TABLE OF CONTENTS - Medassets Documents... · Web viewTABLE OF CONTENTS UR Direct Overview 3 Workflow Diagram 4 System Access Patient Census 5 6 Account Details 7 Note Pad 9 Clinical

Concurrent Review System

User Manual & Training Guide

Version 4.1.1

UR DirectUser Manual & Training Guide

TABLE OF CONTENTSTABLE OF CONTENTS

UR Direct Overview 3Workflow Diagram 4System AccessPatient Census

56

Account Details 7Note Pad 9Clinical Reviews 1

0Reviews Required Work List 1

2Reviews Not Communicated Work List 1

4Awaiting Outcomes Work List 1

6Pended Days Work List 2

0Denied Days Work List 2

2Reconsideration Request Work List 2

4Avoidable Days Work List 2

6Target LOS Function 2

8Review for Discharge Work List 2

9Review for Continued Stay Work List 3

0Discharge Planning Work List 3

1Search Accounts 3

3Payer Contacts 3

4Reminders Listing 3

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5Insurance Changes Report 3

6Ask MD-X 3

8eFax Status 3

9Unit Assignment 4

0Payer Aliases 4

1DRG Manager 4

2Appendix 4

3Technical Specification & System Requirements 4

4MD-X Contact Information 4

5

UR Direct OverviewUR Direct Overview

What is URDirect?URDirect is a web-based, concurrent review application for utilization management professionals. URDirect is a “Day Management” system, rather than the standard “Case Management” system. This means that each day of a patient’s case is handled independently from the other days.

What is the goal of URDirect?The system establishes a best practices approach to internal processes in conjunction with payer outcomes to help manage length

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of stay and reduce denials by improving payer/provider communication.

How does it work?

Workflow DiagramWorkflow Diagram

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Client Database

MD-X Database

Data is securely transferred to MD-X every half hour

URDirect is accessed over the

Internet


System AccessSystem AccessUR Direct is accessible over the Internet by entering www.md-x.com in a standard browser.

Enter your Username and Password to access the secure MD-X Portal.

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http://www.md-x.com/


Please write your Username and Password on the spaces provided.

Username:

Password:

Click on the MD-X Direct link under Applications to launch the application.

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Patient CensusPatient Census

The Patient Census displays all patients occupying an inpatient bed in your facility at that time, excluding Same Day Surgery or Same Day Medical patients.

The pull down menu allows the user to identify all patient or only those patents where NO Initial Review has been performed.

By clicking on any value, a detailed list of accounts will be displayed. This list follows the same color-coding convention as the summary report. To view the Account Details, click on the appropriate Account Number or Patient Name.

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Account DetailsAccount Details

The Account Details interface centralizes and displays the following:

1) Patient Demographics2) Insurance Information3) Acuity Level(s)4) Clinical Review Status5) Outcomes6) Add Days7) Note Pad

There are three tabs at the bottom of the page: Scheduler, Target LOS and Prior Visits.The Scheduler Tab allows the user to over write the default interval that is stored in the system.The Target LOS Tab allows the user to assign a “Working DRG” to the patient. This ‘Working DRG’ has the CMS geometric mean LOS that is used to identify problem patients.The Prior Visits Tab allows the user to see all prior visits for a patient with the same medical record number.

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Patient DemographicsThe patient’s information is extracted directly from your registration or patient accounting system. For data integrity purposes, these fields are not editable by the user. If you encounter a patient related data error, please contact your registration or patient accounting department for assistance.

Insurance InformationThe patient’s insurance information is displayed as a Payer Alias. The system allows the user to control the Payer Code to Payer Alias mapping as described in the Payer Aliases section of this guide.

Acuity Level(s)Using the hospitals revenue codes, the patient’s actual acuity level is displayed on a day-by-day basis.

Clinical Review StatusThe icons displayed below the R (review) column alert the user to the current status of the clinical review. The description of the various icons can be found in Table I of the Appendix.

OutcomesThe payer’s responses are captured and displayed in the Certified Days pane.

Add Days ( )To add additional days to an in-house patient, click on the above button. This feature allows the user to enter reviews and certifications for dates of service that occur in the future.

Note PadSee next section.

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Note Pad Note Pad The Note Pad serves multiple functions and display the following information:

1) Process & Outcome history

2) General Comments/Notes

3) Reminders4) Attending Physician

Requests

Process & Outcome History

This information is automatically entered by the system for auditing and tracking purposes.

