Account Information

The Account Information tree summarizes patient demographic information (based on custom system configuration) with data captured for purposes of state and/or registry reporting. To update data fields in the Account Information tree, click on the blue button and select the appropriate selection from the drop-down menu.

Users can expand the width of the Code Summary tree by clicking on the arrow in the top right corner of the viewer.

Unspecified Code Edit Flag

On April 1, 2022 CMS made the Unspecified Code Edit effective. This new edit is triggered when a code from the unspecified code list is assigned by a coder. It is the provider’s responsibility to determine if a more specific code from that subcategory is available in the medical record documentation by a clinical provider.

If additional information to identify the laterality from the available medical record documentation by any other clinical provider is unable to be obtained, or there is documentation in the record indicating that the physician is clinically unable to determine the laterality because of the nature of the disease/condition, then the provider must enter that information into the remarks section. Specifically, the provider may enter “UNABLE TO DET LAT 1” to identify that they are unable to obtain additional information to specify laterality or they may enter “UNABLE TO DET LAT 2” to identify that the physician is clinically unable to determine laterality. If not entered, the claim will be returned.

Fusion CAC/CDI can support the addition of this field to your account information viewer and send the necessary information, known as the billing note, downstream if required. If this is something that you need, please reach out to the Dolbey SME Team at smeteam@dolbey.com.

Add-On Modules and Viewers

Audit Module

The Audit Worksheet displays when the account is opened by a user in the role of Auditor. The Audit Worksheet can be popped out onto a separate screen, allowing the Auditor to have a screen for reviewing the chart. By selecting “Show All” codes in the Unassigned code tree, the Auditor is taken to the documents/documentation supporting that code. This will help streamline the audit process.

An account can have one or more audits added to it. By clicking +Add Audit a new, blank audit worksheet will be created. These worksheets are numbered and displayed at the top of the audit viewer, along with a date stamp indicating when each worksheet was opened. The worksheet currently being viewed will be highlighted with a green background.

Data in the audit viewer is only intended for coder education and administrative staff to score how the Coder is doing in a report card. The Auditor will need to add the Coder of Record so that the Coder of Record, any Auditor, or other user role that has been given access can view the audit worksheets.

The audit module allows for the role of an Auditor within the application. The role of an “Auditor” has the same privileges as a “Coder” when it comes to account editing. More details on audit functionality can be found in the Audit Worksheet.

Discrete Values (Viewer)

This feature may not be supported by your organization’s EHR vendor. The Discrete Values viewer show trending data or data that has values. The most common examples of discrete values are lab values and vital signs. The viewer can be popped out into another window by clicking on a little square with an arrow pointing to the right in the navigation tree next to the viewer name.

An older style of discrete data can be displayed in a Discrete Values viewer. Tabs across the top of the screen display the categories of data. This displays each of the types of discrete data elements, which may vary by organization.

The Discrete Values viewer has a Filter by Month box, listing the months that contain values. Selecting a month will highlight all the corresponding dates in the Filter by Date box. The resulting values will show in the viewer. The Normal and Abnormal tabs both have this functionality and are filtered separately.

Discrete Values with a grey header are within normal limits. Each organization sends what is the reference point to determine what is normal and what is abnormal. If a header is display in red, it is considered abnormal by the organization. In addition to the header color, users can tell if the value is out of normal limits as there is a flag that indicates if the value is low vs. high.

Flowsheet (Viewer)

This feature may not be supported by your organization’s EHR vendor. The Flowsheet viewer shows information found in nursing documentation such as nursing or respiratory assessments, skin assessments, intake and outake data, etc. The viewer can be popped out into another window by clicking on a little square with an arrow pointing to the right in the navigation tree next to the viewer name.

The Flowsheet viewer is the most recent style of discrete data viewer. This viewer is organized much like a spreadsheet. Depending on configuration, users may see major categories on the left-hand side of the spreadsheet (there are many different options as each site is a little different.). Upon clicking on one of these items users will be presented with a grid to the right. That grid will have multiple columns, the first column being name. Hovering over the column name will display three little lines. Clicking on them, will allow the user to filter in order to narrow down the data. If any of those names appear in red that means that at least one of the data elements are outside of the normal limits if there is a range.

To the right of the name, if applicable, is a reference column. This reference column will indicate if the value is within normal limits. This is data that the EHR system has sent to Fusion CAC. If the reference column is available, then to the right of that is a flag column. A checkmark in that field also means the value is out of the normal range. This column can also be filtered if the user wants to look at everything outside of the normal limits. Next to that field is a date and time column. The user may see multiple dates and times depending on how the data is organized and how frequently it is documented. If a discrete value on the Flowsheet viewer has a specimen, it will show as a beaker symbol in the Results column. Hovering over the symbol will provide the name and site of the specimen.

Right clicking in the Major Category column will show a menu allowing the user to expand or collapse all categories. That configuration will be saved for all accounts that have the Flowsheet Viewer, per user role. Note that if a user collapses/uncollapses a major category in the pop-out, it will not be seen on the main page until the user moves to a different viewer and back.

ER E/M Module

The ER E/M viewer is part of an add-on module for any chart with a “Is Emergency” flag within the account properties. If this module is turned on, any “Is Emergency” chart will have the “E/M Coding Worksheet” in the Navigation menu. There are several sections to the E/M Coding worksheet including: E/M No Charge, E/M Level, Trauma, Critical Care, Medications, and Additional Charging. More details on ER E/M functionality can be found in the Administrative User Guide.

Completing the ER E/M Worksheet

ER Date and Provider

The first step in completing this worksheet is filling in the ER Date and the ER Physician fields. Once these are completed, the rest of the worksheet will populate.

No Charge

If a patient fits the criteria for “no charges” (for example, a registration error), all other fields in the worksheet go away because there is nothing else to be done from an ER charging perspective. However, other selections from the list will populate the fields accordingly.

Critical Care

Select appropriate answers to “Is Criteria Met” and “Is Time Determined.” To enter the duration, click on the clock icon.

Enter start date/time and click on the Update button for the minutes to display.

If there were multiple spans of time for critical care, click on +Add and enter any additional durations of time. The system will add up on the minutes and display once “Update” has been selected.

E/M Levels Matrix

The E/M Levels martix is configured per organization. This matirx will allow the user to check what interventions were completed during the ER visit. Once an intervention is selected from one of the columns, that becomes the minimal level and all columns before that will gray out. As the remaining sections are completed, users may see the level advance.

Trauma

If the case was a trauma, make the appropriate selection from the dropdown menu (pre-hospital notification, post-hospital notification, consult).

Medication Administration Qty

Based on the selection, additional fields or boxes will populate. Complete the quantities, add modifiers, and any notes. Modifier fields are available in the appropriate sections of the worksheet. The user can add up to four (4) modifiers unless they are using the Solventum CRS encoder, then they will be able to add up to five (5) modifiers. The “Notes” field is available for the coder to track things such as medications.

Medication Administration Time/Modifier

Update this section with the duration of each medication as needed, any modifier(s), and notes. The user can add up to four (4) modifiers unless they are using the Solventum CRS encoder, then they will be able to add up to five (5) modifiers.

If there are multiple infusions (for example, one infusion started in left arm and one infusion stated in the right arm), click on the Action button to create another row to be completed including appropriate modifiers for each infusion.

Additional Charges

Add any additional charges. Much like the matrix, the additional charges section will be configured per each organization to include the necessary charges each organization captures.

Charges for Assigned CPT Codes

If the Coder adds a CPT code (otherwise referred to as “soft code”), the codes will appear in this section of the E/M Coding worksheet. It must then be determined by the Coder, or Charger, if the procedure added by the Coder occurred in the ER and should be charged. If so, the fields should be completed. If the procedure is determined to have occurred elsewhere, leave the 0 in the field.

E/M Summary

Once the Additional Charges section is complete, users will see the Summary which details the E/M level and other charges with the corresponding CDM Code.

When all charging is complete and the charges are ready to be submitted, check the “Send Charges Outbound” checkbox and click on the Save button in the banner bar. This action sends charges out and the account will automatically route to a coder worklist so the rest of the coding that is not charge-related can be completed.

If the charges cannot be completed for some reason (missing trauma documentation), the box should NOT be checked, and instead, a pending reason should be assigned on the Code Summary. Once a pending reason has been added, click on the Save button in the banner bar.

If the “Send Charges Outbound” checkbox is NOT checked, the Coder will get a warning that ER charges are missing and will not be able to submit the account upon completion of coding. The Coder, in this case, would attach a pending reason to send the account back to the user applying charges to check the box. The account then goes back to the Coder to submit the account for final billing. This workflow ensures that the Coder does not submit an account unless all ER charges have been completed.

E/M History

This section displays the history of charges submitted. Click to expand for details.

Physician Coding/Single Path

Physician Coders differ from hospital coders in that they will usually work for a doctor who specializes in a specific type of medicine. As a result, they typically code for just that specialty. These coders will only deal with a subset of the ICD10 code set. Within the CAC system, functionality is built to allow a Physician Coder to code charts just like hospital coding staff. The Single Path coding role allows the user to code an account as a final coder and a physician coder simultaneously. When a Single Path user opens up the detail on a CPT code, they will see two separate fields for modifiers, and they can enter modifiers for both.

A Single Path role can also be modified from the Profile drop-down menu under the user name at the top of the Account Detail screen, provided that another changeable profile role, such as CDI, Coder, or Physician Coder, is available on the User Profile. When adding or editing modifiers in the Charges viewer, the Single Path user sees the Coder’s version of the viewer, so what is added will be viewable to both a Coder and a Single Path user. The Physician Coder charges viewers are different and viewable only to them.

Charges or Transactions

If an interface for account charges or transactions is set up during configuration, the Charges viewer shows a listing of charges on the account.

There are activity buttons to “Save Layout” or expand the Charges viewer. Users can expand the width of the Charges viewer to view more available columns by clicking on the arrow in the top right corner of the viewer. This viewer also provides information on CPT Codes, Descriptions, Modifiers, Quantity, Service Date, Revenue Code, and Total Price.

Column Settings

Each column within the Charges grid has menu options to Pin Column, Autosize, and Reset Columns. Click on the Menu icon to view the drop-down listing. After making column setting selections, click on the button to retain column settings for future coding sessions.

Adding Modifiers to Charges

Click on the BLUE PENCIL button to open the Modifiers window. Start entering the digits for the modifier to bring up the drop-down listing of available modifiers and their descriptions to select the appropriate modifier. After the modifier is in the window, click on the OK button to save the selected modifier. Continue this process to add all applicable modifiers to charges in the Charges viewer. The user can add up to four (4) modifiers unless they are using the Solventum CRS encoder, then they will be able to add up to five (5) modifiers.

Editing Hard Charge Details (Physician Coder)

A user with the role of a Physician Coder can now add assigned diagnosis codes along with physicians and CPT Modifier codes to hard charges listed in the Charges viewer. When a Physician Coder opens the Charges viewer, new columns with edit buttons will be seen.

Clicking on the BLUE PENCIL button in the Diagnosis column will open a code field, which when dropped down, will list all assigned diagnosis codes on the account. The Physician Coder can then select which diagnosis code(s) to attach to the hard charge. The top most diagnosis code of a charge is designated the “principal” diagnosis. If you add or remove codes, whatever code is listed first is the principal – the principal code on a charge can be different than the principal code on the account. If a user moves the codes around, the top code will always become the primary code.

Clicking on the BLUE PENCIL button in the Physician column will open a physician field to allow the selection of a physician. This is the same for the Physician Modifiers column which will open a modifier window allowing modifiers to be selected. When launching the encoder, the physician coder’s modifiers will be sent instead of the final modifiers in the Charges viewer.

Clicking on the BLUE PENCIL button in the Quantity column will open a field to allow the end user to enter a new value for the quantity of the charge. The dialog will perform validation so that invalid quantities are not recorded such as letters, blanks, and/or a zero quantity. Negative quantities are permitted. Decimal quantities are permitted.

Assigning a Pending Reason per Charge (Single Path & Physician Coder)

Users that have a Physician Coder or Single Path Coder role will have the ability to place a pending reason per charge on the physician charges.

• If a charge is removed, then the pending reason would be removed.
• If a charge is updated, then the pending reason would not change.

Caution Column (TruCode)

A Caution Column is avaialble for sites that use the TruCode Encoder to the Charges and Transactions viewers. This column will indicate a flag if TruCode reports an edit on a charge on an outpatient account.

Code Summary

The Code Summary is the last viewer to be reviewed prior to chart submission. This screen shows a summary of activity on the account and provides activity buttons to Claim Ownership, Show History, and Print Summary (if a printer is configured). This viewer also provides information on Current Owner, First Coder, Last Saver, and Last Submitter. Users can expand the width of the Code Summary viewer by clicking on the arrow in the top right of the viewer.

Show History

The Show History button provides a timeline view of activity on the account along with an audit trail of account activity from point of admission to the current date. It includes a visual timeline and below the timeline there will be an audit trail of account activity.

Upon opening Show History, users will see the entire history from a birds-eye view. The user has the option of using the Zoom In and Zoom Out buttons to expand or collapse the timeline. The Zoom Fit will bring the visual timeline back to its original collapsed grid. Hover over any of the event boxes and the contents will be displayed.

The legend can be found by clicking Show Legend to let the user know what the colors represent without having to hover over them. When clicked, it will open the Legend and the button name will change to “Hide Legend”. Click again to close.

Click on an entry by date to view the changes that were made to the account on the date and time indicated.

Admit Diagnosis

The Admit Diagnosis code and description are displayed below any Validation Results and/or Pending Reasons.

Visit Reasons

Listed beneath Admit Diagnosis are the Visit Reason codes in code sequence order. The list includes the Visit Reason code and description.

Assigned Diagnosis Codes

The Assigned Diagnosis Codes are listed in code sequence order below Visit Reasons. The listing includes the diagnosis code, description, and POA assignment (Y/N).

Assigned Procedure Codes

Listed beneath Assigned Diagnosis Codes are the Assigned Procedure Codes in code sequence order. The list includes the procedure code, description, Service Date, and Physician.

Assigned CPT Codes

Listed beneath Assigned Procedure Codes are the Assigned CPT Codes in code sequence order. The list includes the CPT code, Modifiers, Code Description, Service Date, Physician, APC and Servier Indicator.

Print Summary

If a printer is configured for the computer, click on this button to print a copy of the abstract for this account.

Claim Ownership

Use the Claim Ownership feature based on the organization’s requirements and procedures. Consult your manager for more information on claiming ownership of a chart.

Final Code Summary

The Final Code Summary will only be available once the facility Coder clicks the Submit button. This provides transparency between CDI and physician coding teams (if also using Fusion CAC) as to what was coded. When a submitted chart is open again, users will see a new viewer under the navigation menu called the Final Code Summary. This will display what the coders coded along with code status details and sequencing. This data is viewable only for the role of ‘CDI’.

Clicking on the header will expand the selection to display the codes that were coded and DRG/APC, if applicable. Any codes with a plus (+) sign indicates the code has not been added to the account. The plus (+) sign does not indicate that the code needs to be added. It is for the user to quickly add the code if they determine it is needed using coding judgment and supporting documentation. If applicable, the code’s HCC designation will show the HCC number and its version.

Physician Coding Summary

The Physician Code Summary will display if the Physician Coders are also coding within Fusion CAC, and they submit the chart. This provides transparency between the facility and physician coding teams as to what was coded.

Clicking on the header will expand the selection to display the codes that were coded. Any codes with a plus (+) sign indicates the code has not been added to the account. The plus (+) sign does not indicate that the code needs to be added. It is for the user to quickly add the code if they determine it is needed using coding judgment and supporting documentation.

Denial Management

The denial management viewer displays on submitted accounts. Clicking on this viewer presents a form with several fields to be filled in when an account has been denied payment.

Denial management tracking involves monitoring cases where a patient’s submitted billing chart is rejected by the payer. Various reasons, such as medical necessity, code, or DRG assignment, could lead to these denials. This tool is designed to comprehensively record the specifics related to denial management and tracking. It is capable of documenting multiple denials for each chart, with the ability to log and categorize them for the purpose of tracking, managing workflows, and generating reports.

Adding a Denial

To add a denial, select “Denial Management” in the Navigation tree. This option will only be available if the account has been submitted. This will open up the Denial Management viewer in the center of the screen to then click on the +Add Denial button.

Once a denial has been added, a form with multiple fileds will need to be filled in by the user working the denial. The fields are made up of various drop-down options, dates, and financial information about the denial.

The Root Cause field has a drop down of options where one or more options can be selected.

There can also be multiple Code(s) in Question entered.

Options in the fields above with dropdown lists can be customized per organization by editing the appropriate mapping table in Mapping Configuration. These fields include the following:

• DenialType
• DenialStatus
• DenialOutcome
• DenialAppealRoute
• DenialReason
• DenialCodeChangeNeeded
• DenialDRGChangeNeeded
• DenialRootCauses

Each field (except Comments) can be added to Grid Column Configuration for display in Account Search. These fields can also be used in workflow if necessary.

