PrognoCIS Help: Scrubber Checks EMR

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Introduction: CMS records a high percentage of claims rejection due to entry of incorrect diagnostic codes. To avoid such rejections Scrubber Checks are implemented on the Assessment screen. Scrubber Checks are customized validations that help to evaluate the claims before posting them to Insurance Companies. From the Scrubber Checks Master screen, the user has provision to define or edit new or existing Scrubber Checks respectively.
Depending upon checks being implemented, the types of alerts on the Assessment screen are:

Warning (System displays the alerts but allows User to continue further)
Error (System displays the alerts and does not allow User to continue further until the error is rectified)
Update (System auto corrects the problem) – ONLY PrognoCIS implementers are required to apply this function.

Field Description
Add button:

On click, the Add button opens a new and unsaved Scrubber Checks form.

Search button:

On click, the Search button opens a popup to search and open an existing Scrubber Checks form.

* Name: The name of Scrubber Check to be saved in the system is defined here. This field accepts a maximum of 50 characters.

Sequence No.: Enter a sequence number for the Scrubber Checks that would define its position on the Search invoked by clicking Search binocular. By default, system considers the sequence no as ‘1’. User can change the sequence of the scrubber check definition. This field accepts upto 3 numeric values.
For example, if a Scrubber Check A is given the sequence number of 7 and another Scrubber Check B is given the sequence number of 5 then on the Search popup Scrubber Check B is displayed before Scrubber Check A.

Conditions: This table helps define scrubber checks.The Conditions table has eight columns. Based on the option chosen in the Select Type dropdown, the Operands can be selected and checking the checboxes for the open and close parentheses defines the nested conditions for the scrubbers. Here, the and, or logic can be applied.

Select Type: The Select Type drop-down is provided with the following options;

• Assessment
• Insurance
• Provider
• Patient
• Encounter

Depending on the selected Type, the ‘+’ on ‘Field Name’ invokes the appropriate fields/Operands.

