Creating rules for incentive billing management

Rules are patient searches that “flag” patients if they match the associated practice search criteria. Patients are automatically “un-flagged” as soon as they no longer match a rule’s parameters.

Note: If you want to exclude a patient from being flagged by a rule, you can exempt the patient from the rule for a defined period of time.

Using the eligibility criteria set by the GPSC, you can create and activate practice search rules that flag patients who are due for their annual chronic disease or complex care management billing.

Note: Wolf EMR also comes with a number of pre-configured rules that flag patients who are due for chronic disease or complex care management incentive billing. See Practice search rules.

Each day, the clinical staff can review rule matches and:

Bill patients flagged for chronic disease management billing.

Book patients who are due for their annual Complex Care Plan appointment (enabling you to bill for their annual complex care fee).

You create a rule by producing or selecting a practice search that defines what criteria patients must meet to be flagged by the rule. You then choose to make the practice search a rule, and define the rule’s properties. When the rule is complete, by default the EMR executes the rule (that is, the EMR searches for and flags matching patients) every evening.

Steps

1.

From the Wolf EMR home page, click Practice Search . The Practice Search window opens.

2.

Perform one of the following actions:

To create a new rule, produce a practice search that defines the parameters patients must meet to be flagged by the rule. See Creating a provincial incentive billing practice search.

To use a pre-configured rule, click Open a Previously Saved Search . The Open Saved Search or Rule window opens, with a list of searches and rules. Click the rule you want to use.

Note: Wolf EMR comes with a number of pre-configured rules for chronic disease and complex care management. In your list of practice searches, you can easily identify these rules, as they start with CDM (for example, “CDM DM Billing Incomplete”), or CC (for example, CC H250 DM/CVD No Billing).
You may have to modify the parameters set for pre-configured rules to take in account your clinic’s workflow.

4.

In the Save Current Search As window (if you created a new rule) or in the Open Saved Search or Rule window (if you are using a pre-configured rule), using the following table, enter or modify the rule’s properties.

Field	Description
Save Item as Rule	To make the practice search a rule, select this check box.
Text to display for patients who match this rule	Enter a prompt to display for patients who are flagged by this rule. The prompt you enter displays as the Rule Text in the Rule Matches window. See Viewing and managing incentive billing rule matches.
Rule Priority	Select a priority for the rule. The range is between 1 and 9, with 1 being the highest priority. When you later view rule matches, you can filter the list based on priority level. For example, you can choose to view only Priority 1 rules.
Default Action	To set an action to be selected by default in the Rule Matches window, in the list, click the action.
Security Group	To assign a specific role or team to address the rule matches, in the list, click the role or team. A role or team displays in the Security Group list only if a security group has been created for the role or team. Tip: If a group of billing staff manage CDM and/or Complex Care billing, create a specific security group for these staff members (for example, a security group called “Billing”). When you create a CDM billing rule, you can then assign “Billing” as the Role for the rule. When the billing staff view the clinic’s rule matches, they can filter the list to display only rule matches assigned to “Billing”.
Scheduled to run on	Displays the time and frequency the EMR will search for and identify patients who match the rule. You cannot edit information displayed in this field. All rules run nightly.
Active	To activate the rule, select this check box. The rule will execute on a nightly basis until you clear this check box.
Portal Notifications (This area displays only if the patient portal is enabled for your clinic)	If you use the patient portal, and you want patients who match the rule to receive a notification on the patient portal: 1. In the Portal Notifications area, select the Display Rule Match in Portal check box. 2. Click Notification Settings. The EMR displays the Portal Notification Settings window. 3. In the text area, enter the notification message that patients will see in the patient portal. 4. If you want patients to receive an email indicating that a notification is present in the patient portal, select the Send Email Alert check box. 5. Click Save.

6.

Perform one of the following actions:

If you are creating a new rule, click Save as New.

If you are modifying and/or activating a pre-configured rule, click Exit Menu.

After the rule is activated, it executes (that is, produces a list of rule matches) on a nightly basis after clinic hours. The rules does not automatically execute as soon as you save it.

Tip: You can manually run a rule (that is, produce a list of rule matches) at any time. In the Open Saved Search or Rule window, select the rule you want to run, and then click Open Selected. In the Practice Search window, click Execute the Rule Engine .
When you execute a rule, it can take a long time to complete, and as the rule is being executed, Wolf EMR may slow down for you and other clinic users. For this reason, it is recommended that you execute rules after clinic hours.