As needed, mutiple denial sheets can be created for a single account. To do this, click on the +Add Denial button. As more denials are added to an account, they will be listed at the top of the Denial Management viewer. The denial a user is working on will be indicated in green bubble.

Appealing a Denial

If a denial needs to be appealed, there are separate fileds to track when those appeals were sent, how it was sent, and the outcome of the appeal. A user can track the strength of the appeal as low, medium, and high based on their organizations preferences. Additionally, a comment section has been added for any free text the user would like to enter.

Deleting a Denial

If a denial needs to be deleted from the account, click on the denial the user wishes to remove, which will bee in the green bubble, then click on the xDelete Denial button.

Reporting Denials

For reporting within Account Search, a Denials drilldown is available. This drilldown only reports on the first denial on the account.

Documentation Reviews

The Documentation Reviewss module is designed to provide flexibility for sites that prefer a different style of Clinical Documentation Improvement (CDI) reviews or need alternative methods for tracking management reporting. This module allows users to customize and monitor documentation reviews by various topics and types. It is particularly useful when reviews do not fit the conventional workflows of initial, follow-up, or reconciliation reviews, such as for utilization management purposes.

Why Use Documentation Reviews?

Sites sometimes choose to add documentation reviews because reporting productivity is more complex than tracking initial, follow-up, or reconciliation reviews. The module’s flexibility allows CDI teams to capture and track additional review types that are essential for comprehensive reporting but might not fit within the standard review categories.

Standard Review Definitions

Before exploring the customization capabilities of the Documentation Review module, it is essential to understand the baseline definitions of reviews in a CDI system:

• Review: A review is defined as a save on an account by a CDI Specialist (CDS) on a single day. For inpatient accounts, the specialist must also calculate a Working DRG. Multiple saves on the same account by the same CDS within the same day count as one (1) review. In other words, there can be only one review per account per CDS per day.

• Initial Review: The first review saved on an account by a CDs. For inpatient accounts, the CDS must calculate a Working DRG for it to count as an initial review. There can only be one initial review per account.

• Follow-up Review: A review saved on an account by either the same or a different CDS on a different day, following the initial review. No account will have more than one follow-up review per day for the same CDSS.

Example:

Day 1: CDI Specialist “A” saves an inpatient account with a Working DRG.

Day 1: CDI Specialist “A” updates the Working DRG (does not count as a separate review since it is within the same day).

Day 2: CDI Specialist “B” saves the account with the same Working DRG (counts as a follow-up review).

Day 3: CDI Specialist “A” saves the account with the same Working DRG.

Day 3: CDI Specialist “B” saves the account with a different Working DRG (counts as a follow-up review).

In this scenario, there is one initial review and three follow-up reviews. The change made by CDI Specialist “A” on Day 1 does not count as a follow-up because it occurred on the same day as the initial review.

Customizing Documentation Reviews

By default, the Documentation Review module includes a free-form text field, allowing CDI specialists to capture detailed information about their reviews. However, sites can further customize the module by creating forms specific to different review types, enabling more structured and consistent data entry.

Creating Custom Forms

Using the Worksheet Designer, sites can create tailored forms for different documentation review types. These forms can help standardize data collection and improve reporting accuracy. Some common examples of custom review types include:

• MD Advisor Response
• Query Opportunity Reply
• Coder Question Response
• Post-Discharge Follow-up
• Pre-Bill Review
• Retrospective Query Needed
• Query Review
• Case Management Review
• Quality Improvement (QI) Review
• Utilization Review
• Types of Reviews

Custom reviews allow CDI teams to track reviews that fall outside of traditional CDI workflows. These reviews can be particularly useful for:

• Post-Discharge and Pre-Bill Reviews: These reviews focus on ensuring documentation accuracy and completeness before the billing process, helping to reduce denials and optimize revenue capture.
• Query and Retrospective Reviews: These reviews allow CDI teams to capture follow-up actions taken after initial queries or when additional queries are required after discharge outside of a traditional review.
• Utilization Management Reviews: These reviews may not fit into the standard initial or follow-up workflows but are crucial for tracking how effectively hospital resources are used and ensuring proper reimbursement.
• Reporting and Productivity: Tracking productivity for non-standard reviews (such as utilization reviews or post-discharge follow-ups) can be more complex than traditional reviews. Customizing the module allows sites to generate more meaningful reports that reflect the variety of documentation efforts made by CDI teams.

In the CDI Summary section of the dashboard, counts of reviews are displayed, such as “In the Last 7 Days,” excluding the current day. This allows for real-time tracking of CDI efforts and helps managers assess team productivity.

CDI Productivity by Review Type

This report shows productivity by each user by custom documentation review type.

CDI Detailed by Review

This report provides details about the custom documentation review type of CDI reviews performed by account.

Navigating to Documentation Reviewss

Unlike the CDI Worksheet which is located under the Document tree, the Documentation Reviewss section is found on the Navigation tree within the user interface. This distinction allows easy access to reviews that are separate from the standard CDI workflows and documents.

Steps to Access Documentation Reviews

1. Locate the Navigation tree: Once logged into the system, navigate to the left-hand side of the screen where the Navigation tree is displayed.
2. Select Documentation Review: Under the Navigation tree, will be the Documentation Reviews section. Click on it to open the review interface.

3. Adding a New Review: Upon opening the Documentation Reviews viewer, there will be the option to +Add Review. This allows the user to select the specific review type from the list of available choices. The choices available are customized per organization and can include any form types an organization has designed.

DRG Reconciliation

The DRG Reconciliation viewer displays the differences between the last known Working DRG and the Final DRG coded by a Coder, with symbols indicating the discrepancies. The viewer updates in real time and does not store historical information. If the Coder updates the DRG, the changes will reflect immediately in the DRG Reconciliation viewer. For historical data, please refer to reports.

Impact Queries

The Impact Queries Viewer is designed exclusively for CDI teams. This tool may not be necessary for all customers, but it serves a specific purpose for those who use it. CDI teams often issue multiple queries per account and require a way to track the impact of each query distinctly. This viewer allows teams to determine whether the impact of a query accounts for the total change in the account or if it shares this impact with other queries.

Purpose and Use

• Impact Tracking: Allows CDI specialists to clearly see the account impact of each query, from the initial baseline to the final assessment after all queries.
• Impact Assignment: Within each query, CDI specialists can assign a percentage to quantify the impact of the query on the account. This percentage is then translated into a dollar value attributed to the query.

This feature helps prevent double-counting and overestimating the impact that CDI claims on an account. After coding is completed, CDI specialists must revisit and reassess the account to determine and specify the precise impact each query had.

By using the Impact Queries Viewer, CDI teams can ensure more accurate and accountable query impact assessments, contributing to more precise documentation and reimbursement processes.

To access the Impact Queries Viewer, the user must have a CDI role AND there must be at least one (1) query sent by a CDI user.

Displayed at the top of the viewer is the Baseline, Working and Final DRG. The account impact equals Final DRG – Baseline DRG.

Clicking on the View Codes button in either the Baseline or Working DRG boxes will take the user to the Working CDI History viewer to allow the user to view how the CDS developed their DRG at different stages. Clicking on the View Codes button in the Final DRG box will take the user to the Final Code Summary viewer to show the user how the account was final coded by the Coder.

To review the query that was assigned, click on the BLUE ENVELOPE . This will open the query in a dialouge box.

To assign the impact of the query, the user will enter a percentage in the “Assigned Impact %” field. This will autocalculate the following fileds:

• Total Impact %
• Remaining Impact $
• Remaining Impact Weight
• Assigned Impact &
• Assigned Impact Wgt.

Audit Worksheet

Starting an Audit

The pre-audit codes and DRG are displayed for easy reference by the Auditor. The Auditor conducts the review (see steps 1-9) and makes changes to the codes in the Assigned code tree.

Step 1

Ensure the current user role is set to have the Auditor role as well as Chart Access of Auditor.

Step 2

Open a chart that has been submitted by a Coder. This may come from a worklist or by manually typing in an account number.

Step 3

On the Navigation tree select the viewer called “Audit Worksheet”, then click the +Add Audit button to begin.

Step 4

Select the appropriate audit type from the dropdown. This will be used for reporting on the types of audit performed and can also be used for workflow purposes.

Step 5

The codes in the Assigned code tree are the same codes initially submitted by the Coder, allowing the Auditor to start the audit with the codes from the Coder. The Audit viewer can be popped out onto a separate screen, allowing the Auditor to have a screen for reviewing the chart. Selecting “Show All” codes in the Unassigned code tree and then clicking on the codes assigned, the Auditor will load the documentation supporting that code. This will help streamline the audit process.

Step 6

Once the Auditor has made changes and is completed with the audit, they can click “Update Codes” which automatically calculates and populates the audit statistics section. There is a comment bubble next to each code as well as the DRG for the Auditor to enter any comment(s). A symbol may display next to the codes. - A green ‘plus’ sign will show if the code was added. - A red ‘minus’ sign will show if a code was deleted. - A orange up or down ‘arrow’ sign will appear if the code location has been changed, as in a primary and secondary are swapped.

Step 7

Although audit statistics have been automatically calculated and populated, the Auditor must manually enter in the “Total Errors” which then automatically calculates the “Error Rate”.

Step 8

Complete additional sections as needed.

Abstracting

The Audit viewer also allows Auditors to review the abstraction performed by the Coder. Abstraction is managed on the Account Information page, and the specific fields audited can be customized. By default, the system audits the discharge disposition, but additional fields—such as point of origin, admit type, admit source, or others can be included upon request. To enable auditing for additional fields, contact the CAC Support Team (CACsupport@dolbey.com).

Once the desired fields are configured, the Auditor can make any necessary corrections directly in the Account Information viewer. Click on the Update Codes buttong next to the Auditor Outcome. This will cause the system to compare the updated information against the Coder’s original entries and include the selected Account Information fields for auditing.

Before:

After:

Charges

The Audit viewer also enables users to audit hard charges, but this functionality requires a configuration change by the CAC Support Team. To enable this capability, provide the CAC Support Team with the specific revenue codes to audit, as not all charges in the Charges or Transaction viewer will require auditing. Commonly audited revenue codes include 450 and 762, but others may apply depending on organizational needs.

Once the specified revenue codes are provided and configured, the Audit viewer will flag accounts containing charges that match the selected codes. When an audit is initiated, the user will see sections for “Charge Codes” listed under both the Coder Outcome and Auditor Outcome. Below these outcomes there will be a section for “Audited Charges,” where changes amde to the charges can be recorded.

Training Recommendations

At the conclusion of the audit, the Auditor can list any recommended training topics. If no recommendations are necessary, “None” should be indicated. These topics can be modified using the mapping table. Additionally, the Auditor has space to provide any additional details as needed.

Auditor Outcome

Step 9

The Auditor can then re-submit the chart or route it back to the Coder of Record by using the Route to Coder button in the top right corner of the audit worksheet. This will route the chart to the Coder’s You worklist for the Coder to complete the Coder Acknowledgement section.

Missed Queries

This section will only be available if queries were initiated after the audit began. The query does not have to be initiated by the Auditor to be attributed to the audit as a missed opportunity.

Multiple Audits per Account

An account can have one or more audits added to it. Clicking the +Add Audit button will create a new, blank audit worksheet. These worksheets are numbered and displayed at the top of the Audit viewer, along with a date stamp indicating when each worksheet was opened. The worksheet currently being viewed will be highlighted with a green background.

Coder Acknowledgement

If there are changes for the Coder to address post-audit, the Auditor will route the chart back to the Coder by clicking on the Route to Coder button.

When the Coder opens the chart to review, there will be a “Coder Acknowledgement” section. This section gives the Coder the opportunity to either agree with the audit or to provide a rebuttal. If the Coder selects the outcome to be a rebuttal the Coder must provide a comment for the Auditor. Once the Coder has added their comments they will route the chart back to the Auditor by clicking on the Return to Auditor button.

Once the chart is returned to the Auditor, there are a few actions the Auditor can take based on the Coder Acknowledgement response:

1. Review the rebuttal, select agree, and finish the audit.
2. Review the rebuttal, select disagree, and finish the audit OR initiate the Audit Escalation process.

Audit Escalation

The Audit Escalation feature is triggered when the Coder’s outcome results in a rebuttal, and the Auditor disagrees with the rebuttal and further action may need to be taken. In this case, a section labeled “Escalation Requested” becomes available. The Auditor can activate this section to indicate that an escalation is necessary. Once this is set, an additional section called Audit Escalation will appear. This section allows the user to document the outcome of the escalation and provides a designated space for comments related to the escalation.

This feature is governed by role-based permissions in the Role Management settings. Within Role Management, there is an option to specify who has the ability to edit the Audit Escalation section.

If a coding manager or another designated individual is responsible for responding to escalations, they must meet the following requirements:

1. Audit View Access: The user’s role must include permissions to view audits.
2. Audit Role Setting: The role assigned to the user must have the Audit option enabled in the top-right corner of Role Management.
3. Edit Escalation Access: The user must also have explicit permission to edit escalations, as defined within the Role Management settings.

These permissions ensure that only authorized individuals can manage and resolve the escalation process effectively.s

Finishing an Audit

To finish an audit, whether it goes through a rebuttal process or not, the Auditor would simiply click on the Finish Audit button. This closes the audit, but the Auditor has the option to re-open the audit as needed.

Matched Criteria

The Matched Criteria viewer allows a user to see why the chart was routed to them. The matched criteria group is a list of “Criteria Group” that the chart matched upon when it went through workflow. These criteria groups are used to indicate a “possible” query opportunity based upon the criteria outlined in workflow.

Prioritizing Workflow using Matched Criteria

Matched Criteria can be used to prioritize workflow using one of two fields:

1. Criteria Group - This field will tell the name of the criteria that the workflow routed the chart to the CDI users. Often times the field is renamed to “Routed Reason” because this field represents why the chart was routed to the user. If the chart matches multiple criteria groups the criteria group that is displayed in this field is the first one that it matched. All others that it matched with will display within the Matched Criteria viewer when the chart is opened.

2. Active Matched Criteria Groups - This is often renamed as “Opportunities” and is defined as the number of matched criteria groups the chart matched with, which reflects the total number of possible query opportunities currently present on the patient chart. This field can be used by the CDI user to sort the worklist based upon the charts that have the most to least possible query opportunities.

Once a CDI user validates a criteria group by checking the box next to its name in the Matched Criteria viewer, that criterion is removed from consideration for routing purposes. However, this does not affect other criteria that may still be active in the workflow.

If multiple worklists contain the same matched criteria group names and a chart has already had a prior matched criteria group with the same name validated, it will not be retriggered or displayed in the Matched Criteria viewer.

Medications

A Medication Administration Record (MAR, or eMAR for electronic versions), commonly referred to as a drug chart, is the report that serves as a legal record of the drugs administered to a patient at a facility by a health care professional. The MAR is a part of a patient’s permanent record on their medical chart. The health care professional signs off on the record at the time that the drug or device is administered.

Activity Buttons

There are activity buttons to “Save Layout” or expand the Medications viewer. Users can expand the width of the Medications viewer to view more available columns by clicking on the arrow in the top right corner of the viewer. This viewer also provides columns that can be sorted or filtered based on the user’s need. The columns include the medication Group, Category, Medication name, Dosage, Route, Rx#, Start Date/Time, and End Date/Time.

Column Settings

Each column within the Medications grid has menu options to Pin Column, Autosize, and Reset Columns. Click on the Menu icon to view the drop-down listing. After making column setting selections, click on the button to retain column settings for future coding sessions.

Notes & Bookmarks

Notes & Bookmarks becomes visible in the center viewer after clicking on the hyperlink from the Navigation tree. This viewer presents a summary and chronological history of all notes and bookmarks added to an account. Users can expand the width of the Code Summary viewer by clicking on the arrow in the top right corner of the viewer.

Notes

Notes can be added to the patient chart by clicking on the +Add Note button within the Notes & Bookmarks viewer.

When notes or bookmarks are applied to the chart, the Notes and Bookmarks link in the Navigation tree will turn red.

The columns in the Notes & Bookmarks viewer include the following:

• Action - Notes can be deleted, edited, or made private.
• Type - This will show if it is a Note or a Bookmark.
• Create Date/Time - This is a timestampe of when the Note or Bookmark was created.
• Created By - This shows the user’s name
• Role - This shows the user’s role, which will be the role they were logged in as when they made the note if they have multiple roles.
• Comment - This is the section where the user made the note.

The columns can be sorted in ascending or descending order. The column that is sorted will have a green arrow next to the column name. This is helpful if the user is looking for a note or bookmark by a specific date, user, or user role as an example.

Account Notes also have formatting options for text. Highlighting the text displays a pop-up with formatting options. A user can now select text in those areas and can change the styles of text.

Users have the option to make notes publicly visible among all users by clicking on the checkbox. Even if an end user marks a note/bookmark as private, users with the role of administrator or manager can still see private comments. This feature allows for a manager to review a patient chart and if they do not want the existing public note to show in the account note, they can change an existing note to private without putting in a new note. Then they have to make it public, then switch it to private in order to have the account note blank.

To keep your Comment box open while continuing to work on the chart, click on the Minimize Editor button. This will move a placeholder to the Accounts Action Bar.