No.	Type	Field Names	Description
1.	Encounter	Encounter - Encounter Date MM-DD-YYYY	Encounter Date on the Patient→Encounter screen is validated for this field.
2.	Encounter	Encounter - Encounter Type	Encounter Type on the Patient → Encounter is validated for this field.
3.	Encounter	Encounter - Followup Date MM-DD-YYYY	Follow up Encounter date on the Patient→ Encounter is validated for this field.
4.	Encounter	Encounter - Appointment Location Code	Location Code on the Patient → Encounter is validated for this field.
5.	Encounter	Encounter - ENM Code	ENM code on Encounter TOC → E&M is validated for this field.
6.	Encounter	Encounter - Case No	Case No. on the Patient → Encounter is validated for this field.
7.	Encounter	Encounter - Copay Payment Amount	The system identifies the value if Greater or Less than the mentioned numeric value added to the operand - Copay Receipt Amount.
8.	Encounter	Encounter - Copay Amount	The system identifies the value if Greater or Less than the mentioned numeric value added to the operands - Copay Amount.
9.	Encounter	Encounter - Copay Deductible Amount	The system identifies the value if Greater or Less than the mentioned numeric value added to the operands - Copay Deductible Amount.
10.	Encounter	Encounter - Copay Visit/Selfpay Amount	The system identifies the value if Greater or Less than the mentioned numeric value added to the operands - Copay Visit/Selfpay Amount.
11.	Encounter	Encounter - Copay Advance Amount	The system identifies the value if Greater or Less than the m entioned numeric value added to the operands - Copay Advance Amount.
12.	Encounter	Encounter - Copay PatOsPay Amount	The system identifies the value if Greater or Less than the mentioned numeric value added to the operands - Copay PatOsPay Amount. For the Copay Remark the system identifies whether the value is blank or not blank.
13.	Encounter	Encounter - Copay Remark	For the Copay Remark the system identifies whether the value is blank or not blank.
14.	Encounter	Encounter - Reason for Visit	The following Operators can be used: Greater Than, Greater Than Equal To, Less Than, Less Than Equal To, Equals, Not Equal To, Starting With, Contains, In Comma separated List, Not In Comma separated List, Range : separated, Not in Range : separated, Is Blank, Is Not Blank.
15.	Assessment	Assessment - Health Status	Health status on the Encounter TOC → Assessment is validated for this field.
16.	Assessment	Assessment - Primary ICD10 Code	Primary ICD-10 code on Encounter TOC→ Assessment is validated for this field.
17.	Assessment	Assessment - ICD10 Codes	ICD-10 code on Encounter TOC→ Assessment is validated for this field.
18.	Assessment	Assessment - SNOMED Codes	SNOMED code on Encounter TOC→ Assessment is validated for this field.
19.	Assessment	Assessment - CPT/HCPC Codes	CPT/HCPC Code on the Encounter TOC → Assessment is validated for this field.
20.	Provider	Provider - Attending Doc Display Name	Attending Doctor’s Display Name on the Claims →Edit Claims →I button is validated for this field.
21.	Provider	Provider - Attending Doc Last Name	Attending Doctor’s Last Name on the Claims →Edit Claims →I button is validated for this field.
22.	Provider	Provider - Attending Doc NPI	Attending Doctor’s NPI on the Claims → Edit Claims → I button is validated for this field.
23.	Provider	Provider - Last Seen/Sup Doc Display Name	Last Seen Provider’s Display Name on the Claims →Edit Claims →I button is validated for this field.
24.	Provider	Provider - Last Seen/Sup Doc Last Name	Last Seen Provider’s Last Name on the Claim →Edit Claims →I button is validated for this field.
25.	Provider	Provider - Last Seen/Sup Doc NPI	Last Seen Provider’s NPI on the Claims →Edit Claims →I button is validated for this field.
26.	Provider	Provider - Referring Doc Display Name	Referring Provider’s Display Name on the Claims → Edit Claims →I button is validated for this field.
27.	Provider	Provider - Referring Doc ID	Referring Provider’s ID on the Claims →Edit Claims →I button is validated for this field.
28.	Provider	Provider - Referring Doc Last Name	Referring Provider’s Last Name on the Claims →Edit Claims →I button is validated for this field.
29.	Provider	Provider - Referring Doc NPI	Referring Provider’s NPI on the Claims → Edit Claims → I button is validated for this field.
30.	Provider	Provider - Rendering Doc Display Name	Rendering Provider’s Display Name on the Claims → Edit Claims →I button is validated for this field.
31.	Provider	Provider - Rendering Doc Last Name	Rendering Provider’s Last Name on the Claims → Edit Claims →I button is validated for this field.
32.	Provider	Provider - Rendering Doc NPI	Rendering Provider’s NPI on the Claims →Edit Claims → I button is validated for this field.
33.	Provider	Provider - Rendering Doc Taxonomy Code	Rendering Provider’s Taxonomy code on the Patient → Encounter is validated for this field.
34.	Patient	Patient - Age in Days Today	Patient’s Age as of Date of Service is validated for this field.
35.	Patient	Patient - Patient Type	Patient’s Type selected on Patient Registration →Other Info tab is validated for this field.
36.	Patient	Patient - Age in Years Today	Patient’s Age in Years is validated for this field. Example: The age could be defined as 52.2 indicating 52 years and 2 months then it will round off the age and consider it as 52.
37.	Patient	Patient - Sex	Patient’s Gender selected on Patient Registration is validated for this field.
38.	Patient	Patient - Employer	Patient’s Employer Name selected on Patient Registration →Contacts tab is validated for this field.
39.	Patient	Patient - Attorney	Patient’s Attorney Name selected on Patient Registration → Billing Info tab is validated for this field.
40.	Patient	Patient - Financial Class	Patient’s Financial Class selected on Patient Registration →Billing Info tab is validated for this field.
41.	Patient	Patient – Patient Chart No.	When this scrubber is defined, the system identifies the value as Contains depending on the available patient chart no. conditions added to the scrubber.
42.	Insurance	Insurance - Claim Filing Code Medicaid Y/N	Claim Filing code of Patient&’s Primary Insurance is validated for ‘MC’ value defined on Insurance Master.
43.	Insurance	Insurance - Claim Filing Code Medicare Y/N	Claim Filing code of Patient’s Primary Insurance is validated for ‘MB’ value defined on Insurance Master.
44.	Insurance	Insurance - Pri AR Code	AR Group of Patient’s Primary Insurance is validated for this field.
45.	Insurance	Insurance - Pri Claim Filing Code	Claim Filing Code of Patient’s Primary Insurance is validated for this field.
46.	Insurance	Insurance - Pri Company ID	Main Insurance defined of Patient’s Primary Insurance is validated for this field.
47.	Insurance	Insurance - Pri name	Name of Patient’s Primary Insurance is validated for this field.
48.	Insurance	Insurance - Pri Out of Network Y/N	Out of Network checkbox on Patient’s Primary Insurance is validated for this field.
49.	Insurance	Insurance - Pri Payer ID	Professional Payer ID of Patient’s Primary Insurance is validated for this field.
50.	Insurance	Insurance - Pri Subscriber ID	Subscriber ID of Patient’s Primary Insurance is validated for this field.
51.	Insurance	Insurance - Pri Subscriber ID Len	Subscriber ID Length of Patient’s Primary Insurance is validated for this field.
52.	Insurance	Insurance - Sec AR Code	‘AR Group’ of Patient’s Secondary Insurance is validated for this field.
53.	Insurance	Insurance - Sec Company ID	CMain Insurance defined of Patient’s Secondary Insurance is validated for this field.
54.	Insurance	Insurance - Pri Name	Name of Patient’s Primary Insurance is validated for this field.
55.	Insurance	Insurance - Sec Name	Name of Patient’s Secondary Insurance is validated for this field.
56.	Insurance	Insurance - Sec Payer ID	Out of Network Patient’s Secondary Insurance is validated for this field.
57.	Insurance	Insurance – Sec Subscriber ID	Professional Payer ID of Patient’s Secondary Insurance is validated for this field.
58.	Insurance	Insurance - Sec Subscriber ID Len	Subscriber ID Length of Patient’s Secondary Insurance is validated for this field.
59.	Insurance	Insurance - Eligibility in 7 Days Y/N	The following conditions are validated for this field: No Eligibility record is present for Secondary Insurance. Eligibility record with status other than A. Eligibility record with status A but IE_ELIG_DOS less than 7 days by Encounter date. Eligibility record with status A but IE_ELIG_DOS greater than 7 days by Encounter Date.
60.	Insurance	Insurance – Pri Eligibility in 7 Days Y/N	The following conditions are validated for this field: No Eligibility record is present for Primary Insurance. Eligibility record with status other than A. Eligibility record with status A but IE_ELIG_DOS less than 7 days by Encounter Date. Eligibility record with status A but IE_ELIG_DOS greater than 7 days by Encounter Date.

