Improving Patient Account Management Processes with EMUE Script Automation

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Improving Patient Account Management Processes
with EMUE Script Automation
INVISION RCM1Session 312

• Carol Maier, Project ManagerRon Powell,
  AnalystSUNY Upstate Medical University,
  Syracuse, NYChristine Bachtel, Director of Rev
  Cycle Support  St. Vincents Hospital, NYC
• Bridget Palan, Technical Support Manager
• Aria Health
• Paul  Martin, VP Rachel Bowles,
  AnalystDatabound Healthcare Solutions

Innovations 09 Siemens Customer Education
Symposium Sharing ideas. Expanding knowledge.
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What is This Presentation About?

• Sharing Ideas and Processes
• EMUE Overview what is it?
• History, Capabilities, Product Goals Roadmap
• SUNY Upstate Medical University
• Discharging and re-registering recurring
  outpatients
• Bad debt write-off
• St. Vincents Hospital
• Translating charges for special billing scenarios
• Automated Medicaid research and re-billing
• Frankford Hospital
• POS system cash posting
• Medical Record system charge posting with Patient
  Management Updates

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What is EMUE anyway?

• What is OLIE?
• What exactly is the Express Mainframe User
  Emulator?
• Runs existing OLIE scripts with
• Complete Automation Scheduling, built-in
  terminal management, password encrypted sign-on
  and file management with email notification of
  success or failure
• Saves Time.
• Development Tools OLIE specific editor with
  interactive source-code debugging to create and
  modify scripts on-the-fly.
• Saves Time and minimizes costly errors.
• Multiple Sessions Up to 10 simultaneous scripts
  per PC.
• Saves Time Money
• New command and functional enhancements
  Automate more processes and automate them more
  completely.
• Saves Time.
• Use for ad-hoc functions, scheduled jobs, or as
  an interface
• OLIE on steroids.

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EMUE Overview - History

• OLIE is a great tool for automating user data
  entry into INVISION and SIGNATURE.
• EMUE has grown into a full featured process
  automation and data movement tool.
• OLIE 3270 ? ? text file
• EMUE

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How does EMUE Automate Processes?

• Our development goal with EMUE is to automate all
  activities associated with a script.
• File polling, file identification, archiving,
  scrubbing, and preparation
• Connect, Sign-on (dedicated or pooled), and run a
  script
• Notify appropriate persons upon success and/or
  failure of a script, and include appropriate
  information and/or files.
• Archive and/or perform additional post processing
  tasks like
• Time/Date stamping a file.
• Staging file for another process
• Starting additional processes.
• Make it easier to create and debug scripts, and
  help prevent costly errors.
• EMUE makes it easy to create robust, hands-off
  processes for sharing data between systems.
• Doesnt require a PhD in Computer Science to
  build robust processes use existing knowledge
  and resources.

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EMUE Overview - History

• Statistics
• First Installation in 2002
• OLIE has about 35 commands (3270 screen, files,
  and workflow)
• EMUE has over 90 commands plus 90 configuration
  options
• Automation (scheduling and polling)
  Notification (email)
• Enhanced analysis and workflow
• Database access
• Running 3rd party programs
• Date processing, String manipulation,
  Validation
• Data scrubbing
• File management
• Web scripting
• Archiving
• Encrypting passwords and other sensitive
  information

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EMUE Roadmap

• EMUE 3.1 Progress
• Beta Spring and Summer of 2009
• GA Fall 2009
• Highlights
• FTP
• Pooled sign-ons
• Overnight script suspension
• Run OLIE scripts by adding one configuration
  option

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EMUE Roadmap

• Future Release Feature Options
• Soarian Interoperability
• Email as a data source (pop3 message retrieval)
• File compression (Zip and Unzip) capability
• Structured Error Handling

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SUNY Upstate Medical University