General Comments/NotesUsers can enter comments or notes related to the day or case as required.

Reminders Reminders are comments/notes that require additional follow-up in the future. Set a reminder by entering a comment and a date in the appropriate field. The user will be alerted of the reminder when the Reminder date is reached.

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Clinical Reviews Clinical Reviews

The Clinical Review interface captures a number of key clinical elements, which are used by the payer to authorize the appropriate level of care.

There are three broad categories of information on the Clinical Review page:

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1) Patient/Account Details2) Medical Record Details3) Communication Details

Patient/Account DetailsThe data displayed is not editable and is designed to give the payer the information necessary to identify the facility, patient, and date of service.

Medical Records DetailsDiagnosis: Additional diagnosis informationProcedures: Major procedures performed on a given

dayVitals: Heart Rate, Resperatory Rate, Max

Temp, Blood PressureLab/Diag. Results: Important or relevant lab or diagnostic

resultsComments: Not displayed on faxed version of reviewSocial Worker: Applicable only if a social worker is involvedMedical History: Medical history related to prior visits that is

pertinent to current visitSeverity of Illness: Describe why the patient is in your

facilityIntensity of Service: Describe what your clinicians have done

to the patientTreatment Plan: Describe what the expected care plan isDischarge Plan: Describe expectations with respect to patient

discharge

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Communication DetailsNot Communicated – all new reviews are by default not

communicatedLive – verbal communication either in-person or via phone callVoicemail – clinical review left on recipient’s voicemaileFax – clinical review has been electronically faxed to the payerFaxed – clinical review has been faxed to the payerNot Required – a clinical review does not need to be

communicated to the payer

To navigate from one date of service to another, click the appropriate arrow button.

NOTE: The navigation arrow(s) also saves the information.

Reviews Required Work ListReviews Required Work List

Reviews Required is a summary report of all patients that have at least one date of service without a review entered into the system. By using the pull down menu at the top of the page, the user is able to identify patients requiring a review with the selection criteria: All, No Initial Review, Discharged, In House and One Day Stay

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By clicking on any value, a detailed list of accounts will be displayed. This list follows the same color-coding convention as the summary report. To view the Account Details, click on the appropriate Account Number or Patient Name.

Click on any Review Required icon:

Enter the appropriate clinical information in the Clinical Review screen. After saving the information, the icon will change as shown below. Refer to Table I in the Appendix for all icon descriptions.

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Work List Criteria Clinical Review Completed Clinical Review

Communicated Day Pended Entered Day Denied Entered Reconsideration Requested Reconsideration Outcome

Entered


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Reviews Not Communicated Work ListReviews Not Communicated Work List

Reviews Not Communicated is a summary report of all patients that have at least one date of service with a review entered into the system and not yet communicated to the payer. By using the pull down menu at the top of the page, the user is able to identify patients with reviews not communicated with the selection criteria: All, Discharged and In House

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Entered


Click on any Review Completed icon:

Enter the appropriate communication method in the Clinical Review screen. After saving the information, the icon will change as shown below. Refer to Table I in the Appendix for all icon descriptions.

Please note: A communication method can not be selected until the “Review Completed” check box is selected.

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Awaiting Outcomes Work ListAwaiting Outcomes Work List

Awaiting Outcome is a summary report of all patients that have at least one date of service with a review entered and communicated to the payer, yet the initial certification level is unknown. By using the pull down menu at the top of the page, the user is able to identify patients with reviews that have been communicated and are awaiting an outcome with the selection criteria: All, Discharged and In House.

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Based on the payer’s outcome, the user enters one of the following three choices:

1) Certified Days2) Pended Days3) Denied Days

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Entered


CERTIFIED DAYS

To certify a day select the word Certified from the drop down for the date a service and then hit the save button in the right hand corner of the screen. The date of service will now have an authorized and a outcome level displayed. The Certified level will automatically update to reflect the Acuity level.

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PENDED DAYS

To pend a day select the word Pended from the drop down for the date a service and then select a pended reason from the drop down in the pop up window. Then hit submit in the pop up and it will pend the day. The pended reason will show up in the notes for that date of service.

