As a clinic administrator, how can I manage, enable or restrict privileges for users?

As of September 2015, we released several updates to user setting that aid to improve your workflow.

User can now:

1. Automatically prefill the supporting diagnosis on the claim summary tab during documentation.

2. Make supporting documentation a mandatory element on the flowsheet to further compliance efforts.

3. Enable Medicare 8-minute rule for all patients with other insurances aside from Medicare.

4. Switch landing pages upon login for efficiency. (This can only be done by the superuser/administrator of your account)

5. Add physician signature field on completed notes.

6. Enable chat for LIVE support and assistance.

7. Carry forward FLG code reporting to further completeness with G code reporting.

8. Enable Time Verification to further compliance efforts with documenting on your flowsheet. This will enable you to compare appointment duration time versus actual treatment times.

9. Sorting document in progress and completed documents is much more faster and convenient.

10. Re- evaluation, Progress Notes and Plan of Care is automaticaly listed to Pending Certifications once it is faxed.

11. Enable the 15 minutes rule for a patient with non-Medicare payer.

12. Enable the physician’s signature.

Administration Section

Icon designation of the clinic administrator under (1) Administration > (2) Staff> (3) Staff Overview. The clinic administrators can be identified with a (4) ‘hierarchy’ icon.

Improvements to the user interface for edit staff. Separate sections are now available for ‘Fundamentals’ and ‘Compliance’.

1. Fundamentals – this area is where you can edit the Staff’s information, including modifying their access rights.
2. Compliance – this section is where you can enable and disable providers permission and privileges when documenting.
3. Back to Staff List – click on this to go back to the Staff List

Fundamentals

Compliance

Go to Admin > Staff
Click on Action icon 
Toggle No or Yes based on preferences for these features. 
To assign a specific landing page: Select Modify on Access Rights. 
Select Save to update changes.

GENERAL

Auto Certification List – By default, auto certification is set to ‘No’. When set to ‘Yes’, every progress note for a Medicare patient that is faxed is added to the pending certification list. Also, every reevaluation for a non-Medicare patient that is faxed is added to the pending certification list. Also, every plan of care that is faxed is also added to the pending certification list for all payers.

Auto 15-Minute Rule -By default, this is set to ‘NO’. When set to ‘YES’, the 15 minute rule will be applied automatically for a patient, if the primary payer is non-Medicare.

Sort by Most Recent – When enabled, the documents in progress and completed documents will re-order and appear with the most recently created documents first, based on the time and date of document creation. By default, this is set to NO, which means that documents in progress and completed documents appear with the most recently document last, based on the time and date of document creation.

Prepopulate Dynamic Goal Box – When enabled, the questions “Is the goal stated in measurable terms?” and “Is the goal linked to the problems identified?” will default to YES. The rehabilitation prognosis will also default to ‘Good’

Mandatory Override – By default, this is set to ‘NO’. When enabled, In Touch EMR will allow partial saving of mandatory components in the subjective and objective section in all note types. Upon clicking the ‘Save Billing’ button in the claim review tab, an error message will appear indicating the mandatory components that need to be completed. Until these mandatory components are completed, the ‘Finalized Document’ button will not appear.

When set to ‘NO’, In Touch EMR will require all mandatory components in the subjective and objective section to be completed, failing which none of the mandatory components will be saved.

Global Vertical Scroll – By default, this is set to ‘NO’ for all providers. When enabled, this provider will see a ‘globe icon’ adjacent to the document title on the patient dashboard. When the user clicks on the globe, you’ll see S, O, F, A, P components in one tab (Global) one below the other and Claim Review in a separate tab. The user see all elements carried forward from the previous note and will be able to scroll down past the Subjective, then Objective, then Flowsheet, then Assessment, then Plan sections.

The user will NOT have the ability to answer questions that were NOT entered in the previous note (this option, along with the ability to choose templates is available in the traditional documentation panel).

Advantages of this feature –
1. Ability to view all data without having to click on tabs
2. It will ONLY display questions and answers that are carried forward, and allow editing of these fields.
3. 1 minute auto-save will save all data in all sections.
4. All traditional features like auto text, goal box and flowsheet popups will work exactly as expected.