Bookmarks

Users can add a bookmark to a document by highlighting the relevant word(s), phrase or location within the text and then right-clicking to open the Bookmark menu.

From the Bookmark menu, select Bookmark to open the Note window to add your note for this bookmark. Add the note for your bookmark in the Note text box, then click the checkmark button to save the bookmark with your note for future reference. Bookmarks within documents will have the bookmark icon. To view bookmarks from within a document, click on the green icon to open and view the bookmark note.

To review all bookmarks within a chart, go to Notes & Bookmarks in the Navigation tree. All of the bookmarks within the chart are listed in the Notes & Bookmarks viewer.

The RED X button will delete the selected bookmark. The BLUE PENCIL button is used to edit a previously added bookmark. The GREEN PAPER button will jump to the location where the bookmark was created.

Physicians & Queries

Within this viewer users can add physicians and change the physician’s staff function, if necessary. They can also intiaiate the physician query process in this viewer. Users can expand the width of the Physicians & Queries viewer by clicking on the arrow in the top right corner of the viewer.

Adding/Editing Physicians

The are several fields that are pre-populated by the organization’s registration system including “Physician Number”, “Physician Name”, “Specialty” and “Staff Function”. Physicians can be added, changed, or removed if incorrect or missing. To add a physician, click on the +Add Physician button and begin typing in the physician’s last name to populate the correct physician. Choose the staff function that fits the chosen physician. If it is a consulting physician, also enter the consultation date.

To remove a physician that either you added or was sent incorrectly from the registration system click on the RED X button to remove the physician.

Querying a Physician

Adding a Query

There are two ways to add a query to a physician that is listed. The first is to click on the BLUE ENVELOPE icon next to the physician.

The second way is to click on +Add Query. This would also be how to query a physician that is not already listed.

When a physician is listed, the query will auto-populate the physician name. If a physician was not already listed, simply begin typing in the last name in the “Physician” field by entering two or more characters to find the correct physician name.

If configured, users can see a cosigner field that allows assignment of a cosigner. The cosigner field is a field that can be sent in the outbound interface for the query. The receiving system can choose to use this process if the cosigner needs to receive the query after the main recipient answers, but before it gets returned to Fusion CAC. When a physician query is created, a new “Cosigner” physician dropdown appears below the existing “Physician” dropdown. Filling in this field is optional. When the query is saved as a draft or sent outbound, the cosigner field will be saved with the query and sent as an additional recipient. In the grid inside the Physicians & Queries, the user may also choose to add “Cosigner” as a visible column.

Continue through the query build by selecting the query template.

Sending a Query

Write the query or fill out the template details as needed.

Once completed, select from the reason dropdown why you are sending the query, and above that field, check the box if the query will affect final coding.

Click Send to Physician to complete the query and send it, or click Save Draft if the query is not ready to be sent. If the query is saved as a draft, a draft query section will appear that is separate from sent or closed queries. If a user has at least one draft, but no sent queries, the total drafts count on their personal dashboard will display as zero.

Alternatively, for organizations who do not have a physician query interface AND do not create a physician query until a response is received, a query can be created and not sent. When enabled, a physician query will show a Continue button in place of Send. Clicking Continue will refresh the query to open the physician response fields so that the query can then be closed.

Editing a Sent Query

The physician the query was orginally sent to can be changed after sending the query by opening the query and clicking Change Physician. A dropdown will appear so the user can select the reason the physician needs to be changed.

Closing a Query

To close a query—whether to review a response and update the outcome or to cancel it—simply click the RED ENVELOPE icon. If a response from the provider is available, clicking the icon will open the query to display it.

The user can then choose how to close the query using options in the screenshot below.

Query Response Show Diff

The physician query has a “Show Diff” toggle above physician query responses in the Physician Query dialog. Clicking it will show additional text in blue highlighting and deleted text in red highlighting. When the diff is shown, the button changes to “Hide Diff,” which when clicked will show the unaltered response.

Once a query is opened and responded (or the user is recording the response on behalf of the physician), the responding physician and the date/time of the response can be editied. If the organization is manually closing queries, this information ensures that the management reports reflect accurate turnaround times.

If an organization has choosen to collect shift reasons, a dialog box will appear upon selecting an outcome for the query.

Documenting Query Shift Reasons

Shift reasons can be categorized as either automatic or manual. If manual shift reasons are enabled, users will encounter a dialog box after closing a query.

This dialog box will display the pre and post-query DRG (if applicable) along with options for shift reasons. These shift reasons can be chosen by the end user to explain the rationale behind the change in the DRG. It is important to note that changes in the DRG might occur for reasons unrelated to the query outcome. Please be aware that the shift reasons dialog is customizable, so each organization may offer different options than what is shown in the screenshot.

Query Impact

Upon initiation of the query, the user will see a Compute button below the template name. Click to compute the Pre-Query DRG if not already showing. Clicking this button will use currently assigned codes on the chart to compute a DRG. Once the pre-query DRG is completed users will follow the standard process to send the query.

When the query has been responded to, open the query to complete by clicking the RED ENVELOPE icon. Users will be able to compute a post-query DRG in order to capture impact. The previous DRG will auto-populate (unless the user added, deleted, or changed any codes, re-sequenced or changed the discharge disposition). If the pre-query DRG does not populate, it will need to be calculated again by clicking the Compute Pre-DRG below the template name. Users will now also see a Compute Post-DRG below the template name.

Users can minimize the query as needed to add, delete, or otherwise change any codes before clicking compute.

Placeholder Queries

Some organizaitions create a physcian query within Fusion CAC and then copy and paste it into a different system rather then send them through an interface. Dolbey refers to this as a place holder query for reporting and transparencey. A feature can be enabled so that text entered into fields on the place holder query will no longer display in bold. To activate this option, please contact CAC Support (cacsupport@dolbey.com).

Quick Complete

The Quick Complete query feature is designed for sites that create placeholder queries ONLY. This feature allows a user to log a query without sending it externally. The user can assign a provider, template, reason, and both pre and post-DRG information along with closing the query with shift reasons all in one session. This quick complete feature aims to streamline these actions into a single, integrated process. This feature is optional and needs to be turned on. Contact CAC Support (cacsupport@dolbey.com) to enable this feature.

Once enabled, create a new physician query, and notice a new Quick Complete button in the footer. Clicking it will automatically save the query and reopen it with “Record Physician Response” expanded to record a physician’s response. The Quick Complete button only appears on new queries, including queries opened from drafts. It will not appear if a query is edited or if a query’s physician is changed.

Query Status

The status of the query will display in the actions column on the query grid. The following are status options:

Per User Settings

This grid will display key details about the query, including the creator, recipient, creation date, reply status, and response timestamp. Columns can be reordered based on user preference. When moving around the columns in the Physician Queries grid and then clicking the Save Layout button, the columns and order will be saved for the Queries grid for all future accounts for that user. Any other user will see the default layout. Next to the Save Layout button is a Reset Filters button, this will take any custom layout and change it back to the default fields.

If the organization chooses to use signatures when sending queries, automatic signatures can be addended to the query. Signatures can be editied within each user’s profile.

Query Impact

Query Impact = Pre-Query Working DRG Weight – Post-Query Working DRG Weight

Query impact is calculated using the working DRG calculated within the same session in which the physician query was created. Once the physician replies to the query, the CDI will close the query. During the session the query was closed, the system will then capture the working DRG that was calculated. A session is closed by saving the chart.

If a physician query shifts the assigned DRG, diagnosis, procedures, CC/MCC/HAC/ROM/SOI or Quality metrics, the shift reason is automatically calculated by the system. The shift reason is captured by looking at the difference between the last working DRG and the Current Working DRG as well as the Code Sets difference in the most current working DRG. Code sets will be automatically captured for reporting.

Previous HCC

The Previous HCC Overview will display the HCC history to show for both the current and prior year. When HCCs are enabled, these will display grouped by HCC category and by code — showing the account number and MRN for the visits each were associated to.

If a check mark appears next to the HCC category and code, this indicates the code on the previous stay was also suggested for the current stay. If the patient chart currently being coded has codes that result in HCCs once they are added to the assigned code tree the code will display with an ‘H’ next to the code. By hovering over the ‘H’ icon, the HCC category will display.

It is recommended to turn HCCs on for all patient types to capture a more complete picture of HCCs. HCCs will be collected once HCCs have been enabled in the mapping table. To enable HCCs, check the box in the Category mapping table.

As a reminder, this will not capture data prior to turning this feature on in the mapping table.

Readmission/Previous Visit

If the patient has been readmitted within 30 days of an admission date, the patient demographic data will display below from the previous stay. This is not just for inpatient readmissions, but also includes if the patient was ever seen for any patient type within the last 30 days. The 30 days look back can also be expanded to 45 or 90 days. If the previous stay was also coded, you will see the Code Summary display below. If a check mark appears next to the code, this indicates the code on the previous stay was also suggested for the current stay.

If an account has multiple re-admissions, they will all show if they are in the default time of 30 days. A setting can be changed to allow the number of days to be customized. If the setting is updated to an amount other than 30, that new amount will show in the Re-admission Viewer AND in the red tag in the banner. Please contact Support (cacsupport@dolbey.com) to have the setting configured, if desired.

Transfer Account Codes

Transfer codes can be used to help combine account codes into one encounter. Most sites leverage the ADT to combine the actual account; however, there are times it is necessary to copy codes from one encounter to another.

If a patient has two different accounts and the coder has already done work on each of the accounts, the Transfer Codes feature can be an easy way to post codes when you’re within one account and want to search in another account, and have the ability to open that other account and see the codes.

To transfer codes either select the Account# radio button and type in the account number, or select the MRN radio button where the MRN of the opened account will populate. Once either of those numbers are entered, click the Load Account button. When the account or MRN is loaded, use the check boxes to the left of the codes to choose which codes will transfer. Once the needed codes are checked, click on the Transfer Codes button and the codes you selected will be added to the “Assigned” codes tree that is on the current account.

Working CDI History

The working CDI History can be used to look at historical working DRG calculations. The Coders cannot edit this information, but they can review the data.

The first calculated DRG will assume the Baseline DRG role, which is used to calculate the CDI impact on a chart. Users wishing to change the Baseline DRG, can click the Set Baseline DRG button.

Users can also indicate which Working DRGs are an alternative DRG for reconciliation. By checking the box next to each DRG, users are approving it as an alternative DRG to auto-reconcile the chart. Users can manually add an additional DRG if it does not appear in the list.

Clicking on the arrow prior to the DRG information will expand the selection to display the codes that went into the DRG and the sequence. Any codes with a plus sign indicates the code has not been added to the account. The plus sign does not indicate that the codes need to be added. It simply allows the user to quickly add the code if they have determined it is vaild using their coding judgment and supporting documentation. If applicable, the code’s HCC designation will show the HCC number and its version.

Account Search

Account Search is helpful for reporting when creating a report that is not in the default user reports. Account Search allows the user to search most data points to export the raw data into a CSV file.

Sample Use Cases:

• How many inpatient accounts were discharged last month with a pricipal diagnosis of sepsis?
• What accounts were discharged with pending reasons?
• Of the inpatient accounts coded and then discharged last month, what is the total of each CC and MCC?

To answer any of the questions above, the data will need to be filtered as Account Search can pull all account/chart data available in the system.

Setting Criteria

Account Search is highly dynamic in the types of data users can pull. Account Search, much like workflow, has two different options to create a filters using the AND/OR criteria.

• AND criteria
• OR Criteria

AND Criteria

When using AND criteria, think about adding AND at the end of each criterion. For example, this criteria will cause the account search to display results if the patient chart had both the coder AND the CDI user identifying a PSI.

OR Criteria

When using OR criteria, think about adding OR at the end of each criterion. The OR criteria will display in blue to differentiate between the first and second criteria that will trigger the results. For example, this criteria will cause the account search to display results if the patient chart had either the Coder OR the CDI user identifying a PSI.

Start to filter the data by clicking the appropriate criteria button and selecting fields to constrain the data.

Continue to constrain the data for the desired results. There are over 250 fields that can be used to constrain the data. Each organization will have their own custom fields, depending on how the system was configured.

Selecting Columns

Once the data has been constrained, select the columns to display by selecting Columns.

When the results are initally returned, there will be more column fields displayed than needed. Users can pair down the columns by removing or adding the columns as needed. Clicking on the drop-down arrow on Columns allows the user to select or unselect all columns. Use the check box to indicate the column should display and uncheck it to remove the column from the Account Search or Scheduled Account Search report.

Drill-Down Level

Account Search allows for the ability to search for account level data or drill down to an array of different data collections.

• Account (Default)
• Audits
• CDI/Clinical Alerts
• Denials
• Final Assigned Codes
• Final CPT Codes
• Final Diagnoses
• Final Procedures
• Final Visit Reasons
• Pending Reasons
• Physician Coding Assigned Codes
• Physicians
• Queries
• Working Assigned Codes
• Working CPT Codes
• Working Diagnoses
• Working Procedures
• Working Visit Reasons

When a choice other than Account, which is the default view, is selected the columns for that choice are added to the beginning of the original grid. The drill-down level can be saved to the grid. For example, if there is search the user has saved called Unsubmitted, and the user added the Final Procedure drill-down to it, then when Unsubmitted is pulled up in Account Search it will include the drill-down columns. Additionally, the name of the drill-down will appear in the drill-down level field instead of the default of Account.

Searching for Data

The data filter allows user to constrain the data before returning results in account search grid.

For example, a search for patient charts that CDI reviewed in the previous month might look like this:

To learn more about the fields and how they are defined, navigate to the Fields section in this user guide.

Sort and Filter Results

Each column has menu options to filter the data to restrict the view for only the data the user has defined.

To manually filter:

• Click the 3 lines on the column to be filtered
• Click on the Filter icon
• Check or uncheck the boxes depending on the data to be filtered
• Click on the filter to close the box

Additionally, users can choose to group the data creating a pivot table.

Using the data to create a pivot table allows users to reorganize the selected columns and rows of data in the account search grid table to obtain a desired report. The fields that can be filtered on and/or displayed can be found in the Fields section in this user guide.

Saving a Search

Account searches can be saved for future use.

When saving a search, a new field will show in the save box called Filter Summary. If filled out, the summary will show in the banner of the search next to the Drill-Down Level.

Scheduling a Report

When a search is saved, a +Add Scheduler button will appear for users in Account Search to open a dialog box to create/edit/delete a schedule. Each saved search can have one schedule.

Once the user fills this out and saves, the button changes so the user can edit the scheduled report from account search.

Users can also see the account searches that were scheduled under the reporting tabs and scheduled user reports.

Export to CSV

Search results can be exportd from the right click menu. Exporting in the CSV format allows users to view them in Excel. Exported results will maintain the columns and grouping.

Calendar View

The calendar view will show which users touched charts on a specific day and the actions they took. Upon first logging on, users will be presented with a calendar view. By default, the view shows the current calendar week.

To view the entire calendar month or choose a date range use the control keys at the top of the calendar.

The left and right buttons located at the right of the date field will allow you to change the month forward or backward one month per click. Each of the calendar days have information provided which are defined below. The facility drop down menu, will allow the user to select a facility (if applicable). The type drop down menu, will allow the user to select a patient type (category) (if applicable). Once the parameters havee been defined, click Submit to display the data within the calendar.

Statistics

Each Calendar date has its own overview statistics. The numbers and totals shown on the calendar are distinct numbers, meaning each chart is only considered once per each category below even if a user clicked save or submit multiple times it will be ONLY counted once.

To review the details surrounding a calendar date, click on the square with an arrow next to the calendar date. This will display the calendar day statistics making up the overview data.

Calendar Day Statistics

All counts on the grouping row of the Calendar Stats by Day page are based on distinct accounts. Categories will be hidden if they have a count of zero. The information grid below the total sum will be an audit trail and will not add up to the grouping counts.

View Account Codes

To view an account, right click on any of the grid rows. This will display codes assigned to this account.

This view provides a look at codes that were assigned by Coders and/or CDI. Not all charts will have both user views. Available views will depend on if the chart opened yields information from one or both user types. This view will indicate the state of chart for the audit item selected.

The columns listed below are default, however a user can change this display by hovering over a grid field and selecting the 3 horizontal lines.

User Reports

User reports are canned reports that are preformatted. User reports were created to be run on-demand, but many reports can also be scheduled to run at a specific date/time interval. Each report is outlined below along with a brief description.

Users looking for data that is not available in user reports can use account search to create custom searches and then export the raw data.

Running a User Report

1. Select the report from the available list - the selected report will display a short description on the screen

2. Filter as needed - each report is unique in the style of data it will yield. Review filter options and use as needed.

3. Select the format of the report - .xlsx will result in a file in the users downloads folder.

4. Select Run Report

User Reports and Descriptions

The following is a complete list of Fusion CAC’s default reports and their descriptions. An organization may have custom reports that do not appear in this list. Additionally, some reports may be part of an add-on module. For questions or if there are other reports your organization would benefit from and you cannot pull the data you need from account search please contact our SME Team (smeteam@dolbey.com) to discuss options.

25 Most Common CPT Codes Report

This report is to provide a listing of the top 25 CPT® codes by patient type (category) for the discharge date range provided. The Date Range for this report is the Chart Discharged Date.