• 378 Licensed Inpatient Beds
• 18,071 Inpatient Admissions
• Inpatient Length Of Stay of 6.5 days
• Adult/Peds Emergency Department
• 51,262 ED visits
• 77 Hospital-Based Clinics
• 202,487 Hospital Clinic Visits
• 225,000 Referred Ambulatory Visits
• Only Academic Medical Center in CNY
• Level 1 Trauma Center
• Specialty Centers Include
• Pediatric ED, Pediatric ICU, Clark Burn Center,
  Regional Oncology Center, CNY Gamma Knife Center,
  Joslin Center for Diabetes, Renal/Pancreatic
  Transplant Program, Designated Stroke Center

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Motivating Factors

• We were a big OLIE user
• BUTOLIE needs babysitting
• SO, When we saw EMUE, we were very excited to get
  a product that would allow us to run OLIE scripts
  at defined times with a tool to manage OLIE

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Implementation Process

• EMUE gets installed on a workstation
• Training sessions were held for 2 days
• Then we rolled out some simple scripts

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Problems with Old Process

• High volume OLIES were effecting CPU
• Staff Time spent babysitting OLIE
• Difficulty debugging OLIE

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How EMUE could help

• EMUE can be scheduled to run at night and on
  weekends
• EMUE can kick off other EMUEs
• EMUE can send email on script status-Success/Failu
  re
• EMUE includes a tool for debugging OLIE scripts
• EMUE has all the functionality of OLIE plus lots
  more

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Discharge and Pre-Registration of Recurring
Outpatient Accounts

• Previously we had run an OLIE script on the last
  business day of the month. This was both system
  and resource intensive.
• Initially, we continued to run OLIE/EMUE during
  the day so we could monitor it.
• Once we gained confidence and knowledge, we
  schedule it to run at 230 a.m.
• It is completed by 600 a.m. when the system
  usage begins to climb

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Script to Discharge and Pre-Register Recurring
Outpatients

• At 130 A.M. on the last business day of the
  month the Windows scheduler kicks off an EMUE
  script that runs six ad hoc reports which
  identify all open (OA) recurring (pt type D)
  accounts with a specific hospital service.

GQ
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Script to Discharge and Pre-Register Recurring
Outpatients
At 230 A.M on the last business day of the
month, a chain of six EMUE scripts are run, using
the six Ad Hocs produced at 130 as input.
Dsch/Prereg script
GQ
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Script to Discharge and Pre-Register Recurring
Outpatients

• Each service specific script passes the name of
  its ad hoc and the name of its successor script
  to the main discharge and prereg script.

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Script to Discharge and Pre-Register Recurring
Outpatients

• The main script, DSCHPREALL, searches for the
  newest version of the requested ad hoc. When it
  finds the report it loads account numbers into a
  temporary list. It then processes each account
  through a custom built pathway that discharges
  recurring patients with a month-end date,
  pre-reg's them with a 1st of the next month date,
  then copies orders from the discharged case to
  the pre-reged case

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Script to Discharge and Pre-Register Recurring
Outpatients

• After processing all of the accounts loaded from
  the Ad Hoc , email notifications are sent to
  notify of success, or failure with output logs
  attached.

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Script to Discharge and Pre-Register Recurring
Outpatients

• As the DSCHPREALL script concludes, it calls the
  next service specific script using the name
  passed to it by the previous service specific
  script and processes the next hospital service
  through the main script.

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Script to Discharge and Pre-Register Recurring
Outpatients

• This repeats through six iterations. The last
  service script passes a blank nextscriptname and
  gotoscript which tells the DSCHPREALL script that
  we are finished.

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SUNY Upstate Medical UniversityBad Debt Write-off

• Bad Debt accounts need to be identified and zero
  balanced
• The old process required several manual steps to
  prepare the input files, then additional manual
  intervention to run and monitor the three OLIEs
• The EMUE process accepts the input on .XLS files
  directly from Finance. It also processes all
  three CDM types without manual intervention.
• Benefits include the time formerly spent
  preparing input, no tweaking of OLIE scripts, and
  all three CDMs are processed at the same time.
  In addition the EMUE script outputs a detailed
  log file listing bad accounts, accounts that are
  in historical, and recurring accounts.