Limitations of this feature –
1. More time spent scrolling up and down. For example, you’ll scroll down past subjective before you can get to objective. Scrolling can be reduced by using the top section buttons (at the top of the page) to auto-direct to either S, O, F, A, P. Scrolling (to go up from the bottom) can also be reduced by using the blue circle button (on the bottom right side of the page) to auto-redirect to the top section.
2. If you want to select additional questions or change templates, the traditional view must be used.

One Click Calendar – By default, this is set to ‘NO’. When set to ‘YES’, one click from the calendar will redirect the user to the Document In Progress (if the document is in progress) or Patient Dashboard (for all other appointment types). This function is available on Control Center 2.0, and not on Calendar 1.0 and Calendar 2.0.

Discharge Automation – By default, this is set to NO. When set to YES, In Touch EMR will automatically inactivate a patient, when a discharge note is finalized. Please note that even if a patient has multiple episodes, with multiple ongoing conditions (presumably with different rendering providers), a single discharge (for any episode) will inactivate the patient. An inactive patient is depicted with a red exclamation mark, in parenthesis, on the patient dashboard as well as the patient locator view.

The discharge must be FINALIZED and only then will In Touch EMR trigger the automatic inactivation of the patient. If a discharge note is in progress, the patient will not be inactivated.

Even when a patient is inactive, a clinician can continue to work on the patient record. The ‘inactive’ status does not limit the user in any way, it is simply an ‘internal tag’ for the patient. When an initial evaluation is done, the patient will automatically become active.

Ignore Non Billable Visit – By default, this is set to ‘NO’ for all providers. When enabled, all non-billable visits will not be count. When set to ‘YES’, a non-billable visit will not contribute to the visit count. This also affects all alerts since alerts are dependent on the visit count.

For example, let’s say this setting is enabled for Lance (PT). When Lance documents a non-billable visit for any document type (initial evaluation, daily note, progress note, reevaluation note and discharge), In Touch EMR will not increase the visit count.

Functional Limitation Code and Outcome Measures Mandatory – By default, this is set to ‘NO’ for all providers. If this is set to ‘NO’, then neither the functional limitation section nor the outcome measure section are required for each visit. This is the default for all providers.

When set to ‘YES’, then a minimum of one functional limitation G code must be entered in the FLG section and a minimum of one outcome measure must be entered in the outcome measure section.

In other words, both sections are required for each visit. Please note that this requires the selection of an objective template that includes both sections. If the user selects an objective template that includes neither the functional limitation G code section nor the outcome measure section, then this condition is not triggered, and is therefore becomes invalidated.

Dashboard New Tab Default – By default, this is set to ‘NO’ for all providers. When set to ‘YES’, most actions on the patient dashboard will result in a new tab.

For example, let’s say this setting is enabled for Lance (PT). When Lance clicks on any buttons on the patient dashboard (edit patient, amendments, uploads, episodes, comparator and countdown alerts), a new tab opens up with the desired destination. If this is set to ‘NO’, then the desired destination opens up in the same tab.

Display Servicing Provider in PDF – by default, this is set to ‘YES’ for all providers. When set to ‘NO’, the servicing provider will no longer appear in PDF.

Physician Signature Display – When enabled, designated PDF documents generated by this user will display the physician signature.

SUBJECTIVE

Pain Scale on Daily Notes –When enabled, every daily note will contain the pain scale for this user.

ICD-10 Selector – When enabled, this user will be able to select and submit ICD-10 codes, which will replace ICD-9 codes.When enabled, this user will be able to select and submit ICD-10 codes, which will replace ICD-9 codes.

Hide Non-Rehab Subjective Components –When enabled, designated components such as medical background, recommendations and transfer to healthvault will be hidden from the default subjective section in the initial evaluation, re-evaluation and progress notes.

OBJECTIVE

Carry Forward FLG code – When enabled, G codes will carry forward automatically from one note to another for this user. Facilitates compliance with Medicare

Disable Template List View – When enabled, the user will not see the list of available templates in subjective or objective and will therefore be unable to accidentally alter documentation. By default, this is set to NO, which means that every user can see (and change) the selected template. When switched to YES, this option is ideal for administrative staff who reviews the documentation, but should not have the ability to switch templates and accidentally alter documentation.

Objective Template Alphabetical Sort – By default, this is set to NO for all providers, which means that all available templates of the users may/may not be in alphabetical order, when set to YES, the user will be able to see the list of available templates in alphabetical order.

