Orders

Medicare Medical Necessity Checking

Click the link for a handout tutorial on Advanced Beneficiary Noticies with Medicare patients and Medical Necessity Checking.

What:   Patient Status Order (PSO), Medicare Medical Necessity, and Order to Scheduling go-live

When:  Go-live will coincide with Cerner Registration & Scheduling go-live, August 4th

Who:    All clinicians and end-users who order and/or schedule any radiology orders, PT/OT, Rehab orders (e.g., MRI, CT, US, CV, Mammograms, NM, etc.)

*Does NOT apply to Perinatal Center or GYN ultrasounds or plain DX films

FOR MEDICARE PATIENTS ONLY:

If an inappropriate diagnosis is placed with a testing order, you will have to either:

  • Select the proper diagnosis (icon goes away), or
  • Fill out the advanced beneficiary notice (ABN) and explain to the patient the cost of the test that will not be covered by Medicare, as the incorrect diagnosis code has been applied
  • Diagnosis codes determined by CMS
  • Will always qualify for mammogram exams due to frequency rules
  • If not addressed, and is a schedulable test, this will be prompt those scheduling the test that an ABN is required

Medical Necessity ABN Checking – In Summary

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    • Qualifies ONLY for Medicare Patients
    • CMS defines imaging and lab tests that must have a valid diagnosis
    • When a test is ordered without an applicable diagnosis
    • A target will appear with a “Review ABN” button

HOW to RESOLVE

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    • Add an applicable diagnosis for each specific order
    • OR perform the “Review ABN” process, have form signed and scanned

Click HERE for Tutorial Handout

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Related Results Functionality

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Related Results is functionality that allows for existing results to be displayed when placing orders. 

When the order is added to the scratchpad, the 3 most recent reports/images will display in related results. Clicking “more…” will display more reports/images.

To view the report/image, right click on the result and select “View Details”.

**note- we are still working on getting images for echos, but the reports are there.

Right now this is on for all echos, and chest x-rays.

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PDMP Information for PowerChart

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On March 1, 2020, the requirement will go into effect for pharmacists and prescribers to check the Prescription Drug Monitoring Program (PMP) history before dispensing or prescribing opioids, benzodiazepines, barbiturates, or carisoprodol. To make this easier and improve compliance, we are bringing the PDMP information to PowerChart via the MPages.

There is a new component on all provider-facing MPages that will launch a new window linking out to the state PDMP. This link does not require additional credentials. It is updated real time as the state PDMP is updated with new prescriptions.

Things you need to know:

  • Providers MUST click the “View Drug Report” link for the state to keep record that the PDMP was accessed prior to writing a prescription. Just looking at the score on the MPage does not count.

  • The report gets more specific as providers move down the page (see examples on page 2).

  • There are tutorials and informational links throughout the drug report that link out to information like how the NarxScore is calculated or what the Overdose Risk Score means.

  • The last digit in the score means that there are that many current, active prescriptions of that type for this patient. (ex: 839 narcotics score from the picture above = 9 active narcotic prescriptions)

How to document you consulted PDMP in your Note

Dynamic Documentation Users:

The EMR Team has created a global autotext of “;substancescreening” for you to add to the appropriate section of your note. You will notice when you enter the autotext, it will pull in the statement “Review of opioid prescriptions performed and screening for SUD completed.” Please add this autotext to your personal list to ensure you use it when necessary.

PDMP.png

Powernote Users:

In the Medicare Annual Wellness Exam encounter pathway, the EMR Team has added the verbiage of Review of Opiod Use as a required field to complete the note in the Review Management section. Please select the statement of “Review of opioid prescriptions performed and screening for SUD completed” when appropriate.

PDMP 2.png
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DNR Consent and Order

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The 2017 Texas Legislature added new Subchapter E to the Health & Safety Code Chapter 166, entitled “Health Care Facility Do-Not-Resuscitate Orders.” The new law establishes requirements for the issuance of a DNR order.

INPATIENTS: The law applies to patients who are admitted to UMC under observation or an an inpatient. This does not include outpatient settings such as radiology, clinical laboratory, Southwest Cancer Center, home health, outpatient rehab, and emergency center. Four outpatients areas, continue to honor the Texas "Out-of-Hospital Do-Not-Resuscitate" order if the patient has one.

INFORMATION: Upon admission, UMC must provide the patient, or the person authorized to make treatment decisions on behalf of the patient, information about Advanced Directives and DNR orders.

CONSENT. The consent of the patient or patient’s surrogate decision-maker is necessary for a DNR order except in very limited circumstances. Use the UMC DNR Consent form. This form can be printed by any HUC or nurse and is located on the UMC Intranet with other consent forms.