Del checkbox: Selecting the checkbox would delete the selected scrubber condition.

Opening parenthesis - (: Parentheses help to define set of condition in one expression. Example: ((A+B)-C)/10.

Type: This column displays the corresponding ‘Type’ value of the selected Operand/Field.

Field Name: Click the (+) button to add the actual name of the selected object.

Operator: The list of supported operators are as follows:

Greater Than
Greater Than Equal To
Less Than
Less Than Equal To
Equals
Not Equal To
Starting with
Contains
In Comma separated List
Not In Comma separated List
Range : separated
Not in Range : separated
Is Blank
Is Not Blank

Note: The list of operator varies depending upon the data type of the selected field.

Value: User can specify the value relevant to the objects. The specified value is used for comparison.

Closing parenthesis - ): This is closing the parenthesis.

Logic: The logical operators are AND or OR conditions.

On Validation radio buttons: As explained earlier, select the appropriate validation that has to be displayed on the Assessment screen.

For example,

Warning (System alerts but allows you to continue further).
Error (System alerts and does not allow you to continue further until the error is rectified).
Update (System alerts and with no further notice, auto corrects the problem).

Message: Enter the message which you wish to display when validation conditions is TRUE. This field accepts a maximum of 255 characters only.

Active checkbox: Select the option to keep the scrubber check in active mode and to be available in the Scrubber Checks search.

Action Buttons:

save button: Click to save the Scrubber Checks.

delete button: Click to delete the Scrubber Checks.

reset button: Click to revert any unsaved changes.

save as button: Click to save the current Scrubber Check with a different name and same configuration. In other words, it creates the copy of the current Scrubber Check with a different name.