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St Vincents HospitalEntering Evaluation and
Management Charges for Clinic Visits

• Requirement - Automate the posting of clinic
  visit Evaluation and Management charges and still
  be able to identify the visits from the Chinatown
  or Senior Health clinic. The workflow of the
  clinic staff could not be impacted.
• Old Process - There was an auto-charging process
  based on the Clinic Code. One visit charge per
  clinic. The EM Level was identified by the CPT
  code only. Corporate Compliance mandated that
  the auto-charging process be discontinued.

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St Vincents HospitalEntering Evaluation and
Management Charges for Clinic Visits

• EMUE Process - The clinic staff continues to
  enter the EM CPT codes in INVISION Patient
  Management. A Patient Accounting Ad Hoc report
  is scheduled daily for Chinatown and Senior
  Health accounts that had CPT Procedure segment
  created today. The Chinatown EMUE script is
  scheduled thru Windows Scheduler to run at 7 am
  daily. The EMUE script copies the patient
  number, clinic code, CPT code and date of service
  from the Ad Hoc Report, maps the clinic code and
  CPT code to the correct charge code and enters
  the data on the Charge Entry screen in Patient
  Accounting.
• Benefits - We have been able to discontinue the
  auto-charging as mandated Post charges based on
  EM levels without changing the workflow of the
  clinic staff Reduce the number of incorrectly
  posted charges that need to be manually reversed.

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St Vincents HospitalAutomated Medicaid
Eligibility Search and Re-billing

• Requirement - We have a large population of
  patients that are registered as self pay. Many
  of these patients have active Medicaid or are in
  the process of applying for Medicaid. The
  request was made by the VP of Patient Accounting
  to improve the identification of the active
  Medicaid information using HDX Eligibility.
• Old process - A vendor would do a sweep of the
  New York State Medicaid file and find valid
  Medicaid numbers. This information was returned
  to the hospital to bill. The vendor received a
  percentage of the reimbursed amount.

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St Vincents HospitalAutomated Medicaid
Eligibility Search and Re-billing

• EMUE process A query was created in Echo Loader
  to capture the self pay and pending Medicaid
  accounts in the Active and Bad Debt files. The
  EMUE script creates a list by executing the query
  using the command getodbcdata. Using the
  accounts listed, the script pulls and logs data
  from the Patient Accounting screens (Name, Date
  of Service, Date of Birth, SS, Sex, FC, Medical
  Record , Account Type, Hospital Service and
  Insurance Plan 1). If there isnt a SS an HDX
  Equifax inquiry is requested and the results
  logged. EMUE will launch a Medicaid Eligibility
  request and log the results. Comments with the
  results are added to the accounts. There are
  rules for finding Medicare, Medicaid and Medicaid
  Managed Care. Logs are created for Patient
  Access to review the found Social Security number
  and for Billing to review the found insurance
  information. We eliminated the script updating
  and re-billing the accounts because of the risks
  associated in incorrectly updating insurance
  information. We can also exclude accounts from
  qualifying for the script by entering a 28
  record. This is used if a patient has limited
  Medicaid coverage.

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St Vincents HospitalAutomated Medicaid
Eligibility Search and Re-billing

• Benefits We have eliminated the dependency on
  the vendor to find active Medicaid. We have been
  able to expand the script to find missing Social
  Security numbers and average about 150 valid
  Social Security numbers per month. We find an
  average of 400 active and billable Medicaid or
  Medicaid Managed Care accounts per month.

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St Vincents HospitalOther Scripts/Processes on
CD

• Ad Hoc Script (my favorite) - Did you ever have
  a list of values, patient account numbers or
  medical record numbers that you needed to add to
  an Ad Hoc report? We have a script that takes
  the list and populate the qualifications of an Ad
  Hoc report. This eliminates the need to manually
  enter hundreds of numbers and eliminates
  inaccuracies.
• High Volume Comments By using the Ad Hoc script
  as a model, we created a script to post High
  Volume Comments. This came in handy when we had
  to post the comments from 10 days of Medicare
  remits that were on the TCEs.

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Aria HealthPOS System Cash Posting

• Problem We needed to automate the posting of
  the cash that is collected at the point and time
  of service via our POS Payment System in a
  timely, accurate and efficient manner.

