PrognoCIS Help: Scrubber Checks EMR

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Introduction: CMS records a high percentage of claim rejections due to the 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 claims before posting them to insurance companies. From the Scrubber Checks Master screen, the user has the provision to define or edit new or existing Scrubber Checks respectively.
Depending upon the checks being implemented, the types of alerts on the Assessment screen are:

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

Field Description
Add Button:

Upon clicking, the Add Button opens a new and unsaved Scrubber Checks form.

Search Button:

Upon clicking, the Search Button opens a popup to search and open an existing Scrubber Checks form.

* Name: The name of the 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 Check that would define its position on the Search popup invoked by clicking the Search binocular icon. By default, the system considers the sequence number as '1'. The user can change the sequence of the scrubber check definition. This field accepts up to 3 numeric values.
For example, if Scrubber Check A is given a sequence number of 7 and another Scrubber Check B is given a 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 drop-down, the operands can be selected, and checking the checkboxes for the open and close parentheses defines the nested conditions for the scrubbers. Here, the and or 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	The Encounter Date on the Patient → Encounter screen is validated for this field.
2.	Encounter	Encounter - Encounter Type	The Encounter Type on the Patient → Encounter screen is validated for this field.
3.	Encounter	Encounter - Followup Date MM-DD-YYYY	The follow-up Encounter date on the Patient → Encounter screen is validated for this field.
4.	Encounter	Encounter - Appointment Location Code	The Location Code on the Patient → Encounter screen is validated for this field.
5.	Encounter	Encounter - ENM Code	The ENM code on the Encounter TOC → E&M screen is validated for this field.
6.	Encounter	Encounter - Case No	The Case No. on the Patient → Encounter screen is validated for this field.
7.	Encounter	Encounter - Copay Payment Amount	The system identifies whether the value is Greater Than or Less Than the mentioned numeric value added to the operand - Copay Receipt Amount.
8.	Encounter	Encounter - Copay Amount	The system identifies whether the value is Greater Than or Less Than the mentioned numeric value added to the operand - Copay Amount.
9.	Encounter	Encounter - Copay Deductible Amount	The system identifies whether the value is Greater Than or Less Than the mentioned numeric value added to the operand - Copay Deductible Amount.
10.	Encounter	Encounter - Copay Visit/Selfpay Amount	The system identifies whether the value is Greater Than or Less Than the mentioned numeric value added to the operand - Copay Visit/Selfpay Amount.
11.	Encounter	Encounter - Copay Advance Amount	The system identifies whether the value is Greater Than or Less Than the mentioned numeric value added to the operand - Copay Advance Amount.
12.	Encounter	Encounter - Copay PatOsPay Amount	The system identifies whether the value is Greater Than or Less Than the mentioned numeric value added to the operand - 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 or Equal To, Less Than, Less Than or 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	The Health status on the Encounter TOC → Assessment screen is validated for this field.
16.	Assessment	Assessment - Primary ICD10 Code	The Primary ICD-10 code on the Encounter TOC → Assessment screen is validated for this field.
17.	Assessment	Assessment - ICD10 Codes	The ICD-10 code on the Encounter TOC → Assessment screen is validated for this field.
18.	Assessment	Assessment - SNOMED Codes	The SNOMED code on the Encounter TOC → Assessment screen is validated for this field.
19.	Assessment	Assessment - CPT/HCPCS Codes	The CPT/HCPCS Code on the Encounter TOC → Assessment screen is validated for this field.
20.	Provider	Provider - Attending Doc Display Name	The Attending Doctor's Display Name on the Claims → Edit Claims → I Button is validated for this field.
21.	Provider	Provider - Attending Doc Last Name	The Attending Doctor's Last Name on the Claims → Edit Claims → I Button is validated for this field.
22.	Provider	Provider - Attending Doc NPI	The 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	The 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	The Last Seen Provider's Last Name on the Claims → Edit Claims → I Button is validated for this field.
25.	Provider	Provider - Last Seen/Sup Doc NPI	The Last Seen Provider's NPI on the Claims → Edit Claims → I Button is validated for this field.
26.	Provider	Provider - Referring Doc Display Name	The Referring Provider's Display Name on the Claims → Edit Claims → I Button is validated for this field.
27.	Provider	Provider - Referring Doc ID	The Referring Provider's ID on the Claims → Edit Claims → I Button is validated for this field.
28.	Provider	Provider - Referring Doc Last Name	The Referring Provider's Last Name on the Claims → Edit Claims → I Button is validated for this field.
29.	Provider	Provider - Referring Doc NPI	The Referring Provider's NPI on the Claims → Edit Claims → I Button is validated for this field.