25 Most Common Diagnosis Codes Report

This report is to provide a listing of the top 25 diagnosis codes by patient type (category) per the discharge date range provided. The Date Range for this report is the Chart Discharged Date.

25 Most Common PCS Codes Report

This report is to provide a listing of the top 25 PCS codes by patient type (category) per the discharge date range provided. The Date Range for this report is the Chart Discharged Date.

Assigned Workgroup Report

This report provides details about each of the users and what workgroup they are assigned to in sequence. The date range input is irrelevant for this report and will always display the user’s current workgroups.

Audit Abstract Report

This report will provide an overview of the abstraction scores for each user based upon a date range.

Notes:

• Abstract Pre-Audit value is the total number of abstraction items (discharge disposition change, date changes and provider changes) added pre-audit.
• Abstract D/C Disp Errors value is the total number of discharge disposition errors.
• Procedure Provider Changes value is the total number of procedure provider changes (PCS and/or CPT).
• Procedure Date Changes value is the total number of procedure date changes (PCS and/or CPT).
• Procedure Modifier Changes value is the total number of procedure modifier changes (CPT).
• Total Abstract Errors value is the Sum of all abstract (discharge disposition change, date changes and provider changes) errors during audit.

Audit Executive Summary

This report is an executive level view that shows an overview of inpatient and outpatient audit activity by Auditor. It includes the audit rate and average error rates for diagnoses and procedure coding. The date of this report is based on the date the account was first submitted.

Inpatient Audit Scorecard

This monthly report provides a summary of the Auditor’s work completed for any type of inpatient audit and the financial impact based on the audit findings. This report will show number of coders and coded encounters audited that resulted in a DRG change and either over payments or under payments. This report will also show the details of physician queries that resulted because of the audit and financial impact of changes made.

Inpatient Auditor Productivity

This report shows auditor productivity by audit type and sub-type and a sum of the total outcomes for each.

Inpatient Coder Scorecard

This report shows, on an individual coder basis, the principal diagnoses, secondary diagnoses, and procedure code assignment errors that may or may not have resulted in a DRG change and financial impact. The report has an audit present. The date range for this report is for the date the audit was performed.

Outpatient Audit Scorecard

This monthly report provides a summary of the Auditor’s work completed for any type of outpatient audit.

Outpatient Auditor Productivity

This report shows auditor productivity by outpatient audit type and sub-type and a sum of the total outcomes for each.

Outpatient Coder Scorecard

This report shows, on an individual coder basis, the errors and accuracy rates for diagnosis codes including Reason for Visit and secondary diagnoses; errors in CPT code assignments, modifiers, charges, and procedure details (provider name and date of procedure). The date range for this report is for the date the audit was performed.

Cancelled Query Report

This report is to track Physician Queries that were cancelled within the date range specified. Only queries cancelled from within the Physician Query viewer will be tracked on this report, i.e. any third- party cancellations will not appear. Created date and cancelled date will be displayed, along with the amount of time the query was open. The date range for this report is the date that the physician query was cancelled.

Case Mix Index Comparison Trend Report

This report shows the Baseline, Working, and Final CMI per discharge month. (Filtering: Only run as a monthly report). The date range on this report is the Chart Discharge Date please note the range is expanded to the full month.

Case Mix Index Report by Attending Physician Report

This report will show the difference between the most Current Working CMI and Final CMI, additionally providing the CMI Difference (Final CMI – Current Working CMI.) This report will show how the physician’s documentation impacted the chart over the course of the patient’s stay. If the physician documented appropriately, the Current Working and Final DRG should be very close. If the DRGs are far apart, the likely cause is that either the CDI did not have the documentation, or the physician did not document the chart comprehensively. This report should be used in conjunction with additional auditing on the attending physician if you are questioning the results. (Filtering: Only run as a monthly report). The date range for this report is on the Chart Admit Date

Case Mix Index per Month

Date Range: Chart Discharge Date (only Submitted Inpatient charts with a DRG Weight valued will appear in this report) This report will provide a monthly case mix overall for all financial classes then for each financial class. This report is based upon final coded outcomes. A “case mix index” is the average DRG Weight of accounts that have a DRG Weight - This report only includes submitted inpatient accounts with a DRG Weight.

CC/MCC Capture Rate

This report provides the final outcome of CC/MCC capture rate. This can be used to compare the CC/MCC capture rate to those DRG’s that don’t have a DRG but, have the opportunity to be maximized which is defined as DRG’s with a DRG description of without CC/MCC, w/o CC, w/o MCC. This report will tell you what opportunities may have been missed

CDI Executive Summary Report

This report is an executive level view broken down per month that shows total discharges vs. total reviews in addition to the # of total queries, response rates and improved DRG’s. The improved DRG is calculated by determining if there was a positive reimbursement gain from the baseline to the working DRG. (Filtering: Max of 12 months selected; only run as a monthly report). The date range on this report is the Chart Admit Date, please note that this report date range is expanded to the full month

CDI Financial Benefit Report

This report is broken down per month coded and the total financial impact CDI had on the chart. The report will only display charts with unmatched DRG’s and show a financial impact based on the baseline DRG to final coded DRG. The date range on this report is the Chart Submitted Date (LastSubmitter).

CDI Metric Score Card

This report shows CDI productivity based upon the CDI user reviews and queries. The report will show CDI activity specifically on the number of initial reviews (first time a CDI reviews a chart), number of follow up reviews (reviews beyond the first time a CDI reviews a chart), queries issued, agreed upon query amounts, and the number of days we show activity occurring.

CDI Productivity - Admission Month Report

This report shows CDI productivity based upon the admission month of the patient. The report will show CDI activity specifically on the # of initial reviews (first time a CDI reviews a chart). A review is calculated by the following:

• Inpatient: First time a user with a role of CDI computed a Working DRG and saved the chart.
• Outpatient: First time a user with a role of CDI saved the chart.

This report will also tell you out of the charts the CDI staff member completed what the query rate is and on average how many days did it take before the chart was initially reviewed. Reporting is done on the admission month, so this report displays any patient discharged or not discharged during this admission month if there was a CDI review. (Filtering: Only run as a monthly report). The date range on this report is the Chart Admit Date, please note that this report date range is expanded to the full month.

CDI Query Detail Report

This report provides details of physician queries created by CDI Specialists on accounts that have since been discharged. This report details how the account evolved from a Baseline DRG to a Final DRG.

Any non-canceled physician query created by a CDI Specialist on an inpatient, now-discharged account should appear as a line item on this report.

CDI Query Score Card Report

This report is displayed in several sections:

1. Discharge/Reviews – This section reports on the review rate of the CDI team. It displays the number of patients discharged in the current month along with how many of them were reviewed by CDI.
2. CDI Query Outcome – Of the charts that made up the review rate under discharges, this section displays the total that resulted in queries that are broken down more granularly by the physician’s response rate.
3. Reconciliation – This section displays charts that created the review rate section and have a final DRG without having a submitted status. This section shows how often CDI and coders agree on the DRG.
4. CMI Comparison – This section reviews where the chart started (Baseline DRG CMI) and where the chart ended up (Final DRG CMI – which is the reported CMI). (Filtering: Max of 12 months selected; only run as a monthly report).
5. CDI Team Metrics - The calculations within these sections are like the existing fields in the CDI Metric Score Card report, but the review counts are determined by the discharge date or admit date of accounts, respectively

The date range on this report is the Chart Discharged Date, please note that this report date range is expanded to the full month

CDI Query Score Card by Admission Month

This report is displayed in 4 sections:

1. Admit/Reviews – This section reports on the review rate of the CDI team. It displays the number of patients admitted in the current month along with how many of them were reviewed by CDI.
2. CDI Query Outcome – Of the charts that made up the review rate under admits, this section displays the total that resulted in queries that are broken down more granularly by the physician’s response rate.
3. Reconciliation – This section displays charts that created the review rate section and have a final DRG without having a submitted status. This section shows how often CDI and coders agree on the DRG.
4. CMI Comparison – This section reviews where the chart started (Baseline DRG CMI) and where the chart ended up (Final DRG CMI – which is the reported CMI).

(Filtering: Max of 12 months selected; only run as a monthly report).

CDI Rounding Report

This report shows all charts reviewed and not reviewed by CDI. If the account has not been reviewed by CDI, working information will be blank to allow CDI to take notes while rounding. If the account has been reviewed by CDI, this report will show an account level view by admit date of the difference between the ALOS and the GMLOS based on the most current Working DRG. The variance is the difference between ALOS and the GMLOS. The higher that number, the chart is identified as needing a re-review for potential DRG change and SOI/ROM. The date range on this report is the Chart Admit Date. To qualify for this report the chart must be an Inpatient Chart.

CDI Activity Report

This report shows the number of ‘Initial Reviews’ vs ‘Followup Reviews’ per category (patient type) with the total number of queries sent. (Filtering: Max of 31 days selected). The date range on this report is the Chart Working DRG Save Date/Time (Query Create Date for the Queries.)

CDI Codes on Submitted Charts Report

This report shows the list of diagnosis codes and procedures that CDI assigned in sequenced order.

Coder DRG Summary

This report is to show the breakdown per coder MS-DRG to show the total visits per DRG.

Engine Outcome Summary by Coder Report

This report can be used to determine how the engine performed for the coder. It shows whether they leveraged the code suggestions or if they manually entered codes, bypassing suggestions. Data is gathered based on the date the chart was coded, and is based on final codes, not working. This report should be used in conjunction with a coding audit if needed.

• Accepted: A code suggestion was assigned directly to the account.
• Added: A code was added to a text document manually and assigned to the account.
  • Added Text: counts the number of codes added to phrases in text documents that were not suggested by FAE.
  • Added Non-Text: counts the number of codes added to the top of text documents and worksheets that were not suggested by FAE.
• Edited: A code suggestion was edited and then assigned to the account.
• Direct: A code was assigned directly to the account manually or from the Solventum CRS encoder, but also suggested by FAE
• Image: A code was assigned from an image document.
  • Image (Non-Duplicate): counts the number of codes added to image documents not suggested by FAE.
  • Image (Duplicate): counts the number of codes added to image documents that were also suggested by FAE.

The date range on this report is the Chart Submitted Date (FirstSubmitter.)

Coded Procedure Account Details Report

This report provides details about charts with assigned procedures. The date range on this report is the Chart Last Submitted Date. To qualify for this report the chart must have at least one Procedure code assigned on the chart.

Coder Activity Report

This report shows the distinct number of accounts that were ‘Viewed’, ‘Saved’, ‘Submitted’, and ‘Resubmitted’, then the total number of Queries created, the total time updating, time viewing accounts, and total time spent per day - grouped by coder then by category (patient type) over the date range. Date Range is the date of the activity, beginning of start date to the ending of end date. (Filtering: max of 31 days selected). The date range on this report is the Change History Audit Date (Viewed, Saved, Submitted, Resubmitted actions.

Coder Detailed Activity Report

This report is very similar to the “Coder Activity Report” but with two notable changes:

1. The new column “Chart Touches” counts the number of times the user touched" an account on a specific date. A touch is defined as a unique save or submit action.
2. The times submitting and times saving are split. If the user loads an accounts, saves it, keeps the account loaded, and then submits it, the time between loading the account and saving it counts as time submitted instead of time saving.

Physician Coding Activity

This report shows the distinct unique charts a physician coder viewed and how many changes were submitted and pended, then the total number of Queries created, the total time updating, time viewing accounts, and total time spent per day - grouped by coder then by category over the date range. Date Range is the date of the activity, beginning of start date to the ending of end date.

Coding Chart Status Report

This report displays coding productivity in regard to submitted, pending, and unbilled charts. This report shows how long the chart took to code from the time the patient was discharged and how long the chart took from the time the coder had accessibility to the patient chart. Once a patient is discharged, it may be examined for completeness and non-coding staff may place pending reasons on the chart to indicate deficiencies. When the deficiencies are resolved, the chart is then assigned to a coding worklist to indicate the chart is ready for coding. The date range on this report is the Chart Discharged Date

Discharged Not Final Coded Report

This report will show management all of the discharged charts within the system that do not have final coding. The date range for this report is the Chart Discharged Date. To qualify for this report the chart must have a status of Unbilled. If there are multiple pending reasons on a qualifying chart, they will be separated by a comma.

DRG Comparison Report

This report shows the difference between Baseline DRG and Final DRG per account. Only accounts that have both a CDS calculated Baseline DRG and a Coder Submitted Final DRG with an Admit Date within the selected range will be included. The user(s) selected below will constrain the data to either (or both) by the CDS on the most current calculated Baseline DRG or the Coder that last submitted with a Final DRG. (Filtering: Minimum of 1 category selected). The date range on this report is the Chart Admit Date.

Engine Outcome Detail per Coder

This report should be used to show if the user is using code suggestions or manually adding codes. It will show total assigned codes broken down by code set along with how many codes were suggested by the engine versus added by text documents and non-text documents in addition to those that were added in duplicate. This report card should be used as an educational opportunity to show possible improvements for the end-user and/or code suggestions. This report is recommended to be used in conjunction with an audit.

Engine Outcome Detail per CDI

This report shows the total codes that the engine is suggesting, and what CDI is using vs. what CDI is manually adding compared to the coder’s Final Codes. This report should tell the level of manual effort per CDI of those codes that are being used for final code assignment by coders. It will show total assigned codes by CDI broken down by code set along with how many codes were suggested by the engine versus added by text documents and non-text documents in addition to those that were added in duplicate. There is also a column to indicate of the codes manually added how many did the coder assign for final code assignment. This report card should be used as an educational opportunity to show possible improvements for the end-user and/or the code suggestions. This report is recommended to be used in conjunction with an audit.

Engine Results by Documents Report

This report shows the default engine accuracy per document at the time of submission. Also, shows the first and last times the document was received on the submitted accounts. The report is sorted from most to least added/edited codes by the coder. The date range on this report is the Chart Submitted Date (FirstSubmitter).

Financial Class Outcome by Discharge Report

This report shows the breakdown per financial class per month. It will breakdown the total patient charts, average length of stay total charts and case mix index.

Final Code Count per Account Report

This report shows the submitted chart high level outcomes for diagnosis and procedure codes per account. The Total Dx column displays the total of unique diagnosis codes on the account (visit, admit, principal and secondary); the # of DX Unspecified column shows how many of those codes are showing an ‘unspecified’ designation in their description. This report will allow managers to target coder audits to determine if the chart is being coded correctly or if additional data should have been requested through a query. This report would be used in conjunction with an audit. The date range on this report is the Chart Last Submitted Date (Must have a status of Submitted.)

Global Productivity Report

This report shows coder productivity by patient type per day, the number of ‘Viewed’, ‘Saved’, and ‘Submitted’ actions, and the total time logged working on that patient type. (Filtering: Max of 31 days selected). The date range on this report is the Change History Audit Date (Submitted, Resubmitted, Saved, Viewed actions.)

HAC Report

This report is to provide a listing of all patients admitted within the date range of this report that contains hospital acquired conditions. This report only looks at final coded data and does not reflect working data. The date range on this report is the Chart Admit Date.

Incentive Productiviy Report

This report applies an incentive multiplier to the distinct number of accounts that were first submitted each week, per user, to calculate incentive points.

• Multiplies the number of first submitted accounts per week by an incentive multiplier per category that is configured in Mappings Configuration.
• The administrator can optionally record an incentive multiplier that is used in this report.
• Categories without a value in the incentive multiplier will be calculated with an incentive multiplier of 1.0.
• This report is like the “Weekly Coder Productivity Report” in that it reports on whole weeks, but only produces an entry if the coder first submitted an account that week.

Length of Stay Variance Report

This report shows an account level view by admit date of the difference between the ALOS and the GMLOS based on the most current Working DRG. The variance is the difference between ALOS and the GMLOS. The higher that number, the chart is identified as needing a re-review for potential DRG change and SOI/ROM. The date range on this report is the Chart Admit Date (Must be an Inpatient Chart).

Outstanding Queries Report

This report displays a list of the physicians that have open queries. At the top of the report there is a summary that shows the Top Physicians with outstanding queries and the length of time their oldest query has been open. Date Range: Query Create Date (The date that the query was initially created and sent).

Pending Reasons Report

This report shows which charts are pending, who placed the pending reason, what the pending reason is, and which physician was assigned to the pending reason. Not all pending reasons will have a physician assigned as some pending reasons are not a result of chart deficiency. The date range on this report is the Chart Admit Date.

Query Impact Report

This report includes all charts that received queries and resulted in at least one of the following:

• A change in DRG
• Change in CC/MCC/HAC Totals
• Other reasons your facility has defined as a query shift reason

This report will show you the impact that the query made. The report is grouped by query template name, then by Author, then by account #. The query will also show if there was a shift in DRG and what the user listed as the reason for the shift. The date range on this report is the Query Create Date (The date that the query was initially created and sent)

Query Impact by Discharge Date Report

This report includes all charts that received queries and resulted in at least one of the following:

• A change in DRG
• Change in CC/MCC/HAC Totals
• Other reasons your facility has defined as a query shift reason

This report will show you the impact that the query made. The report is based on the patient’s discharge date and is grouped by query template name, then by Author, then by account #. The query will also show if there was a shift in DRG and what the user listed as the reason for the shift. The date range on this report is the Chart Discharged Date.

