choosing an Existing CT Record

42. Linking a Consult & Clinical Tracking Record • Or Create a new CT record to link the consult to. • The linked Consult IEN will display in the CT record.

43. Admin Actions FBCS has modified the Administrator Tab’s Hidden Consults listing to provide a tool to purge user-hidden consults when an administrator deems it appropriate to do so. This will NOT override the read/unread flag but will instruct FBCS that the hidden consults will not need to be added back to the worklist unless an aforementioned consult action takes place. Consults will be removed from the Hidden Consults list if no action has taken place after 90 days.

44. Admin Actions • Located in the Options 4 menu • The user upon selecting “Purge Consults” will receive an alert confirming this action. User must have DSIF Administrator key

45. Admin Options • Administrator can apply default filters to control the number of consults displayed in the homepage upon login, via the Options 5 menu. • Administrators may specify how many days the Home Page date filter should encompass. • Per usual, user must have DSIF Administrator menu option

46. Admin Options • Per present functionality the HomePage date filter only affects Pending and Active consults. • This filter does NOT apply to consults with FBCS captured actions and/or other statuses.

47. Admin Options • Category of Care has been removed from the “populate authorization comments field” in the Options 2 tab and is no longer optional Old functionality New functionality

48. Admin Options • It is no longer optional as FBCS will now automatically embed every 7079 with the category of care as though an administrator chose to include it in the Supplemental Data summary. • Per present functionality embedded supplemental data is not editable. (highlighted in yellow in screenshot)

49. Changes in D&P • Changed the calculate button's illumination criteria to NOT ghost if the claim is marked as contract. • Added code to restrict claims linked to an incomplete 7078 from being sent to Payment. • Added functionality for D&P to alert user when denying a claim in which a Veteran is not yet associated. • Added code to mark row “PriorPaymentsA” in claim data grid with red color when the value is greater than 0. • The field Admitting Diagnosis has now been added to FBCS for UB claims.

50. Other FBCS Module Changes • FBCS Payment • CNH batches should NOT be worked in FBCS, if the batch was created in VistA all batch procedures with the exception of Transmit must be performed in VistA. CNH batches will not be released in FBCS. The user will now be prompted with an error message. • FBCS Verify • Fixed a bug that was disabling suspend menu option after sending a claim to OCR. • Fixed a bug in the background image selection. The background will now show based upon the user’s previous selection.