ATTENDING PHYSICIAN: Only an ATTENDING PHYSICIAN may issue a DNR order. The attending Physician is the physician selected by or assigned to a patient who has primary responsibility for a patient's treatment and care. It may include another physician within the primary physician's service who is covering for the primary physician. It does not include resident physicians, fellows, or advanced practice providers. The consent form must be valid, signed, and on the chart PRIOR to placing any order for DNR.

If you have questions, please contact Legal at 761-0995. Michael Economidis is the main point of contact for consent issues, but Lois Wischkaemper and Kristi Ward are also available

Click HERE for printable handout

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Ambulatory: Consult/Referral Updates

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FYI: Updates to the Consult/Referral Folder for the Ambulatory Locations

New orders to be aware of, as they may change your current workflow...

Consult/Referral Audiology

* This new order is intended for use at the new TTP ENT Audiology location. You will also find the SoHP Speech and Hearing audiology department providers as well.

Consult/Referral Pedi Psychiatry

* Not to be confused with the Consult/Referral Pedi Behavioral Health order/providers at UMCP.  This is a new order for the peditric psychiatrist referrals.  Note the reference text form that pops up when you place the order.  Please print and fax that to the receiving clinic.  When automation of that process is built, we will let everyone know.

Consult/Referral SWCC Lung Screening

* This new order is for the SWCC Lung Screening navigator to call and screen your patient to see if they qualify for the Lung Screen Catscan (currently orderable by only SWCC pulmonolgy team).  This will assist you in determining the risk and necessity of your patient's need for further testing and referral to a pulmonary oncology specialist.  Please call the SWCC Lung Navigator for further questions.

Consult/Referral Transplant Services

* This will eventually be the new consult/referral order for the new Transplant Clinic in the MOP. That department will inform us when they are ready to go

 

 

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Banner Bar: Code Status Addition

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Code Status will now be on the Banner Bar next to the DOB, Age, Gender, and Privacy/Security entry.  This will pull from the status identified within the Code Status order.  The DNR/AND (Allow Natural Death) will be abbreviated to DNR/AND.  The Code Status will show on the Banner Bar with the most recent Code Status for each visit (clinics currently excluded) and will update as the code status is updated.

The code status will be in the Banner Bar beginning Monday, April 10th. Code status is only visible on inpatient encounters. Please see screenshots below.

Ambulatory (Clinic)

Inpatient

 

 

 

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Ameritox Order Information

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Ameritox Ordering Information

Starting Dec 12th, 2016, Ameritox orders for some clinics will now be available to order through Cerner.  All orders start with the words, “Ameritox”. This is to help simplify the order searching process.  The process will be similar to the way other orders are placed in the system today.  However, the Ameritox requisition number will be required and must be placed in the order for the order to transmit.  This is the same number that is being used on the paper requisition today. Furthermore, the clinics will need to continue to send a facesheet and medication list with each order.  This also should be the same process in place today.

 

The results will still flow into the flowsheet as they do today.

 

Search by ICD-10 Code

You have the ability to search by ICD-10 codes by using the IMO quick search box. This can be found on the summary page, add order, and problems and diagnosis menus

Pros:  It is a quicker why to find what you need and your list will be shorter

Cons: You still have to use the DA tool to set the display to get the correct ICD-10 term in your note. So please remember to click on the target or the exclamation point to open up the DA tool.

Here are all the places that you can use the IMO quick search.

Add Order Screen:

Problems and Diagnosis

Summary Views

New Future Order Functionality

We would like to take this opportunity to provide education to all regarding some new future order functionality. Future orders are not new to the outpatient provider workflow.  Almost all orders launched from an outpatient encounter are set to "future".  This allows you to order labs or radiology exams in advance.  For example, if you wish a patient to have a repeat CBC in a month, you can place the order from the clinic visit today and when your patient presents to the lab a month later the order will be there ready to go. 

With the new future order functionality that will be turned on in June, you will be better able to select a time frame or grace period for your patient's tests.  Whether a single order or recurring one, this new ability will make the future order process much clearer to understand.

 

 

Brief Overview:

Future order details support outpatient physician workflow within PowerChart by providing the ability to create one-time and recurring future, non-pharmacy, orders. Future order details target the following functionality:

•Placing an order - Specify an approximate time frame for one time future and recurring future orders. An example of a future recurring order is a lab order to be done every one week for the next four months. •Activating an order - Easily view, identify and activate future orders for a specified patient. Updates to the Order profile. •Manage and monitor - Setting an expiration date for when future orders should no longer be considered valid. •Placing Future Order by selecting yes or clicking on the calendar icon.   We can set clinic visits to default to ‘yes’, BUT:  The future order details window will not automatically pop-up, the calendar icon will have to be manually selected as shown below.

•Only certain orders will have future order functionality, such as:

          –Laboratory

          –Diagnostic Radiology

For a full tutorial and discussion regarding single order, recurring orders, and editing multiple future orders at once, please select the BLUE link below.

 

Click HERE for full tutorial