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DENIED DAYSTo deny a day select the word Denied from the drop down for the date a service

The user will then select a Denial Reason and the authorized level of care from the two drop downs in the pop up window. Then hit submit in the pop up and it will deny the day. The denied reason will show up in the notes for that date of service.

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Pended Days Work ListPended Days Work List

Pended Days is a summary report of all patients that have at least one date of service that is PENDED. By using the pull down menu at the top of the page, the user is able to identify patients with an outstanding pended status with the selection criteria: All, Discharged and In House.

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To remove the PENDED status, the user must select the CERTIFIED or DENIED From the drop down for that day

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Denied Days Work ListDenied Days Work List

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Denied Days is a summary report of all patients that have at least one date of service in which the certified level is lower than the acuity level (i.e. a denial) and the authorized (PA/MD) user has taken no action. An account remains on this report until the PA/MD enters an action. By using the pull down menu at the top of the page, the user is able to identify patients with denied days awaiting PA/MD action by using the selection criteria: All, Discharged and In House.

When a date of service is denied the user has two ACTION options:1) Close2) Request Reconsideration

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CloseThe information available supports the payer’s determination. Outcome reflects Certified level automatically. The user is prompted to select a Closed Reason.

Request ReconsiderationThe information available justifies a clinical argument. Outcome remains blank (null) until final determination is received from the payer.

Reconsideration Requests Work ListReconsideration Requests Work List

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Reconsideration Requests is a summary report of all patients that have at least one date of service in which the certified level is lower than the acuity level (i.e. a denial) and the Medical Director has taken action. An account remains on this report until the Insurance Company responds with a determination for the disputed days. By using the pull down menu at the top of the page, the user is able to identify patients awaiting a final determination after the PA/MD action by using the selection criteria: All, Discharged and In House.

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Upon receipt of payer outcome, the user selects the approved level of care in the Outcome drop-down box. UR Direct treats full denials and lower level of care denials in the same fashion in that the user is prompted to enter a Closed Reason upon submission.

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Avoidable DaysAvoidable Days

To enter an avoidable days select the icon under the Avoidable column for the corresponding date of service. The Avoidable Days form is filled out for each day the reviewer feels could have been avoided based on the selection on the form. The form is further explained on the following page.

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Once the avoidable day form is filled out it is placed on the avoidable days work list. This case will stay on the work list until the case complete check box is selected. The supervisor or the Physician Advisor should complete this action.

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Target LOS Target LOS

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The Target LOS feature is used to assign a DRG to the patient while they are still in house so that an average length of stay can be applied to the account. This feature will help the hospital better manage their Medicare length of stay.

Review For DischargeReview For Discharge

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The Review For Discharge is a summary report that shows all the Medicare patients that are currently in house and are at the Medicare geometric mean Length of stay. This work list is used to flag accounts that should be discharged today. The yellow icon will show up on the date of service that is two days away from reaching the target LOS.

Review For Continued StayReview For Continued Stay

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The Review For Continued Stay is a summary report that shows all the Medicare patients that are currently in house and are past the Medicare geometric mean Length of stay. This report is used to flag accounts that are past the length of stay that the hospital will be reimbursed for by Medicare. The red icon will show up on the date of service that the patient should be discharged on.

Discharge PlanningDischarge Planning

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There are two type of discharge planning forms in UR Direct. The first is the daily discharge plan area on the daily review screen. The second is a more complete discharge form that can be used when a patient is being transferred to a different location including home. To access this form select the icon above the patients name on the account level screen as displayed above.

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This form can be started at the time of admission and completed when the patient is finally discharged. Once information is entered into this form and saved it will show up on the Discharge planning work list until the complete check box is selected in the form as highlighted above.

Search AccountsSearch Accounts

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The Search Accounts feature allows a user to locate a patient using one of the following search criteria:

Account Number Medical Record Number Admit Date Discharge Date Patient Last Name Patient SSN INS Policy Number

Launch into the account details by clicking on any of the values listed.

Payer ContactsPayer Contacts

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UR Direct comes with a shared electronic address book. Users can Add and Edit payer contacts and addresses. Contacts are used to identify the recipient of the review in the Clinical Review interface. Only Active contacts can be viewed from the Account Details screen.

Reminders ReportReminders Report

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The Reminders Report aggregates and displays all outstanding Reminders set by users. A reminder will remain outstanding until the user closes the reminder. To close a reminder, select the appropriate check box.