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Aria HealthPOS System Cash Posting

• Our POS Payment System generates a file nightly
  of the cash collected that day and transfers the
  file to a network drive. EMUE picks up the file,
  which includes the payments and user comments and
  posts them to the Invision system. This process
  is scheduled to run after day end, this helps to
  ensure that the accounts have passed from the
  Patient Management system to the Patient
  Accounting system. Once the process has been
  completed, EMUE then forwards a script complete
  notification email to our Tech Support team who
  then will settle the input/output data files and
  forward them to our Batch Control area for the
  finalization of the batch.

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Aria HealthPOS System Cash Posting

• Benefit This process ensures timely and
  reliable results. There is no need for operator
  intervention to process the job, which reduces
  FTE time necessary. EMUE gives us the ability to
  run the process daily, 7 days a week without 24/7
  FTE coverage. Once the process is completed, an
  email is forwarded to our Tech Support team who
  then settles the input/output data and forwards
  to our Batch Control Department for finalization
  of the payment batch.

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Aria HealthMR System Charge Posting w/PM Updates

• Problem ED accounts are coded by our MR
  department. There was a time that these account
  were being sent via batch to our Billing area for
  manual charge entry into both our Invision and
  Signature systems. We are responsible for both
  the facility and professional charge entry for
  the ED, we needed to automate this process.

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Aria HealthMR System Charge Posting w/PM Updates

• Old Process Our first automation with this
  process was to create fields in our Signature
  charge entry screen for the billers to manually
  key the Invision patient number, CDM service code
  and any other data that was needed to update the
  charge into Invision while they were entering the
  professional charges into the Signature system.
  We would then run an ad hoc to extract the
  Invision data and run an OLIE script to upload
  the charges.

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Aria HealthMR System Charge Posting w/PM Updates

• PFS and MR were able to meet and create a pathway
  within our MR coding system that would generate
  files for both the Invision and the Signature
  system daily for upload. The coder enters all
  the charge information while coding the ED chart,
  this includes CDM service code, DX information
  and ED provider information. The files are
  generated daily and are placed on a network drive
  for pickup. EMUE picks up the file, copies the
  file and creates 3 files for parallel processing.
  2 files created are processed the same day
  received, the third file (diagnosis) is sent to a
  holding directory to be processed on day 2.
• The first parallel file that EMUE will process is
  the ED Doctor file. This process updates the
  ED provider that was captured by the coder via
  the ED chart review via the Patient Management
  pathways.
• The second file that is processed is the charge
  entry file.
• The third file is pulled from the holding
  directory on day 2 and adds the diagnosis to the
  accounts that were charged yesterday. This is
  necessary due to the way our Contract Management
  system is set send allowances to Patient
  Accounting.

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Aria HealthMR System Charge Posting w/PM Updates

• Once the files are completed EMUE sends email to
  all responsible team members to alert them that
  EMUE has completed the script.
• Daily balancing is done and forwarded to our
  Batch Control area for batch closure.

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Aria HealthMR System Charge Posting w/PM Updates

• Benefit These processes have saved time and
  are efficient. EMUE is a dependable tool. EMUE
  can be used with existing scripts seamlessly.
  Its easy to debug and modify scripts when needed
  with EMUE. All files are automatically archived
  and easily accessed when needed.

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Aria HealthOther Scripts/Processes on CD

• 72 hour ad hoc sent to users via email.

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Wrap-up

• CD contains
• Scripts presented here
• Additional scripts provided by these sites
• Adhoc Script
• High Volume Comments
• 72 Hour Adhoc Emailed
• A free license for our OLIE/EMUE script editor.
• OLIE/EMUE syntax highlighting, parsing, and more!
• Links to the FREE OLIE/EMUE script library which
  has almost 100 OLIE EMUE Scripts.

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Questions? Comments? Feedback? THANK YOU!
INVISION RCM1 Session 312Please take a few
moments to complete your evaluation form before
you leave.

• For more information you can go to
  http//www.databoundhealthcare.com
• FREE Resources include
• The scripts mentioned in these presentations
• Almost 100 more in the community based script
  library
• Databounds OLIE/EMUE script editing tool