Query Overview Report

This report shows pre-discharge physicians query response or non-response and the template used. The date range on this report is the Query Create Date (The date that the query was initially created and sent).

Query Stats Report

This report shows the physicians within the date range that were queried. The report will show how many charts the physician was queried for and how many queries these charts resulted in. The date range on this report is the Query Create Date (The date that the query was initially created and sent.)

Present on Admission Tracking Report

This report is based on the date the patient chart was discharged and its final diagnosis codes. POA Values will be listed, along with HAC determinations if they are present. The totals for the columns Visit Count, Total LOS Days and Average LOS, (if available; Deaths, Autopsy Required) are figured per account, the Totals for the Present on Admit and HAC columns are figured per code. The date range on this report is the Chart Discharged Date.

Query TAT by Author Report

This report shows all of the queries that have been responded, with who sent the queries and the turn around time, which is based on the date/time it was sent to the physician until the date/time that the query was responded. The date range on this report is the Query Create Date (The date that the query was initially created and sent).

Query Template Volume Overview Report

This report shows the volume of queries per template sorted by whom the query was sent with the date sent and then responded to then when it was closed as agreed, disagreed or no opinion per account along with the discharge date. The date range on this report is the Query Create Date (The date that the query was initially created and sent).

Query Template Volume by Discharge Date Report

This report shows the volume of queries per template for discharged accounts, sorted by whom the query was sent with the date sent and then responded to then when it was closed as agreed, disagreed or no opinion.

Recent Suggested/Working DRG Report

This report shows all unsubmitted inpatient accounts without a discharge date that have a calculated Suggested or Working DRG, grouped by calculation date. Only the most recent Suggested or Working DRG is displayed for each account. The ““Updated By”” column will say ““Suggested”” to indicate that the DRG was calculated automatically from the Suggested DRG module. Sites that do not use the Suggested DRG module can still use this report to get the most recent Working DRGs for all Inhouse accounts. In addition to displaying the GMLOS, it also displays the LOS and Variance.

The date range is irrelevant and will report on all inpatient accounts with no discharge date that have either a suggested DRG (calculated by the Suggested DRG module) or a working DRG (calculated by a CDI Specialist).

Recurring Account Productivity Report

This report tracks daily productivity for recurring accounts. It uses the effective date to track which occurrence of the account was coded. An account can repeat on the report if the chart has been coded multiple times on the same day with different effective dates. Total time in account is shown as HH:MM:SS. The date range on this report is the Change History Audit Date (Submitted, Resubmitted, Saved, Viewed actions

Submitted by Coder Report

This report shows the number of accounts submitted - grouped by facility, category, and submitter - over the account discharged date range. The number of accounts submitted per coder is compared to the total number of accounts per facility and category to calculate a submitted rate. Total discharges are only displayed per facility and category. The date range on this report is the Chart Discharged Date

Submitted by Discharge Date Report

This report shows the number of accounts discharged, submitted, and percent of submitted - grouped by facility, discharge date, and patient type over the date range. The date range on this report is the Chart Discharged Date.

Submitted Secondary Diagnosis Total

This report is based on the first submit of an account. It shows the total number of secondary diagnoses codes per account and whether the end user manually added the code(s), the system suggested them, or the user added AND the engine suggested the code(s). In addition, the total codes still unassigned upon submit will be shown.

Top 10 Coded Medical vs. Surgical DRG Report

This report displays the Top 10 Medical vs. Surgical DRGs for submitted accounts within the defined discharge date. Medical DRGs and Surgical DRGs are defined by the DRG type that is returned from the TruCode or Solventum CRS encoder. The date range on this report is the Chart Discharged Date (Must be Submitted and have a Final DRG).

User Audit Trail Report

This report shows user activities within the selected date range. Not selecting a User will result in only system events being displayed. (Filtering: Max of 1 user selected; max of 1 day selected). The date range on this report is the Date & Time of the action of the activity.

User Detail Report

This report shows the detail of the accounts that are coded including re-submits, the codes Added/Deleted by the coder, number of documents, and Total Charges amounts — grouped by coder over the date range. (distinct accounts) Date Range is the date the account was submitted, beginning of start date to the ending of end date. (Filtering: Minimum of 1 user selected; max of 7 days selected). The date range on this report is the ChangeHistory Audit Date (Submitted actions).

User Session Log Report

This report shows the users log showing the Checkout time (when user went into the account), Checkin time (‘Saved’, ‘Submitted’, or canceled activity in the account), and total time in the account per each account session. (Filtering: Minimum of 1 user selected; max of 7 days selected). The date range on this report is the ChangeHistory Audit Date (Check Out & Check In of the Account Dates).

Weekly Coder Activity Report

This report shows the distinct number of accounts that were ‘Viewed’, ‘Saved’, ‘Submitted’, and ‘Resubmitted’, then the total number of Queries created, the total time updating, time viewing accounts, and total time spent per week - grouped by coder then by category (patient type) over the week range. The week range contains the date of the activity, beginning of start date to end date. (Filtering: Minimum of 1 user selected). The date range on this report is the Change History Audit Date (Viewed, Saved, Submitted, Resubmitted actions).

CDI Query Detail Report

This report provides details of physician queries created by CDI Specialists on accounts that have since been discharged. This report details how the account evolved from a Baseline DRG to a Final DRG. Any non-canceled physician query created by a CDI Specialist on an inpatient, now-discharged account should appear as a line item on this report. The date range on this report is the Chart Discharged Date. To qualify for this report the chart must be an inpatient patient type.

Consulting Provider Report

This report provides a list of all consulting provider(s) that were added to each account. The date range on this report is the Chart Discharged Date. To qualify for this report the chart must be Submitted and have at least one Consulting Provider.

Engine Outcome per Coder Report

This report should be used to show if the user is using code suggestions or manually adding codes. It will show total assigned codes broken down by code set along with how many codes were suggested by the engine versus added by text documents and non-text documents in addition to those that were added in duplicate. Duplicate is defined by codes that both the engine and the end-user added the code. This report card should be used as an educational opportunity to show possible improvements for the end- user and/or code suggestions. This report is recommended to be used in conjunction with an audit.

The field Total Documents had to be constrained to count the total documents on the account with at least one attached code to make the formulas correct. Documents with no codes suggested nor added are not counted in this report and should not be since this report is about engine outcome. The date range on this report is the Chart Submitted Date. To qualify for this, report the chart must be Submitted with assigned codes.

Payor Volumes Report

This report shows the submitted patient account number, full name, MRN#, discharge date, patient type, and facility - grouped by payor with number of accounts submitted subtotals and grand total over the date range. Date Range is the date the account was discharged, beginning of start date to the ending of end date. The date range on this report is the Chart Discharged Date. To qualify for this report the chart must be Submitted.

Current Workgroup Report

This report shows the list of all of the workgroups with the total charts, oldest admit and discharge date along with total charges.

AMA CPT Utilization Report

This report lists all users who have added or edited CPT codes on accounts for a specified date range for AMA license reporting. This is a report Dolbey uses to report CPT code usage to the AMA.

Topics

User reports can be categorized by topic, per organization.

For example, the following reports might be added to a topic of Impact Reports: you are running reports.

• Physician Query Impact
• Physician Query Impact by Discharge Date
• CDI Financial Benefit

Reports can be filtered by topic to narrow down the list of available reports.

To assign a topic to report

• Select the report
• Click Edit Topic
• Edit the selected report
  • Choose an exisiting topic from the dropdown menu
  • Enter a name for a custom topic, and click +Add
  • Click Save

Topics can be managed in the Topics Mapping Table.

Scheduled Reports

Reports in Fusion CAC can be scheduled to be delivered via email at specified times.

Clicking +Create New Schedule will open the scheduling options.

Click Save in the upper right hand corner to save the settings and start the schedule.

Saved reports will display on the left hand side of the screen.

Run History

Scheduled reports will have a run history.

A run history will display above the schedule data for the last three times the report ran, whether it was successful or errored. No text in the message column indicate the report ran and was delivered without error. A message of “No Message Returned” indicates nothing was sent as the report yeilded no results. The application will not send out a blank report.

Code Set Management

Code sets are commonly used groups of codes that can be saved for ease of use and productivity. Codes sets can be saved by topic to provide a quick code assignment. Managers can create code sets to push out to coders and/or users can create their own.

Create a Code Set

1. Click on +Add in the Active Code Set navigation menu on the left hand side of the screen
2. Name the code set so it is clear what codes it contains
3. Select if code set should be shared. Check with management for the organization’s policy on code sets
4. Choose what patient type this code set is relevant to
5. Add codes into the “Add codes" box.
6. Click “Save Code Sets” when completed

User Management

User Management allows management to add, delete, or change permissions and/or set work lists for other users. The grid view will display all users with a Fusion CAC User ID. The columns can be arranged in any order and saved per user.

Column	Description
Action	Copy exisiting profile when creating new user: Edit existing profile: Remove unused profile:
Locked	Indicates if the user is locked out of the application
Employee Number	Employee number from ogranization
User ID	Username used to log into the application
First Name	User’s first name
Last Name	User’s last name
Facilities	User’s assigned facilites
Roles	User’s assigned role(s) in the applicationied to their permissions
Workgroups	User’s assigned workgroups
Active User	Indicates if the user has active access to the application
Last Access Time	Date and time the user last logged into the application
Force Autoload	Status of Force Autoload for the user
Email	User’s email address

Edit User Profile

New User

+Add User allows management to create a brand new user profile from scratch

Copying a user profile will carry over some settings from an existing profile to a brand new profile

• Roles
• Facilites
• Chart Access
• Workgroups

User Name and Password (Required)

It is common practice for organizations to use LDAP to communicate with their Active Directory, which stores user information such as usernames and passwords. When a user logs into Fusion CAC, the application can use LDAP to check Active Directory for the user’s credentials. In short, LDAP allows the application to use existing usernames and passwords from Active Directory, so users do not need to remember separate login credentials specific to Fusion CAC.

For this process to work, the credentials entered into Fusion CAC must be identical to the Windows login provided by the organization. As long as the user name matches, there is no need to enter a password when creating a new profile in the application. Fusion CAC will be able to link to Active Directory and the end user can log into the application using the same information they use to log into their work computer.

Employee Number

If applicable, the user’s employee number can be entered. Only administrators can see and edit user Employee Numbers.

Roles

In Fusion CAC, roles determine the permissions and privileges a user has while navigating the application. Users can have multiple roles. Roles can be configured by management in the Role Management tool.

Default roles include:

Facilities

Multi-site organizations can assign specific facilities to users. Options in the dropdown menu can be customized using the Mapping Configuration tool. Once assigned, the user will only be able to acces charts from their assigned facilities.

Manager

The user can be assigned to an individual manager. Selecting a user from the Manager dropdown and saving the user will add/edit the manager assigned to the coder.

Managers only have accessibility to pull user reports and dashboard activities for the end users assigned to them. When the manager logs in and has at least one coder assigned to them, the coder and audit administrative dashboards will only show data relevant to the assigned coder(s). When the manager runs a User Report, the report will automatically be filtered to the users assigned to the manager. The manager is unable to gather any report information involving users not assigned to the manager.

For this feature, managers are defined as users with the role of “Manager” but not a role of “Administrator.” No users have managers by default, since the configuration of managers is entirely optional. Additionally, a user cannot be their own manager.

Email

The user’s email can be entered for documentation purposes, unless the organization is using the Enable Query functionality.

Name (Required)

Data entered in these fields are used to identify the user various areas of the application, including reporting.

Signature

Clicking +Add next to Signature in the top right corner allows each user to create a signature that will automatically be sent at the bottom of physician queries. This line will appear at the bottom of Physician Queries to show who created the query. A new button is located next to the user’s name in the user profile.

Clicking it will open a box allowing the user to create the signature.

For formatting options, highlight the text in the signature box.

Enable Query

This setting is not commonly configured. Enable Query allows a user to send a Physician Query to a valid email, if the user receiving the query is added in User Management with a vaild email address.

If that checkbox is checked, the user becomes searchable in the physician dropdown within a physician query.

The user will only be visable upon typing in the User ID and will show a little person icon next to their name to indicate they are not a physician.

Active

This field allows management to revoke access to the system. If checked the user is active and can log into the application. If unchecked, the user is inactive and will not have access to the system.

Locked

The user will not be able to login until this box is unchecked. An account will automatically lock by incorrectly after three (3) incorrect sign in attempts. If a user’s profile is locked, they will not be able to log into the Fusion CAC application. Unchecking the box will allow the user to attempt to sign back in.

Workgroups

Workgroups selected from the dropdown are assigned to the user.

Assigned workgroups will display to the end user in the Assgned To: dropdown on the Accounts page.

Primary workgroups will be presented to the end user first. Backup workgroups will be presented if there are no accounts availble in the user’s primary queues.

To select multiple workgroups at a time, hold the Ctrl key while clicking.

Force AutoLoad

Force Autoload helps prevent cherry-picking by forcing the order in which patient charts are presented to end users.

Users with ForceAutoload enabled will bypass the Account List page upon logging in and be directed to the AutoLoad page. To access their next account, they simply click Go To Next Account, which automatically loads the first available account from their assigned workgroups. The system follows the sort order set by the manager and skips any charts currently locked in use by another user.

If there are no accounts left to work, the user will receive a message that there are no accounts in the queue.

Workgroup Limits

When Force Autoload is enabled, Limit: boxes will display next to each assigned workgroup.

Managers can limit the number of accounts per workgroup the user will be assigned before they are presented with accounts from the next list. If no limit is set, the user will have access to however many accounts are currently in the workgroup. To transition to the next workgroup, the current workgroup must be fully completed.

The Autoload page provides a copy of the Coder Personal Dashboard. The coder will also see a list of accounts they saved with a Pending Reason at the bottom of the autoload page.

User Profile Menu

Users can access their profile information by clicking on their name in the top right hand corner.

• Selecting “Profile” will open their profile. The user’s permissions will dictate which settings they are able to edit. Users with multiple roles will need to open their profile to switch roles.
• Log Out will log the user out of the application. It is recommened for users to log out when they are done working rather than just closing the browser window.

Today’s Productivity

Daily productivity stats are displayed when the user clicks on the bar graph icon to the left of the user’s ID. This is an alternative way for the user to quickly see their work if they are not looking at their Personal Dashboard.

When the bar graph icon is clicked, the “Today’s Productivity” dialog box will open.

Coder/Auditor View:

CDI View:

Workflow Management

The Workflow Management tool allows Administrators to create, design, modify, and manage workflow(s) within Fusion CAC.

The purpose of a workflow is to systematically organize and streamline the patient chart activities for proper completion. Workflows are designed to improve efficiency, productivity, and collaboration between the various user roles by defining the sequence of steps, assigning responsibilities, and establishing the flow of information between different individuals or departments involved in the process. They ensure that tasks are completed in a structured and efficient manner, enabling organizations to achieve their goals more effectively.

Worklists

Worklists are organized into one of the following categories:

Categories are made up of one or more worklists. Each worklist is then made up of one or more criteria groups. For example:

• The Post Discharge category
  • contains the Inpatient worklist
    • which has the Ready for Coding criteria group
      • which is then made up of multiple pieces of criteria

It is possible for an account to be in more than one worklist at a time, depending on the category:

• An account may only be in one default category at a time.
• Custom categories allow an account to be in multiple custom categories at the same time.
• An account can also be in one default category and multiple custom categories at the same time.
• An account cannot be in more than one workgroup within the same category.

Often a worklist will contain multiple criteria groups. Each criteria group has many different filters to fully constrain the data. This ensures the appropriate number of charts are caught in each worklist.

Audit

Audit workflow collects charts meeting the specified criteria needed to be reviewed by an Auditor. The workflow can define certain days for when charts are added to the Auditor worklist(s).In Workflow Management the Audit default workgroup category is identical to all other workgroup categories, but Audit workflow is triggered on a schedule instead of in real-time.

Example: Select that workflow automatically adds charts to the worklist on the first day of every month and last day of the month.

On the designated days every month, 5 charts (the limit can be changed) from every Coder (First Submitter) will be automatically routed to the Auditor’s worklist.

Schedule

The setting to determine when workflow will run for this Audit (Daily, Weekly, or Monthly).

Groups

One or more single fields to perform the grouping. For example, a grouping of “Last Submitter” and “Is Inpatient” would tell Audit workflow that after gathering the list of accounts, group them by unique Last Submitter and Is Inpatient.

Limits

The number of accounts to assign from each grouping. This value can be a maximum number, a percentage, or both. Using the example above:

• Setting the selection to 5 maximum with no percentage means that for each unique group of “Last Submitter” and “Is Inpatient” accounts, randomly assign up to 5 accounts
• Setting the selection to 50 percent and 10 maximum means that for each unique group of “Last Submitter” and “Is Inpatient” accounts, randomly assign 50% of the accounts, up to 5 maximum
• Setting the selection to 50 percent with no maximum means that for each unique group of Last Submitter" and “Is Inpatient” accounts, randomly assign 50% of the accounts

Random Audit

The criteria filter, “Random Percentage” is included in the workflow criteria options. When set to a number between 0 and 100 and detected in the workflow engine, a random number will be generated. If the random number is less than or greater than the number in the filter criteria, the Criteria will match.