FLOWSHEET

Mandate Supporting Documentation on Flowsheet – When enabled, the supporting documentation text box on the flowsheet will become mandatory for all flowsheet components for this user.

Flowsheet Time Verification – When enabled, the system will calculate treatment time and scheduled time and display both on the flowsheet tab of each document for this user.

Flowsheet Zero Propagation- When enabled, the system will not propagate zero value CPT codes from the flowsheet to claim review. A zero value CPT code is defined as any CPT code with no duration. This is ideal for practices with flowsheet line items that should not be billed out. Such flowsheet line items must be designated with zero duration. Ideal for practice workflow involving detailed, customizable flowsheets.

Flowsheet Confirm Propagation – When this is set to YES, only flowsheet components that are ‘CONFIRMED’ (in an active flowsheet) will be propagated to the claim review tab. By default, all line items in active, editable flowsheets will display a red ‘PENDING’ button. The user will simply click on the red ‘PENDING’ button to automatically change it to a green ‘CONFIRMED’ button and then click ‘save flowsheet’. The user will also be able to re-edit an active flowsheet, click on the green ‘CONFIRMED’ button and switch the flowsheet component back to a ‘PENDING’ status. Remember to save the flowsheet and then proceed to claim review.

The system will ONLY propagate ‘CONFIRMED’ line items to claim review. The pre-selected ‘PENDING’ items will continue to appear on the flowsheet preview pop up, and also when the ‘duplicate button’ is clicked. These ‘PENDING’ items will appear in red for immediate user reference. This will enable the users to choose flowsheet templates and selectively propagate certain component, while being able to track what was done in previous components, using the duplicate or preview options.

Please note that the ‘PENDING’ components will not appear on the flowsheet preview PDF or the generated flowsheet PDFs since they are considered as ‘not selected / not done’ by the clinician.

In addition, the user will be able to save time by clicking on a ‘CONFIRM ALL’ button to automatically change all ‘PENDING’ components to a ‘CONFIRMED’ status with one click. The user will also have the the additional option of being able to (in active flowsheets) automatically revert one or more ‘CONFIRMED’ components, with a single click, back to ‘PENDING’. Remember to save the flowsheet and then proceed to claim review.

In summary, when this feature is enabled, a user must confirm a flowsheet by clicking on the red ‘checkbox’ otherwise it won’t propagate to the claim. If a component is not confirmed, it does not become a part of the clinical record and is not billed out. If it is confirmed (in a green ‘checkbox’), it is considered ‘done’ for that visit, it is billed out and it appears on the claim form.

Flowsheet CPT Non Mandatory – By default this is set to ‘No’. This means that the selection of the CPT code, when creating / adding every single flowsheet component is required. Be default, this is set to ‘No’ to improve compliance. The user is therefore telling the system what was done, and how the procedure / modality was billed out. We recommend this should be left as is.

When turned to ‘Yes’, CPT codes on individual flowsheet components are no longer mandatory. This means that the selection of the CPT code, when creating / adding flowsheet components is no longer required. In such cases, the flowsheet will save, but since there is no CPT code assigned to some components, the corresponding components will NOT have a CPT line item on claim review, even if the flowsheet component is ‘confirmed’. The user / clinic is responsible for appropriate billing since this can create mismatches between what is documented and what is billed, so please use with extreme caution.

Flowsheet Pre-populate All – By default this is set to ‘No’. This means that the flowsheet pre-populate drop down box in the flowsheet edit screen, by default, displays a drop-down of the flowsheet components associated with that flowsheet only. A one click selection of the appropriate component now populates that component, which can be edited quickly.

When set to ‘Yes’, this available list expands significantly, and a search option is made available instead of the drop-down. This gives the user the ability to search through the entire list of flowsheet components associated with all flowsheet templates. For example, if there are 20 flowsheet templates and each template has 20 flowsheet components, then the search function will allow searching through that entire list of all 400 components.

Please note that the search function (which is not case sensitive) will allow searching through the title of the individual flowsheet components, and not the description or any other part of the flowsheet components. Therefore, use descriptive titles for all your flowsheet components, such as Hip exercises, Lumbar mobilization and so on.

Flowsheet Association – By default, this is set to ‘NO’. This means that the flowsheet preview (flowsheet summary of everything done for a particular date of service) is a separate, stand-alone document that can be printed and faxed separately.