Insurance Changes ReportInsurance Changes Report

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The Insurance Changes feature notifies the user of any account in which a patient’s primary insurance has been changed by registration / patient accounting.

Click on the Account Number or Patient Name to launch the account details screen.

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Click on the Insurance Change icon.

The user has three options:

1) Click the ACCEPT button2) Select the Update current Alias with new Alias and click the

ACCEPT button3) Select the Update current Policy # with new Policy # and

click the ACCEPT button

Option 1) Does not update the Payer informationOption 2) Refers to the Payer Alias functionality, by selecting this check box the current Payer will update to the payer listed.Option 3) Refers to the Insurance Policy #, by selecting this check box the Insurance policy number will update to the new number. This is typically selected when option 2 is selected.

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Ask MD-XAsk MD-X

If you have any questions, please contact us by clicking on the Ask MD-X icon. Simply enter a subject and type a message. Your message will be directed to the appropriate and responsible contact. We will respond as quickly as possible.

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eFax StatuseFax Status

The eFax Status list shows all of the faxes that have been sent out by the user. From this list you will be able to see what the status is of the fax. There are three different status’:1 In process: This fax has not finished transmitting to the payer2 Success: This fax was sent successfully to the payer3. Failed: This fax did not go through successfully and it needs to be resent to the payer.

You can access the account by selecting any of the values listed for the patient to go to the account screen for that patient.. It is the responsibility of the person that sent the review to check that the fax went through successfully.

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Unit AssignmentUnit Assignment

The Unit Assignment page is used to assign units to all the case managers for the hospital. MD-X will set up the default unit assignment when the engagement starts but anyone who has access to this page can make any changes on a daily, weekly or monthly basis by using the “Set Schedule For” functionality.

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Payer AliasesPayer Aliases

This feature allows authorized users to manage the mapping of payer codes to UM Agents or Payers. Many times, hospitals have multiple payer codes representing one payer. Rolling these payer codes up in to one alias helps with maintaining payer contacts. The reports at are generated out of UR Direct are based on Payer Aliases.

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DRG ManagerDRG Manager

The DRG Manager is used to determine which LOS model your hospital will be using. From this screen you have the ability to add key words for a given DRG so that your searches will be more efficient.

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AppendixAppendixTABLE I.

URDirect utilizes symbols to indicate the status of every clinical review. The following table displays each symbol and the associated status description:

Clinical ReviewCompleted

Clinical Review Not Required

ProcedureEntered

Clinical Review Communicated

NO NO NO NO

NO NO YES NO

YES NO NO NO

YES YES NO NO

YES NO NO YES

YES NO YES NO

YES YES YES NO

YES NO YES YES

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Technical Specifications & System RequirementsTechnical Specifications & System Requirements

Software RequirementsINTERNET EXPLORER 6.0 SERVICE PACK 1MICROSOFT EXCEL (SR1A)ADOBE ACROBAT READER 6 OR HIGHER

Hardware Minimum Requirements1 GHZ PROCESSOR 256 MB RAM256 KBPS INTERNET CONNECTION (T1, CABLE MODEM, OR DSL INTERNET CONNECTION)* Please note that this requirement is based on consistent speed availability. Network congestion on user’s own private network could drastically affect performance.

Recommended Requirements2 GHZ OR HIGHER PROCESSOR 512 MB OR HIGHER RAM512 KBPS INTERNET CONNECTION (T1, CABLE MODEM, OR DSL INTERNET CONNECTION)*Please note that this requirement is based on consistent speed availability. Network congestion on user’s own private network could drastically affect performance.

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MD-X Contact InformationMD-X Contact Information

CAITLIN ZULLADirector, Client Services

[email protected] ext. 393

TOM MURRAYManager, Software & Support


TOM PERRYVice President, Operations


KATHY XANTHOSDirector of IT


DOUG MATHEWSSoftware Support Analyst


ARIF BASHIRDirector of IS


Software Support Contact Information:Email: [email protected] Free Phone Number: 866.772.0069After Hours Support Phone Number: 201.779.0087

Corporate Information:MD-X SOLUTIONS, INC.725 DARLINGTON AVE.MAHWAH, NJ 07430PHONE: 201.444.9900FAX: 201.444.0016WWW.MD-X.COM

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mailto:[email protected]