Random Inclusion Factor that is less than 20 will pass a theoretical 20% of accounts through the filter. You don’t want to use this with equals (=) because it would always cause a ~1% result, and you don’t want to use it with greater than (>) because it will pass an inverse percentage.

As noted, this is not going to be an exact percentage, only a theoretical one. In edge cases, you could ask for “20% of accounts” and end up getting zero, or you could end up getting all of them, but most of the time, you should get ~20%.

This field is intended to be used with QA Workflow, although the application will not prevent an Administrator from using it in other types of workflow. Valid values for this field are from 1 to 99; any other values in this field will not work.

Do not think of this field as a percentage, but rather as a 100-sided die. When workflow examines this filter, it will “roll the die”. The common use case for this filter is “Random Inclusion Factor –> less than –> 10”.

AutoClose

This automation is the a process by which an ancillary patient chart can be closed by the application based upon a set of rules without Coder intervention. Autoclose is a process that takes routine outpatient visits and automates the coding process by submitting the chart directly to billing. This concept is known in the industry as autonomous coding.

Organizations often use AutoClose to ensure they can capitalize on the value of these ancillary charts while not sacrificing the staff they have. Common outpatient service lines that make great candidates for AutoClose include:

• Screening Mammogram
• Sleep Lab
• Labs
• Chest X-rays
• ED Left Without Being Seen
• Canceled Accounts
• Cardiac rehab
• Dietary or nutritional counseling
• Esophageal motility studies
• Outpatient dialysis
• Pulmonary function tests
• Vaccine visits

The types of accounts eligible for AutoClose depend on the organization, the type of services offered, payor(s), and state requirements. The Dolbey SME Team is happy to answer any questions and will work with each organization to configure AutoClose.

With AutoClose, charts can be processed within seconds and the total turn-around time can be a little as a few minutes. Charts are processed 24 hours a day, 365 days a year with AutoClose. The impact AutoClose can have on revenue is one of the best benefits of this feature. Many organizations AutoClose, on average, 10,000 or more charts per month. This equals out to about 120,000 outpatient visits AutoClosed per year without Coder intervention. That is an estimate of 2.5FTEs.

Completeing Charts

AutoClose can be set to complete charts on day one. Many organizations, however, choose to learn more about how the engine functions before AutoClose is enabled. Autoclose has a test mode which allows organizations to simulate what would have AutoClosed had it been enabled in production. This allows users to review and determine if AutoClose is ready for production at their facility.

Patient charts that pass AutoClose criteria are coded and submitted to billing. Those that fail AutoClose are rejected and routed to a worklist for Coder intervention. Rejected accounts are presented to the Coder with a failure reason.

As an organization expands their AutoClose capabilities, Dolbey recommends conducting regular audits to ensure the system captures and codes everything correctly.

Edit Workflow

New Category

To add a new category in Workflow Management, click +Add New Category in the top right corner.

The dialog box has options to add a default/standard category or a new custom category.

Add Worklist

To add a new worklist, click +Add under the appropriate category on the left hand side of the screen.

Name the new workgroup.

Add a Criteria Group

Name the Criteria Group something simple but meaningful to describe the reason accounts will move into the workgroup. This will help with troubleshooting in the future.

Set Criteria

Workflow has two different criteria options to build workflow.

• AND criteria
• OR Criteria

AND

All the criteria must be met for an account to “match” and be sorted into a workgroup.

For example, for an account to “match” with the Ready for Coding workgroup pictured below, the category must be inpatient and the admit date/time must exist and the discharge date/time must exist and the stage cannot equal A (submitted) and the workgroupassignedby cannot exist and it must not have a pending reason.

OR

At least one of the criteria must be met for an account to “match” and be sorted into a workgroup.

The OR criteria is listed in blue to call attention.

Workgroup Level Criteria

Workgroup level criteria works like all other criteria, but when enabled will apply to every group under that workflow. This alleviates the need for the same criteria to be added to all of the criteria groups.

After setting the Workgroup Level criteria, check the box to include the criteria in the appropriate criteria groups.

This functionality helps to keep repetitive criteria creation to a minimum.

Add as many values as needed to ensure the data is sufficiently constrained so the appropriate charts make it into each queue.

Workflow Operators

Each criterion has a set of operators. Depending on the property slected, the operators may be different.

Properties

Workgroup properties can be edited by clicking +Properties to expand the dialog.

Workgroup Type

Workgroup Type is used to identify which team or department owns a specific workgroup. This classification is essential for determining ownership and accountability within the workflow. For example, to verify whether a particular chart is accessible or being held up, management can check which team owns that worklist. This property allows users to quickly identify the appropriate workgroup for reporting and ensure accurate tracking and visibility across departments.

Sort Field and Direction

Sort Field is used to define how patient charts are automatically organized when added to a worklist. This field determines the primary criterion for sorting, ensuring that charts are arranged in a consistent and logical order to streamline the workflow. For example, coding worklists are commonly sorted by Discharge Date to prioritize records based on when the patient was discharged.

After selecting the appropriate sort field, setting the Sort Direction allows management to specify the order in which the charts will appear:

• Ascending: Sorts the charts starting with the oldest date, ensuring that older records are addressed first.
• Descending: Sorts the charts starting with the most recent date, prioritizing the newest records.

This sorting mechanism helps users efficiently manage their workload by organizing patient charts in a way that aligns with their operational priorities, such as completing older cases first or focusing on more recent discharges.

Assigned Users

Users listed here are assigned to the worklist and will see it in the Assigned To: dropdown on the Accounts page.

Click in the assigned users box and select the desired user(s). Holding down Ctrl allows for selecting multiple users at once.

Click the X next to an assigned user to remove them from the worklist.

Notes

Notes can be added to indicate to anyone reviewing workflow management why changes were made to criteria or sequencing. As notes are added, they will be added to a table in the workgroup properties.

Reordering Worklists

When workflow is triggered, placement decisions are made top-down and inside-out

• Examine criteria in the first workgroup’s first criteria group
• Potentially assign the workgroup and criteria If the account meets all the criteria
• If no “match”, examine the next criteria group in the same workgroup (if applicable)
• If there are no more criteria groups, examine the next workgroup and repeat until a “match” is found

Worklist order matters because of how placement decisions are made.

Workgroups can be reordered using the buttons at the top of the worklist or by clicking and dragging the worklist name in the list on the left hand side of the screen.

Workflow History Edits

The Workflow Management page displays a running history of edits. A timestamp next to the worklist name will show the date and time of the last change made. Hovering over the date/time stamp will provide additional details. Clicking on that timestamp will open a log of changes made to the workgroup and criteria group(s).

Any change made to criteria will show as a timestamp to the right of the specific criteria that was changed. Hovering over the date/time stamp will provide additional details. Clicking on that timestamp will open a log of changes made to that criteria.

Users and Linked Users will now be seen under the name of the workgroup and will be defaulted as collapsed. Clicking on the link will toggle the box open.

Manual Routing

Users with the ability to route charts, can right-click on an account and manually assign it to a user or workgroup.

If an account is manually routed to a user it will populate their “You” queue.

Role Management

Under “Tools” in the application, is a tab for “Role Management”. Role Management allows administrators and managers to create custom user roles in the Fusion CAC application by checking or unchecking the box next to each of the privileges. By default, Role Management will already have privileges for each default role checked.

Create a New Role

Navigate to the Type new role… field in the top right corner of the screen. Enter the desired name for the new role (e.g., CDI Enhanced) and click the “+Add Role” button.

In the example of a “CDI Enhanced”, management may provide users with this role access to all previous CDI permissions while also enabling the ability to design queries. To start, replicate the settings from the CDI Specialist default role. Then, add privileges for the Query Designer to Create/Edit All Physician Query Templates.

Once all privileges for the custom role are selected, click Save All Roles in the top-right corner.

Features and Privileges

Privileges are assgined to roles for specific features within the application. To grant privileges, first identify the feature the role should have access to. Features can be viewed all at once or narrowd down using the blue dropdown list on the left side of the screen. Application features are sorted into the following:

• Chart - (Access, Editing, Physician Queries, Routing)
• Community
• Dashboard
• Document Types Management
• Grid Column Configuration
• Login
• Mapping Configuration
• Query Designer
• Reporting - (Account Search, Calendar, Scheduled Reports, User Reports)
• Role Management
• Shortcut Configuration
• System Search
• Tuning Dashboard
• Tuning Productivity
• User Management
• Workflow Management
• Worksheet Designer

Hidden Roles

When editing custom roles, consider removing irrelevant roles to make the page easier to navigate. Columns can be hidden and unhidden by simply clickling on the role name. For instance, clicking on “CDI Specialist” will hide the corresponding column, moving it to the “Hidden Roles” section above the role columns. To unhide the role, click on “CDI Specialist” again and the column will reappear.

Deleting Roles

Click the “Delete Role” button in the top right corner to display a list of all custom user roles in the software.

The pop-up box for deleting custom roles provides a warning that any users assigned to the role will lose their privileges. As a best practice, reassign users to a different role before deleting the custom role to prevent them from being locked out of the software.

Locked Roles

A lock icon appears next to certain roles, indicating they are default roles within the application and cannot be deleted. In contrast, custom roles, which do not have a lock icon, are not tied to specific areas of the software and can be removed if needed.

Validation Management

Validation Management allows user roles with the correct permission to create rules that show up on the code summary page prior to submitting an account. Rules can be made to prevent an account from being submitted until certain requirements are met, or issue a warning to alert users about potentially incomplete items while still allowing the user to submit an account.

Examples of rules that can be created include:

• An account must have a discharge date to submit an inpatient chart
• The newborn weight must exist on a newborn chart
• If a certain charge is on a chart and a diagnosis code is not present

Creating a Validation Rule

Begin by entering a rule name in the top right-hand corner of the page and then click on +Add Rule.

When the new rule is added, a number will be associated with the rule. The number will be used as reference when troubleshooting a rule that may not be working as intended.

When a rule is triggered in Code Summary, the rule number will display on the right end of the rule.

Level Type

Once a validation rule has been added, the rule can be edited by clicking on the + to the left of the rule number.

Start by selecting the Level from the dropdown menu on the left-hand side of the screen.

Defining the Criteria

Once you have selected the level of the validation rule you want to create, you must define what the criteria is starting with the verbiage you want to display to the end user. For example, you can display an error if a chart does not have a discharge disposition so it does not get submitted to billing without one. Since we would want to warn the Coder and not the CDI specialist, we would add another criterion input so user role is not equal to CDI specialist. First, type in the display name; this will be what the user will see on the code summary. Keep the information concise, but also provide how they can fix the error.

Example: Missing Discharge Disposition - The end user would know they have to add the disposition to continue.

Type of Criteria

To add criteria to rule, as in the example above, click on Add Criteria to define how the system fires this rule.

Upon clicking on Add Criteria, you will be presented with different types of criteria.

Account - Account type criteria allows you to select fields for a patient chart/account such as discharge date, discharge disposition, admit date, procedure codes, diagnosis codes, and many others.

User - User type criteria allows you to restrict the rule to a certain user role(s), such as a Coder or a CDI user role only. Typically, account-level criteria and user roles are used together, though account-level criteria can be used independently of user roles. However, creating a rule based solely on a user role without specifying any additional account-level criteria is not advisable.

Once you have defined the type of criteria, you can then add the details.

Example: Missing Discharge Disposition

Building criteria for a validation rule is much like workflow. For this example, select account, then in the field name find Discharge Disposition. Once you drop in the field name, it will then give you other fields. In this example it allows you to select an operator.

AND/OR Criteria

Validation Rules, much like workflow, has two different options to create a validation rule.

1. AND criteria - think of adding the word “and” to the end of each criterion This rule will trigger if the user is a CDI Specialist and the discharge disposition does not exist
2. OR criteria - think of adding the word “or” to the end of each criterion in blue. OR criteria will turn blue to differentiate between the conditions This rule will trigger if the user is a CDI Specialist and the discharge disposition equals 30 or does not exist

Once you have selected the field and your operator add a value.

Example: ERROR: D/C Disposition must be present We might select Does Not Exist as an operator. This would mean if a discharge disposition does not exist, then this rule would display on the code summary and prevent the user from submitting the chart.

Additionally, we may only want to display this rule if the user has a role of a coder. To constrain the rule further, click on the Add Criteria again, select user, and then select “Is not CDI Specialist”. This will prevent the rule from display to a user with a role of a CDI.

For Each Check Box

For each is used for fields that are repetitive. For example, a field like discharge disposition is a single field (there are not multiple discharge dispositions on a patient chart) therefore, you do not need the “for each” checkmark.

The For Each checkmark makes sense when you’re trying to create a rule that would have multiple outcomes, such as checking if any diagnosis codes have a POA status of U. We don’t want to check only the first diagnosis rather we want to check all diagnosis to see if it has a status of U. For Each can also be used if you want to check if a procedure code has a date of service and/or provider attached. We don’t want to just check the first procedure code for the date of service, we want to check each of them.

To use this field, first select For Each before defining a field. The system will open another drop-down field to the right of For Each to indicate where you want to create the rule. There are only a handful of fields the For Each field make sense for: charges, CPT codes, diagnosis codes, procedures, pending reasons, and physicians.

Once you have selected a fields, you need to define the field you are looking for. Example: Place an error reminding the Coder to add the POA status on any diagnosis code that has a U Click on For Each, then select diagnosis codes. Select POA from the field drop-down menu which will allow you to review operators. For this example, use the operator of Equals. Once you select the operator of Equals, then you have a field to fill in the value, which would e be “U” in this example.

Adding Fields to a Rule

Fields can be added to the message displayed by rule to tell the user exactly what is triggering the rule when it is displayed in the Code Summary.

You can inject a field within the rule that will be displayed for the end-user. Do this by putting the field name in braces exactly like this {Code}. When the rule fires for the end-user, it will display the code with the issue. If there are multiple, use the For Each field to see each of the codes that are the issue as an individual rule.

Navigate To

Once you have defined your rule, you will want to decide if it makes sense to take the end user somewhere in the software to correct the issue based on the rule created. In the example of a discharge disposition, it does make sense to direct the user to go to the account information page as that is where they would likely change the disposition. Under where you selected the level, there is a field for

Navigate to (these are placed within the patient chart, under the Navigation tree).

• None – Will not take the user anywhere if they click on the error/warning.
• Account Info – Will take the user to the account information viewer.
• Charges – Will take the user to the charges viewer.
• Document Code – Will take the user to where the code was validated/added within the documentation.
• E/M Level - Will take the user to the E/M Level viewer.
• Notes & Bookmarks - Will take the user to the Notes & Bookmarks viewer.
• Physicians & Queries – Will take the user to the Physicians & Queries viewer.
• Working DRG History - Will take the user to the Working DRG History viewer.

Pending Reason

This field will have a dropdown with all available pending reasons. If a rule is triggered on an account and it has a pending reason attached, then the pending reason will be added and the user will be able to see the number of the rule. Pending reasons that have a physician or date requirement will NOT be available in this list. The only way to remove a pending reason that was added by a rule is to have that rule cleared

Saving Rules

Once you’ve completed adding criteria for your validation rule remember to click on Save Rules in the top right-hand corner. It is recommended that you test your validation rule by opening a chart that fits the criteria of your validation rule

ER E/M Configuration Page

Once the E/M Configuration has been enabled, the initial setup must be completed by the Dolbey Team. After this setup is finalized, your organization can make any desired changes directly or contact the SME Team (smeteam@dolbey.com) for additional support.

The configuration page allows for customization of the E/M Level Matrix and other related components. If the organization has Facility Mapping, the E/M Configuration can be copied across different facilities.

When Facility Mapping is available, the facility can be selected in the top right corner. Once a facility is selected, the levels associated with that facility will be displayed. Copy will also appear at the top of the Levels section to easily duplicate settings accross facilites.

Clicking Copy opens a dialog box to choose a destination facility to copy the current levels to. Facilities available for copying will be listed in a dropdown menu.

This option will overwrite and copy the current levels that are onscreen to the facility that is selected.

E/M Matrix

The table below illustrates how the E/M Matrix will appear to end users. Text displayed in this table can be customized to tailor the information shown to end users.

The E/M Level matrix features horizontal columns that display the levels across the top.

Below each level are the defining criteria organized into several topics, each with a list of relevant items. By default, these categories include:

• Mode of Arrival
• Disposition
• Testing
• Medication
• Behavioral
• Procedures
• Other Criteria

Topics are fully configurable based on the specific needs of each facility.

The E/M Matrix configuration allows organizations to customize the content within each field under the respective E/M Level, enabling facilites to tailor the listed items for each code to meet specific requirements.

To make changes to the default options, click the grey numbers to open the matrix configuration.

After expanding the topic, users will see each E/M Level along with its corresponding codes. Next to each level is +Add. Clicking this button allows for the addition of a new level item.