When set to ‘YES’, the user will be asked to select a designated document type (initial evaluation, progress note, daily note, re-evaluation and / or discharge). One or more documents can be selected. Once selected, the flowsheet preview (associated with the same date of service) will also appear on the PDF of the selected document type(s). This applies to that particular user.

Let’s assume this setting is enabled for the daily note for the user ‘sam234’. When ‘sam234’ uses In Touch EMR, the enabling of this feature allows the user to generate and fax ‘combination PDFs’ that include the daily note and the flowsheet preview (associated with the same date of service) to the referring physician or payer. This allows the user to print and / or fax clinical documentation in addition to flowsheets (what was done) at the same time.

CPT Splitting – by default, this is set to ‘NO’ for all providers. By default, if the flowsheet has 2 or more line items with the same CPT code, In Touch EMR combines the duration of all the line items and displays the CPT code with the total duration in the claim review tab.

When said to ‘YES’, this no longer occurs. If there are 2 or more identical CPT codes in different line items on the flowsheet, all the individual line items (including the respective modifier and duration elements) propagate to the claim review tab as is. This is useful when clinicians want to use different modifier combinations for the same CPT code. For example, 28 minutes of 97140 with GP modifier and 32 minutes of 97140 with KX modifier are two separate line items on the flowsheet, and also propagate as 2 separate line items on the claim review tab. When CPT code splitting is enabled and this note is finalized, these will be billed out as two separate line items.

Supporting Documentation Standalone – By default, this is set to NO. When set to YES, the ‘supporting documentation’ component on the flowsheet will display as a separate row with full width, as opposed to a column on the right hand side of the PDF document. This is ideal when the ‘supporting documentation’ component of the flowsheet is long and detailed. We recommend that clinicians enable this, and have long and detailed ‘supporting documentation’ components to facilitate compliance with payer guidelines.

PLAN OF CARE

Auto Physician Signature – By default, this is set to ‘NO’. When set to ‘YES’, the plan of care section in the initial evaluation, progress note and reevaluation will always default to YES for all patients, all payers. This will apply to the initial evaluation, progress note and reevaluation, but not the daily note.

Auto Generate POC – By default this is set to ‘NO’, meaning to generate POC, the ‘Generate Plan of Care’ button needs to be clicked on all types of note. When set to ‘YES’, the finalization of any / all of the following note types – Initial Evaluation, Progress Note and Re-evaluation will automatically generate a POC for that patient, even if the ‘generate plan of care’ button is not clicked.

However, it is important to note that the ‘save draft’ button must be clicked before the document is finalized. This will make sure that the latest version of the plan of care is automatically generated for that document type.

Mandatory Plan Components – By default, this is set to ‘No’. This means that the following components in the plan of care are NOT mandatory for users.

1. Frequency and Duration 
2. Certification Period 
3. Procedures 
4. Goals 
When set to ‘Yes’, In Touch EMR will require ALL of the following components to be on the plan of care, before allowing the user to finalize the document.
1. Frequency and Duration 
2. Certification Period 
3. Procedures (a minimum of one procedure or modality)
4. Goals (a minimum of one goal) 
When set to ‘Yes’, the user must get into the habit of clicking ‘Save Draft’ to save data in the plan of care. Then, the user must proceed to ‘Finalize Document’.

If the user clicks on ‘Save Draft’, and any components are missing, then the user will see the appropriate error message on the plan of care page (Frequency and Duration missing, Certification Period missing, Minimum of one procedure missing, Minimum of one goal missing). The user must enter the missing data and then ‘save draft’ again. Now, when the user proceeds to finalize the claim, he / she will be able to.

If the user ignores the error messages, and proceed to finalize the claim, he / she will be unable to finalize the claim. An error message will appear when the ‘Save billing’ button is clicked (Please enter missing components in the plan of care).

If the user ignores the plan section entirely / forgets to click the “save draft’ button, then he / she will be unable to finalize the claim. An error message will appear when the ‘Save billing’ button is clicked (Please enter missing components in the plan of care).
By default, this is set to ‘NO’. This means that the flowsheet preview (flowsheet summary of everything done for a particular date of service) is a separate, stand-alone document that can be printed and faxed separately.