30.	Provider	Provider - Rendering Doc Display Name	The Rendering Provider's Display Name on the Claims → Edit Claims → I Button is validated for this field.
31.	Provider	Provider - Rendering Doc Last Name	The Rendering Provider's Last Name on the Claims → Edit Claims → I Button is validated for this field.
32.	Provider	Provider - Rendering Doc NPI	The Rendering Provider's NPI on the Claims → Edit Claims → I Button is validated for this field.
33.	Provider	Provider - Rendering Doc Taxonomy Code	The Rendering Provider's Taxonomy code on the Patient → Encounter screen is validated for this field.
34.	Patient	Patient - Age in Days Today	The Patient's Age as of the Date of Service is validated for this field.
35.	Patient	Patient - Patient Type	The Patient's Type selected on the Patient Registration → Other Info tab is validated for this field.
36.	Patient	Patient - Age in Years Today	The Patient's Age in Years is validated for this field. Example: If the age is defined as 52.2, indicating 52 years and 2 months, then the system will round off the age and consider it as 52.
37.	Patient	Patient - Sex	The Patient's Gender selected on Patient Registration is validated for this field.
38.	Patient	Patient - Employer	The Patient's Employer Name selected on the Patient Registration → Contacts tab is validated for this field.
39.	Patient	Patient - Attorney	The Patient's Attorney Name selected on the Patient Registration → Billing Info tab is validated for this field.
40.	Patient	Patient - Financial Class	The Patient's Financial Class selected on the 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 number conditions added to the scrubber.
42.	Insurance	Insurance - Claim Filing Code Medicaid Y/N	The Claim Filing code of the Patient's Primary Insurance is validated for the 'MC' value defined on the Insurance Master.
43.	Insurance	Insurance - Claim Filing Code Medicare Y/N	The Claim Filing code of the Patient's Primary Insurance is validated for the 'MB' value defined on the Insurance Master.
44.	Insurance	Insurance - Pri AR Code	The AR Group of the Patient's Primary Insurance is validated for this field.
45.	Insurance	Insurance - Pri Claim Filing Code	The Claim Filing Code of the Patient's Primary Insurance is validated for this field.
46.	Insurance	Insurance - Pri Company ID	The Main Insurance defined for the Patient's Primary Insurance is validated for this field.
47.	Insurance	Insurance - Pri name	The name of the Patient's Primary Insurance is validated for this field.
48.	Insurance	Insurance - Pri Out of Network Y/N	The Out of Network checkbox on the Patient's Primary Insurance is validated for this field.
49.	Insurance	Insurance - Pri Payer ID	The Professional Payer ID of the Patient's Primary Insurance is validated for this field.
50.	Insurance	Insurance - Pri Subscriber ID	The Subscriber ID of the Patient's Primary Insurance is validated for this field.
51.	Insurance	Insurance - Pri Subscriber ID Len	The Subscriber ID Length of the Patient's Primary Insurance is validated for this field.
52.	Insurance	Insurance - Sec AR Code	The 'AR Group' of the Patient's Secondary Insurance is validated for this field.
53.	Insurance	Insurance - Sec Company ID	The Main Insurance defined for the Patient's Secondary Insurance is validated for this field.
54.	Insurance	Insurance - Pri Name	The name of the Patient's Primary Insurance is validated for this field.
55.	Insurance	Insurance - Sec Name	The name of the Patient's Secondary Insurance is validated for this field.
56.	Insurance	Insurance - Sec Payer ID	The Out of Network checkbox on the Patient's Secondary Insurance is validated for this field.
57.	Insurance	Insurance – Sec Subscriber ID	The Professional Payer ID of the Patient's Secondary Insurance is validated for this field.
58.	Insurance	Insurance - Sec Subscriber ID Len	The Subscriber ID Length of the 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 a status other than A. Eligibility record with status A but IE_ELIG_DOS is less than 7 days by the Encounter Date. Eligibility record with status A but IE_ELIG_DOS is greater than 7 days by the 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 the Primary Insurance. Eligibility record with a status other than A. Eligibility record with status A but IE_ELIG_DOS is less than 7 days by the Encounter Date. Eligibility record with status A but IE_ELIG_DOS is greater than 7 days by the Encounter Date.

Del Checkbox: Selecting the checkbox deletes the selected scrubber condition.

Opening Parenthesis - (: Parentheses help to define a set of conditions 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 is as follows:

Greater Than
Greater Than or Equal To
Less Than
Less Than or 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 operators varies depending upon the data type of the selected field.

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

Closing Parenthesis - ): This closes the parenthesis.

Logic: The logical operators are 'AND' or 'OR' conditions.

On Validation Radio Buttons: As explained earlier, select the appropriate validation 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 the validation conditions are TRUE. This field accepts a maximum of 255 characters only.

Active Checkbox: Select this 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 the same configuration. In other words, this creates a copy of the current Scrubber Check with a different name.