To remove any criteria selections, under each topic and level, simply click on the X button next to the criteria.

To change or udpate the verbiage of the criteria selection, place the cursor into the level item field and change the text.

Configuring Charging Options and CDM

Below the E/M Level matrix configuration is a section for “Other”. The “Other” section allows for the addition of charging components attached to the facility’s charge master. To make changes to the default, click on the grey number to open the charge and CDM configuration.

The Effective Date field specifies the date when the CDM Table and its associated new charge(s) will take effect. This feature allows updates to the CDM Table to be scheduled, ensuring that future changes are staged and ready for the Coding Team when needed.

Updating the CDM

Copy and Paste

Click on the green “Edit CDM Table” button to the right of the effective date.

CDM columns can be copy and pasted directly into the “Edit CDM Table” window from an Excel spreadsheet.

Best practice is to paste in the column for the CDM code, then the description, and finally the CPT code. This step is extremely important because any assigned CDM code will need to be sent in the outbound interface. Therefore, the CDM table in Fusion CAC needs to match whatever system is downstream

After the information has been correctly updated, click Ok to continue.

Manually

CDM codes can be updated manually by clicking +Add CDM Manually.

This will create a new row with free text fields to add the CDM code, the description, and the CPT code.

Once the CDM table is populated, categories can be edited within the “Option” section. The default options are:

• Trauma
• No charges
• Medication quantity
• Medication time/modifier
• Additional charges

Like the E/M Level matrix, these categories can be customized to best fit the facility’s needs.

To edit an option, click the gray date tab to open the options and make changes. If certain options are not relevant, remove items under those sections simply by clicking on the RED.X . Once emptied, the section will no longer for your users.

Options: Trauma

Expanding the trauma section will display several items by default. Each item has a CDM attached per E/M level, including critical care. Ensure that the CDM underneath each of the levels corresponds to what the CDM table indicates.

For end users, this will appear as a dropdown menu in the E&M Coding viewer. Based on the matrix and their selection, the system will automatically populate the corresponding CDM code associated with the assigned level.

Options: No Charge

Clicking on the gray date next to No Charge will exapnd the section. The “Item” field will be the verbiage that corresponds to the CPT code in the CPT column to the right of the Item column.

For end users, this will appear as a dropdown menu in the E&M Coding viewer. The user will choose the item and the outbound interface will contain both the CPT code and the corresponding CDM code listed in this table.

Options: Medication Quantity & Medication Time/Modifier

Click on the gray date next to Medication Quantity to expand the section. Item names, for which Dolbey provides default descriptions, can be listed here. These items will align with their corresponding CPT and CDM codes.

The medication sections are not about the medication, but rather the way the medication was administered. This allows organizations to charge for any injections, infusions, IV pushes, immunizations, and hydration. The medication administration quantity allows facilities to define how many of each occurred on a particular date, if the ER visit occurred over more than one day, and other modifiers as needed.

Medication Time/Modifier includes the ability to indicate that multiples of an item exist on the account. If there are different drugs involved, the user can copy the individual lines and add in the durations of each medication along with the date and modifier if the modifiers, if appropriate.

To the end-user, this will be a table where they can pick all the medication administrations to apply and provide dates and modifiers in the E&M Coding viewer. There is also a section end users to enter a note to keep everything in line so that they can indicate which medications they have already charged for. This helps the end user stay organized while providing information in the event of an audit.

Some organizations like to have Medication Quantity and Medication Time/Modifier. Other organizations choose to relocate all of the items within the Medication Quantity to the Medication Time/Modifier section so that all medications are within the same section.

Options: Additional Charges

Addtional Charges is often a list of items commonly charged in the ER. The default list includes:

• Voiding Cystogram
• Insert Foley (Simple)
• Change Cystostomy (Simple)
• Temporary External Pacing

This list can be modified to best the needs of the organization.

Items listed in this section will align with their corresponding CPT and CDM codes.

To the end-user this displays as a table where they can quickly add a quantity, date, and modifier as applicable.

Grid Column Configuration

Grid Column Configuration is an administrative tool used to identify the columns to be displayed in Account List, Account Search, Calendar Stats, and Dashboard pages. Columns can be set to display per default user roles: Coders (incl Physician Coder, Single Path, and Auditor) and CDI.

All columns added in Grid Column Configuration will appear in Account Search, and selected columns can be made visible on other pages by checking the appropriate box.

The order of the fields in Grid Column Congifguration determines the default order of columns elsewhere in the applicaiton. Each user can then rearrange the column order on specific pages per their preference. Changes are saved automatically on the Account List page, while on Account Search, Calendar Stats, and Dashboard, users must save their adjustments manually.

Add/Remove Column

To add a column, click +Add New Column in the top right of the screen. The new column will appear as the bottom of the list.

Select the field to be added from the dropdown options. Field names that are italicized and grayed out have already been added as a column. By default, the field name will populate in the Title box to the left of the blue dropdown. The title acts as the friendly name that will be displayed to end users. Titles can be changed to best fit the terminology used by the organization.

To the right of the field name are four checkboxes. These allow configuration as to which pages (Account List, Calendar Stats, and Dashboard) will display the column(s).

Actions buttons for each column can be found on the right side of the screen.

Action Button	Description
	Double lined up and down arrows will jump the column to either the top or bottom of the list
	Single line up and down arrows will the column up or down one space
	The red X will delete the column from the application
	Date columns can be filtered to display in ascending or descending order by default

Clicking on the “Filter” button will quickly show what columns are being used for which pages in the application.

Mapping Configuration

Mapping Configuration is an administrative tool designed for users with an administrative role, enabling them to map data field names to user-friendly, end-user-facing names.

Export to CSV on the right-hand side of the the mapping title bar will export the selected mapping table to CSV should the table(s) need to be reviewed outside of the application.

New Mapping Table

A new mapping table can be added by clicking +Add to the right of Active Mappings.

Each mapping table must have a unique ID and Title.

• The ID: is how the mapping table is identified by the application. It cannot contain spaces or symbols.
• The Title: is the user friendly name for the mapping table.

The ID and Title will often match, but the Title tends to be nicer for users to read as it can contain spaces.

Editing Mapping Tables

Click on a table title from the list of Active Mappings. Not every table contains the same information, but for the majority of the tables, the fields that can be updated include the key and the description.

• The Key is a unique value for that entry in the database
• The Description is the friendly value that will be displayed to users.

The Key and Description may or may not match. An example of when they differ is the “Stage” mapping table where the key value of “P” equals “Unbilled”.

To add values to the mapping table, click +Add New… to either the top or bottom of the list as desired.

Table values can be sorted by Ascending or Descending order using the arrow buttons.

Each value can be individually moved using the “Action” buttons.

Table rows can also be reordered by clicking the white space in the desired row, dragging, and dropping it in the new location.

Some tables can be removed by clicking the red X in the Active Mapping list.

If a mapping table does not have a red X to the right of its title, that means it is a default mapping table that cannot be removed from the system.

Special Mapping Columns & Tables

While many of the mapping tables are set up the same way, several are unique and have more fields available to edit.

Category Mapping:

Incentive Multiplier

Incentive Multiplier allows administrators to optionally record an incentive multiplier that is used in the Incentive Productivity Report. Categories without a value in this column will be calculated with an incentive multiplier of 1.0.

The Incentive Productivity Report reports on whole weeks, but only produces an entry if the coder first submitted an account that week. This report pulls its data in real-time.

Display HCC Indicators

• When the user assigns a code that has a CMS HCC, a small H indicator appears.

  • The current version of HCC and the version for the previous calendar year (retroactively) will display when the user hovers over the H in the Assigned codes tree.

• The Previous HCC Overview will be available in the Navigation tree for any subsequent patient chart with the same MRN number that previously had HCC’s.

  

• Current HCC Total will be captured for each chart and is viewable in account search.

Pending Reasons Mapping:

Administrators can specify the facilities, categories, or roles each pending reason applies to. Alternatively, these fields can be left blank to apply the pending reason universally.

When a pending reason has the Physician Required box checked, the user will be prompted for a physician when that pending reason is assigned to an account. The selected physician will appear on the Code Summary page and in the Pending Reasons report.

Additionally, there is another checkbox to indicate a date is required, when applicable.

CDI Review Types Mapping:

CDI Review types are custom and not enabled at every organization. Additional information on the use of custom reviews can be found here.

Payor Mapping:

The “Days to Bill” column indicates how many days are left to bill the payor.

• A default value can be set, which will apply to any payor in the mapping table without a specified value in the “Days to Bill” column.

  

• Each payor can have a unique number of days to bill

  

The billing date is compared to the current date (or the last submitted date if the account has already been submitted) to calculate the “Billing Countdown,” which represents the number of days remaining to submit the account. If an account has no payor, no matching payor mapping, or a payor mapping without a value in the “Days to Bill” field, the “Default Days to Bill” value is used. If the “Default Days to Bill” field is blank, a value of zero is applied.

A “Billing Countdown” field can be added from Grid Column Configuration to use for account search filters and workflow. See a use case for this workflow in the screenshot below:

Query Reasons (PhysicianQueryReasons)

The mapping of PhysicianQueryReasons now has a column called Roles, which will allow the user to assign reasons to specified roles.

Notifications Management

Notifications Manager, found in the Tools dropdown menu, allows users with an Administrative role to create notifications that will alert other users of anything they may need to be aware of within the system and/or organization. The notifications can be added to the CAC login screen, the Dashboard, or both.

Adding a Notification

To add a new notification, select Notification Manager from the Tools dropdown menu, then click on +Add Notification. Fields will become available on the screen to allow the user to build out the notification.

• Title - Name the alert with a brief title.
• Description - Add more detials to the title with a description of what the users should exepct as a result of the notification.
• Style - The notification can be displayed in a color that will draw yhe user’s attention.
• Start and End Date - Each notification can have a start and end date. If there should be no end date to the notification, simply keep the End Date blank.
• Location - Where the notification will appear. It can either be on the login screen, Dashboard, or both.
• Role(s) - If desired, the notification can be directed to a specific user role or roles IF the Location is set to Dashboard only.

There can be multiple notifications and each will be numbered. To collapse the details of the notification, click on the number icon and it will hide the information. If a notification is no longer needed, the user can delete the notification by clicking on the RED X . When a user is done adding or making changes to a notification, click Save Notifications.

Viewing a Notification

Notification on the login screen:

Notification on the Dashboard:

Multiple Notifications:

Worksheet Designer

Worksheet designer is used to create custom worksheets for users, which are used to collect data and/or take notes.

Access to worksheets can be restricted by user role:

• Audit
• CDI
• Coding
• Physician Coder

Alternatively, worksheets can be shared. A Shared Worksheet is a worksheet that can be utilized by Auditors, CDI Specialists, and Coders unlike the “CDI Worksheet” and “Coder Worksheet” which are exclusive to CDI and Coding, respectively.

Creating a New Worksheet

To add a workheet, simply click on the +Add button in the desired section.

A blank template will appear on screen. The first step is to enter a unique a document name. Each worksheet must have a unique name for reporting purposes. A document name must exist before the template can be saved.

To start with a document that has already been created, copy the text and paste it into the form designer. Changes to the formatting may be needed once pasted depending on the original document format.

Text copied or typed directly into the worksheet will be read-only for the end user(s) working with the form. This text is often used as labels and to direct users on completing the template.

Adding Fields

Fusion CAC offers several types of fields that can be added to worksheet templates. These fields allows end users to enter information into the worksheet once it has been added to an account.

Add a new field by clicking +Add Field in the template tool menu.

Field Type

Single Input

A single input field allows the end user to free type text. This field is best used for entering a concise amount of information, such as a name or short series of numbers. The box will grow horizontally as the user types to fit the data entered.

Multiple-Line Text

A multiple-line text field allows the end user to free type text. This field is often used for entering a large amount of information, such as taking notes or providing detailed comments. The box will grow vertically as the user types to fit the data entered.

Checkbox

A checkbox allows the end user to indicate certain items are applicable. This field has been used to show that the worksheet is complete or as a way for users to select certain action items.

Date/Datetime

These fields allow the end user to indicate the date and time of a response, test, or other item being tracked.

Dropdown

Dropdown menus allow end users to select from a pre-determined list of options.

After naming and determining who can edit the field, a dialog box will open to set the options in the dropdown menu.

Dropdown items can be edited by pulling up the template in Worksheet Designer and clicking Edit Dropdown in the template tool bar.

Account Field

Account fields will automatically populate information from the account, if it has been sent to Fusion CAC. Auto-populated account information will be displayed in a bolder font to differentiate it from text manually entered by an end user.

Field Name

Each field should have a unique name for reporting purposes.

Field names can repeat across worksheets, but each field on a worksheet must be unique. If a field name is repeated on a worksheet, whatever is entered into one field will be automatically duplicated into the other fields with the same name on that worksheet.

Editable

Individual fields can be locked down per user role. This way Auditors, CDI Specialists, and Coders can add and view a shared worksheet to a chart, but only users with the specified role can edit certain fields. All users will be able to see the information in that field, but only the specified user role can edit the field.

Make Required

Fields can be made required by checking the box. Leaving the box unchecked means the field is optional and the worksheet can be completed even if that field is left blank.

When a worksheet is added to a chart, required fields will have a light red background to indicate action must be taken. Addiontally, the user will be presented with a red toast message if they try to save the chart without completing all required fields. The toast message will include the fields that need to be completed.

Clicking OK, will add the selected field to the template with the specified settings. A box will then display in Worksheet Designer as a placeholder for the selected field with the field name. The fields are not interactive from Worksheet Designer. Once a worksheet has been added to a chart, the field name will be replaced with instructions for the end user.

Show History

Worksheet Designer will create a history for changes made to templates in Worksheet Designer. Once a change is made on a template and saved, Show History will appear in the top right of the worksheet. Clicking on it will bring up a notes box, just like in Workflow Management.

Source Code

The template source code can be found under the Tools menu within the template tool bar. The source code is the programming language that tells the application how to display the worksheet. It may be overwhelming to look through, but can be helpful in making quick edits to worksheets.

Changing Field Width

By default, fields will take up the full width of the template. The width can be reduced in the source code to best fit formatting needs.

In the example below, the width of the dropdown menu has been modified so that it can be on the same line as a checkbox and a multi-line text box.

This was done by opening the source code, finding the name of the field, and changing the width percentage.

Renaming/Moving a Worksheet

Once a worksheet has been named and saved, the Document Name cannot be edited. This is intentional for accurate reporting. If a worksheet needs to have a new name, the simplest way to change the name is to copy the source code into a new template and give that template the correct name. Copying the source code will bring over the whole body of the worksheet as is, so the only thing that needs to change is the document name.

1. In worksheet designer, open the template to be copied/renamed
2. Open the template’s source code
3. Select all the text in the source code box
   • This can be done by clicking and dragging to highlight or with the keyboard shortcut Ctrl + A
4. Copy the source code
   • This can be done by right-clicking in the highlighted text and choosing copy or with the keyboard shortcut Ctrl + C
5. Click Ok to close the source code window
6. Add a new worksheet in the desired section
7. Open the template’s source code
8. Paste the copied source code into the box
   • This can be done by right-clicking and choosing paste or with the keyboard shortcut Ctrl + V
9. Click Ok
10. Enter a new document name and Save

Click the red X button to remove the original worksheet so it can no longer be used. The deleted worksheet will still show up on accounts it was added to prior to being deleted, but users will not be able to add it to new accounts.

This method also allows for an existing worksheet to easily be re-catagorized by role.

If you have any questions or would like to walk through editing source code with someone, please reach out to the Dolbey SME team (smeteam@dolbey.com).

Query Designer

Query designer is used to create custom queires per organization. Query templates are frequently created and saved as a base template with most of the query written to show as read only text. The creator can then add open fields for the end user to add additional questions to the base query template.

Access to queries can be restricted by user role:

• Audit
• CDI
• Coding
• Physician Coder

Alternatively, queires can be shared. A Shared Query can be utilized by Auditors, CDI Specialists, and Coders.

Creating a Query

To add a query, simply click on the +Add button in the desired section.

A blank template will appear on screen. The first step is to enter a unique a document name. Each query must have a unique name for reporting purposes. A document name must exist before the template can be saved.

To start with a document that has already been created, copy the text and paste it into the form designer. Changes to the formatting may be needed once pasted depending on the original document format.

Text copied or typed directly into the query will be read-only for the end user(s) working with the form. This text is often used as labels and to direct users on completing the template.

Adding Fields

Fusion CAC offers several types of fields that can be added to query templates. These fields allow end users to enter information into the query after it has been added to an account.

Add a new field by clicking +Add Field in the template tool menu.

Field Type

Single Input

A single input field allows the end user to free type text. This field is best used for entering a concise amount of information, such as a name or short series of numbers. The box will grow horizontally as the user types to fit the data entered.

Multiple-Line Text

A multiple-line text field allows the end user to free type text. This field is often used for entering a large amount of information, such as taking notes or providing detailed comments. The box will grow vertically as the user types to fit the data entered.

Checkbox

A checkbox allows the end user to indicate certain items are applicable. This field has been used to show that the query is complete or as a way for users to select certain action items.