When set to ‘YES’, the user will be asked to select a designated document type (initial evaluation, progress note, daily note, re-evaluation and / or discharge). One or more documents can be selected. Once selected, the flowsheet preview (associated with the same date of service) will also appear on the PDF of the selected document type(s). This applies to that particular user.

Let’s assume this setting is enabled for the daily note for the user ‘sam234’. When ‘sam234’ uses In Touch EMR, the enabling of this feature allows the user to generate and fax ‘combination PDFs’ that include the daily note and the flowsheet preview (associated with the same date of service) to the referring physician or payer. This allows the user to print and / or fax clinical documentation in addition to flowsheets (what was done) at the same time.

CLAIM REVIEW

Autopopulate Diagnosis Pointer on Claim – When enabled, this will automatically populate diagnosis pointers adjacent to the CPT code on the claim review tab of each document for this user.

Universal Medicare 8 minute rule – When enabled, the Medicare 8 minute rule will be applied universally across all patients and all payers for this user.

Rendering Provider Authentication – When enabled, this user will not be able to finalize documents.The user will be able to use ‘Submit for Review’ to send documents to a rendering provider for review.

Disable Claim Finalize –When enabled, the finalize claim button will be disabled for all documents for this user.

Submit Claim Finalize – By default, this is set to NO for all providers, which means that providers must finalize a document, for the claim to get generated and transmitted to the billing software. Ideally, we recommend that this is set to NO since it guarantees that finalized documents (and no other documents) are billed out to the payers.

When enabled (set to YES), all document types (for that user) will now show an additional button under the ‘claims’ tab, called ‘Submit Claim’.

When this button is clicked, the user has the ability to submit the claim to the billing software / clearinghouse / payer, without finalizing the document.

In other words, the claim can be submitted for payment, while the document remains ‘in progress’. In this scenario, it is entirely the clinician’s responsibility to return to the note ‘in progress’ and finalize it as soon as possible.

This is ideal when clinicians want to transmit claims immediately, to facilitate cash-flow for the practice, and plan on finalizing notes ‘after the fact’. In other words, you submit a claim even though the note is not finalized yet. Although this adds flexibility to the documentation and billing process, it increases the risk of non-compliance and the probability of missed / incomplete documentation.

By using this feature, you understand that In Touch EMR is not responsible for any claim denials, and it is entirely your ethical responsibility and professional obligation to complete clinical documentation in a timely manner. You also understand and acknowledge that you are submitting claims with an increased risk of denials / refund requests, in the event that notes are not finalized on time / do not match what is billed out / changes are made to a document after the claim is billed out.

Universal PQRS Feature – by default, this is set to ‘NO’. which means that PQRS only needs to be reported for those MEDICARE patients who pass the age, ICD-10 and CPT code requirements. When set to ‘YES’, PQRS alert will be prompoted to all MEDICARE patients regardless of age, ICD-10 and CPT codes used.

Show Claim Status Report –  By default, this is set to ‘NO’ for all providers. When set to ‘YES’, this provider will have an option to view the Claim Status Report under Add Ons – Claim Status.

Note:

This feature is only available for In Touch EMR only user. For more information, please contact your Account Manager.

Payment Status Report – by default, this is set to ‘NO’ for all providers. When set to ‘YES’, this provider will have an option to view the Payment Status Report under Add Ons – Payment Status.

Note:

This feature is only available for In Touch EMR only user. For more information, please contact your Account Manager.

How can a clinic administrator can customize a staff member’s access to use In Touch EMR?

To customize a staff member’s access rights, go to:

1. Adminstration > Staff.

2. Click on the edit access rights icon from this page.

3. You can also modify the access rights inside the Staff’s profile by clicking on the ‘edit icon found on the Action column. (Please see the second diagram)

Note: Only the administrator of the account can assign access rights to other staff member and can nominate other users to be superadmins (co-administrator of the account) to obtain administrator privileges.

Staff’s profle view where you can modify the user’s access rights

Access Right Options for Staff Members – Part 1

A pop up box will appear that will allow you to put a check mark on which access you would like for a staff member to have on their login.

Access Right Options for Staff Members – Part 2

You may also change the Default Landing Page what the staff member will see once they login.

To enable phyisician signature field on completed notes, you would need to enable this setting:

Sample PDF for enabled physician signature field:

Please note that for the DISCHARGE NOTE, selecting NO for the question “Do you want to add the physician signature” will remove the physician signature field.