Date/Datetime

These fields allow the end user to indicate the date and time of a response, test, or other item being tracked.

Dropdown

Dropdown menus allow end users to select from a pre-determined list of options.

After naming and determining who can edit the field, a dialog box will open to set the options in the dropdown menu.

Dropdown items can be edited by pulling up the template in Query Designer and clicking Edit Dropdown in the template tool bar.

Account Field

Account fields will automatically populate information from the account, if it has been sent to Fusion CAC. Auto-populated account information will be displayed in a bolder font to differentiate it from text manually entered by an end user.

Sections

Sections allows end users to customize the query by removing sections as needed from the template or to rearrange the order of information.

Static text and fields can be inserted into a section, however sections cannot be inserted in other sections.

When the query is added to an account, each section will show have arrows so the end user can re-order as needed. Sections will also have a X to remove that section from the query. Once a section has been removed, an undo button will become available to place it back into the query.

Physician

The physician field will auto-populate the name of the physician being sent the query, if the information is available.

Field Name

Each field should have a unique name for reporting purposes.

Field names can repeat across queries, but each field on a query must be unique. If a field name is repeated on a query, whatever is entered into one field will be automatically duplicated into the other fields with the same name on that query.

Make Required

Fields can be made required by checking the box. Leaving the box unchecked means the field is optional and the query can be completed even if that field is left blank.

When a query is added to a chart, required fields will have a light red background to indicate action must be taken. Addiontally, the user will be presented with a red toast message if they try to save the chart without completing all required fields. The toast message will include the fields that need to be completed.

Clicking OK, will add the selected field to the template with the specified settings. A box will then display in Query Designer as a placeholder for the selected field with the field name. The fields are not interactive from Query Designer. Once a query has been added to a chart, the field name will be replaced with instructions for the end user.

Creating Internal Notes

Internal notes can be added to query templates to provide a note for the end user only from the Insert menu in the template tool menu.

These notes are only displayed for the user filling out the query and is not set to the provider receiving the query. When adding a physician query the user will see the highlighted section in the query when that template is selected.

After sending the query, the internal note will no longer be seen unless the user has the privilege of “Edit Open Queries to Resend” in Role Management.

Blank Query Template

If a Physician Query has a document name of “Blank Query Template”, then an additional Add Input For ‘Query For’ field is automatically added for the user to enter plain text when the query is added to an account. This field cannot be removed from the Blank Query Template.

When the end users use this template, they will be presented with a box to free type the query topic.

In the following reports, the Query template column will show “Blank Query Template”: followed by the value for the ”Query For” field:

• Outstanding Queries
• Query Impact by Discharge Date
• Query Impact Report
• Query TAT by Author Report
• Query Template Volume Overview

Verbal Query Template

A verbal query template can be requested through CAC Support (cacsupport@dolbey.com). Scripting logic will be added so that when a template named “VERBAL QUERY” is used, the query will not be sent outbound to the provider.

For accurate reporting on the topics of the query, Dolbey recommends creating a template using the exact name “VERBAL QUERY” and selecting the check box Add Field For ‘Query For’ next to the document name.

When the end users use this template to record the verbal query outcome they will be presented with a box to free type the query topic.

Show History

Query Designer will create a history for changes made to templates in Query Designer. Once a change is made on a template and saved, a Show History will appear in the top right of the query. Clicking on it will bring up a notes box, just like in Workflow Management.

Source Code

The template source code can be found under the Tools menu within the template tool bar. The source code is the programming language that tells the application how to display the query. It may be overwhelming to look through, but can be helpful in making quick edits to queries.

Changing Field Width

By default, fields will take up the full width of the template. The width can be reduced in the source code to best fit formatting needs.

In the example below, the width of the dropdown menu has been modified so that it can be on the same line as a checkbox and a multi-line text box.

This was done by opening the source code, finding the name of the field, and changing the width percentage.

Renaming/Moving a Query

Once a query has been named and saved, the Document Name cannot be edited. This is intentional for accurate reporting. If a query needs to have a new name, the simplest way to change the name is to copy the source code into a new template and give that template the correct name. Copying the source code will bring over the whole body of the query as is, so the only thing that needs to change is the document name.

1. In query designer, open the template to be copied/renamed
2. Open the template’s source code
3. Select all the text in the source code box
   • This can be done by clicking and dragging to highlight or with the keyboard shortcut Ctrl + A
4. Copy the source code
   • This can be done by right-clicking in the highlighted text and choosing copy or with the keyboard shortcut Ctrl + C
5. Click Ok to close the source code window
6. Add a new query in the desired section
7. Open the template’s source code
8. Paste the copied source code into the box
   • This can be done by right-clicking and choosing paste or with the keyboard shortcut Ctrl + V
9. Click Ok
10. Enter a new document name and Save

Click the red X button to remove the original query so it can no longer be used. The deleted query will still show up on accounts it was added to prior to being deleted, but users will not be able to add it to new accounts.

This method also allows for an existing queryt to easily be re-catagorized by role.

If you have any questions or would like to walk through editing source code with someone, please reach out to the Dolbey SME team (smeteam@dolbey.com).

Shortcut Configuration

Keyboard shortcuts are keys or key combinations allowing users to take certain action within the application without using their mouse. Some users find it more efficent to work without having to take their hands off the keyboard to use their mouse.

Many different applications use hotkeys and keys may already be mapped to different software solutions used by an organization. Dolbey allows hotkeys for Fusion CAC to be configured per organization. Default settings have been provided, but can be changed as needed by users with the role of Administrator.

To record a new hotkey combination, simply press the record button on the line of the function you wish to configure and enter in a key combination (usually 1-2 keys on the keyboard). Since Fusion CAC is a browser-based application, standard browswer hotkeys should not be used.

System Search

System Search

System Search works similarly to Account Search.

Creating filters allows the user to search for patient charts using different criteria. System Search is also used by the Tuning Team to identify targeted codes that need reviewed and possibly refined.

An example of a System Search would be all inpatient charts with a diagnosis of hypertension.

Clicking Refresh will display a list of all accounts that meet the criteria. If this is a search that will be used more than once, users can save the search, making it available in the drop-down box.

The results that yield may show other codes, as the filter placed will bring up any chart with the codes suggested. The grid displays all codes on the account as well as the code in question. To filter to only those codes within in the grid column, click on the hamburger button in the column header to further filter the list.

Document Types Management

Filing Documents

To file documents:

• Open Document Types Management
• Sort on documents by clicking on the group name to display the documents currently not in a folder. Choose the documents that need to be filed
• Change the friendly name by double-clicking on the name and replacing it with another name using a naming convention that new users will understand

Engine Handling

Engine Handling is set up after the documents have a friendly name. This set-up instructs the code suggestion engine what to do when it encounters each document.

Depending on how the organization is configured, there may be a drop-down menu to select the type of handling the document receives.

Alternatively, there are two different columns that allow for inclusion or exclusion of certain code sets starting with a prefix.

For example, on a Newborn History and Physical, the engine should exclude O codes to prevent confusion if the account conatins documentation for the mother. This exclusion will prevent O codes from being suggested on the newborn’s chart.

Once engine handling is set up, documents can be sorted into a folders. Sorting is done by double-clicking the empty space in the Group Name column and entering the name of the desired folder. To view the folder structure, go to the top of the group name, hover over the column, and click on the hamburger button to see all the available group names.

Adds/Cancels Pending Reason

This field in Document Types Management can be used to edit any existing pending reason.

A selection in the Cancels column will remove the existing pending reason(s) and re-trigger workflow. If the original pending reason is used for DNFC reporting and/or a user needs to know the original reason for pending, the pending reason does not need to be deleted. Instead, there is an option to Add a Pending reason.

Two important facts about the “Adds Pending Reason” field:

1. The presence of an “Adds Pending Reason” value overrides the functionality that cancels pending reasons from the “Cancels Pending Reason” field. In other words, when a pending reason exists on the account that matches the “Cancels Pending Reason” field, the pending reason is not deleted when there is an “Adds Pending Reason” value present. The functionality is designed to be one or the other – not both – but the account must have one of the “Cancels Pending Reasons” to add the pending reason.
2. The “Adds Pending Reason” is intentionally free-form text. It can contain a value that is not listed in the Pending Reasons mapping so that users cannot select it. Whatever value is recorded in this field will be the pending reason name that the Script Engine will automatically add to the account.

Caution Coding

Documents can be configured in Document Types management to be caution code documents. Coders should not code from these documents, but still be aware that the verbiage exists as it may result in a possible query. For example, if a nurse indicates the patient was being treated for respiratory failure but the provider never mentioned it, the caution code will help to ensure users are not missing anything.

In Document Types Management, change the “Caution Coding” field of the Document Type to “All Patient Types” by double clicking in the Caution Code column. Save the change, then load the account and that document. The code suggestions within the document will have a golden “caution” background instead of the usual lavender background to indicate they cannot be assigned. The Unassigned code tree displays the same caution background for those codes, and the right-click menu on those codes prevent assigning or changing the caution code.

In the Unassigned codes tree, any code attached to a caution document will show in a yellow background and will not have the option to assign on the right click menu.

New Document Grouping

By default, users with the Administrator role or the Tuning role have access to the “New Document Grouping” page in the Tuning menu. This page allows users to create a list of groups that should be created for new document types. For example, if the document name contains the word “consults” or “consultation”, the organization may want to file it within the Consults folder and set the engine handling to Do not Code Procedures.

Creating a New Automated Grouping

To create a new group:

1. Click +Add Group
2. Select the appropriate group name from the drop down or click + to create a custom group name
3. Select how the engine should handle these types of documents using the engine handling dropdown or includes/excludes

The drop down allows users to block certain code sets. If more targeted handling is needed to include or exclude certain codes, consider using the includes or excludes method.

Using includes or excludes allows users to override the settings and choose to either include or exclude certain code prefixes. The image above indicates that the group will uses codes that start with A,B,C,D,E,F,G, or H.

Once the folder and engine handling have been set, select the documents to be included in this group. Click on Edit, then +Add. When choosing an operator, “Contains” will likely be the best choice. For example, if the user wants to put all radiology documents into a folder, consider that if it contains XR, NM, MRA, MRI, US, CT, then those should go into the radiology folder. Use a comma to separate multiple items. Click OK once complete.

Once the new grouping is complete, select Save All in the top right corner.

Adding/Validating Codes

Validating a Code

Codes can be validated/added to the chart as Assigned Codes while reviewing documents and the suggested codes within each document. Right-click on the code to Edit/Assign the code.

Code Highlight	Meaning
	If the background of the text suggestion has a purple background, the text matches a code suggestion
	If the background of the text suggestion has a red background, the text matches only a secondary token
	If the background of the code has a green background this means the code was already validated on a different document

Adding a Code

There are multiple ways to add a code to a chart, if it has not already been suggested by the engine

Add Code via Right Click

After reviewing all suggested codes from either the Documents tree or the Unassigned code tree, users can add a code to a text document by highlighting the relevant word(s) or phrase and then right-clicking to open the Add Code menu.

Add Code via Direct Entry

The Add Code box can be used when the code to be assigned is known and encoder is not needed.

Alternatively, the user can highlight a term, right click, and select +Add Code.

Enter at least the first 2 characters of the code to bring up the drop-down list of available codes for the main term, then scroll down the listing for codes to confirm the sub-term and select the appropriate code for complete coding. From the Code Editor window, users can also confirm the code description, set the POA Indicator, and designate the code as Admit, Principal or Secondary. Users may also enter the text description of the code and select the code that way.

Add Code From Encoder

Users can add a code to a text document by highlighting the relevant word(s) or phrase and then right-clicking to open the Add Code menu. Left-click and drag the mouse to highlight the selected text for code addition, then right-click to open the Add Code Menu. Click on the Add Code from Encoder + sign to launch the Encoder. Continue to use the encoder and accept the final code which will be returned to your chart.

Add Code to Scanned Documents

The engine does not suggest codes from scanned documents. Users can add codes to scanned documents for codes not assigned elsewhere within the chart. Adding codes to scanned documents is recommended only when a code has not already been added to a text document within the chart or documentation to be coded is not found elsewhere.

To add a code to a scanned document, start typing the code in the Add Code box or click on the Encoder button in the bar above the scanned document.

Codes added to the scanned document will appear in the Additonal Codes space at the top of the document viewer.

Add Code From Codebook

Users can add a code to a text document by highlighting the relevant word(s) or phrase and then right-clicking to open the Add Code menu. Left-click and drag the mouse to highlight the selected text for code addition, then right-click to open the Add Code Menu. Click on Add Code from Encoder + to launch the Encoder. Continue to use the encoder and accept the final code which will be returned to the chart.

Code Description Search

Left-click and drag the mouse to highlight the selected text for code addition, then right-click to open the Add Code Menu. Click on Code Description Search to have Fusion CAC present any relevant code based on the highlighted word or phrase. If the correct code appears in this list, clicking on it will add the code to the document.

Supporting Evidence

Supporting evidence is defined as the components within the chart that were used to make up any suggested codes.

The supporting details help the user understand why the engine suggested a code. Clicking on the down arrow next to the code will show the words/phrases used to create the code. This linkage will allow users to determine if the code is correct or if it tried to put two thoughts together together incorrectly.  

Editing Codes

To edit an existing or suggested code, left click on the code to bring up the encoder and Code Editor windows. If the user is set up with dual monitors, the encoder window can be moved to the second monitor to remain open as they work through validation of each the engine suggested codes. From the Code Editor window, users can update codes from the code drop-down menu, via Direct Entry, or Encoder. The POA indicator and code status (Admit, Principal, or Secondary) can also be updated in the Code Editor.

To change a code, place the curser in the drop-down box where the code to be changed is displayed. Code parts, such as the code extension, can be edited instead of removing the whole thing.

Users have the option to minimize and restore the Code Editor window to continue viewing documents or other areas of the chart as they are working to complete additional details for the procedure code.

Code Editor Icon	Description
	This button launches the encoder for the existing code
	Adds a new line for direct entry of additional codes
	Launches the encoder for selection of a code
	Saves any changes for the current session of Code Editor
	Closes window without saving changes from the current session of Code Editor
	Deletes the selected code from the chart
	Minimizes Code Editor window so that the main screen can be viewed
	Restores the Code Editor window to full size for review and completion

Adding Procedure Code Data

Procedure codes typically require additional information such as Physician and Date of Service for the procedure indicated along with procedure details. These fields are configured according to facility requirements and may look different per organization.

To enter in a date and physician to the procedure codes, right-click on the procedure code and then select Edit Procedure Info from the menu. After selecting a procedure code, the Code Editor window for the selected procedure code will open.

Add Procedure Date

To enter the procedure date, start entering the date in MM/DD/YYYY format or click on the calendar to select the procedure date.

Add Physician

To add the physician, click into the Add physician… drop-down menu. Start entering the name of the physician who completed the procedure, then select the physician’s name to complete this field. At least 3 characters of the physician’s last name are needed to view the drop-down listing. Continue entering characters of the physician’s last name to narrow the listing of physicians to choose from. 

Add Additional Procedure Details

Click on the ellipsis … button under the Action heading.

Users have the option to minimize and restore the Code Editor window to continue viewing documents or other areas of the chart as they are working to complete additional details for the procedure code.

Mass Editing Codes

Mass editing of codes can be accessed by right clicking and selecting “Edit All Codes” on any of the code headers such as assigned diagnosis, assisted procedures, admit diagnosis.

Each code has a checkbox, and each section has an ‘ALL’ checkbox. If the user clicks the All checkbox, a checkmark will appear in all codes under it. Any change made to one of those checked codes will be reflected in all other checked codes.

The CPT code section has a Modifier column with a plus sign. Clicking the plus will open up the details window to add/change Modifier, plus other items that are included in that window. Clicking on the ellipsis symbol next to the Episode field will also open the details. The user can add up to 4 modifiers, unless they are using the Solventum™ Coding and Reimbursement System (CRS) then they will be able to add up to 5 modifiers.

Add Another Episode

Right clicking on a procedure allows the user to add another instance of the same procedure without needing to duplicate the effort of recoding the procedure.

From Edit Procedure Info, you can also update additional information for the selection of procedure codes to add procedure date, add physician, and update additional details such as

• Anesthesiologist
• Anesthesia Type
• Tissue Sample
• Procedure Location
• Minutes)

These fields are configured according to facility requirements and may look different per organization.

Code Sequencing and Computing a DRG

Code Sequencing

There are multiple ways to re-sequence codes that have been validated and added to a chart. Dolbey’s recommendation is to re-sequence codes using the existing encoder.

Code Sequencing and Grouping with Encoder

After clicking the Compute button, all patient demographic information and validated codes are uploaded to the existing encoder.

Use the encoder to re-sequence codes, complete grouping, and complete the encoder session to return the computed grouping and re-sequenced codes to Fusion CAC. From here you will be directed to the Code Summary page for review of Validation Results (and resolution or errors), Assigned Diagnosis Codes, and Assigned Procedure Codes.

Code Sequencing with CAC

If grouping and billing edits are not required, codes can be re-sequenced by dragging and dropping codes within the Assigned Codes Pane. Left click and hold the code to be re-sequenced, then move it to the new sequence location and release.