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Here are some sample functional
requirements for Home Health Care: |
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Print report of vendor invoices that exceed
purchase order terms by user-defined criteria (e.g. price is 10% higher).
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Support entry and tracking of referral data
including disciplines referred, funding source, referral source and
diagnosis.
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Print referral summary by source (e.g. hospital,
family, MD) listing referral counts for Medicare, Medicaid, self pay and
other payors.
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Display indicator on screen for patients
requiring prior authorization. |
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Support capture of registrtion and admission
data at remote offices. |
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Patient demographic data includes: directions to
home.
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Patient admission data includes: primary ICD-9
diagnosis code.
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Patient insurance data includes: Medicare Part A
& B policy numbers. |
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Support multi-entity billing and accounts
receivable with separate and consolidated reporting. |
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Provide option to edit charges for valid patient
account numbers and charge code numbers as charges are entered.
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Capture applicable employee ID and visit related
data (e.g. travel time, mileage) during charge entry. |
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Accommodate late billing (e.g. supplies,
contracted services).
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Support HCPC coding and checking for valid code.
(Medicare definition of procedure codes). |
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Print HCFA 1500 billing forms. |
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Support payor-specific UB-92 billing profiles
for different payors and their requirements. |
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Support various billing methods (visit, hourly,
per diem, discount, capitated). |
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Support Medicare electronic remittance advice
processing (e.g. ERA) in which payment data is received via modem and
automatically posted.
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Automatically generate bill for second payor on
remaining balance after first payor's payment. |
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Support entry and tracking of claim denials
capturing visits, discipline, supplies and dollars denied. |
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Print ATB by agency branch or company (Home
Care, Hospice, Home Infusion). |
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Prohibit posting of payment batches that are out
of balance.
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Include a standard care plan set based on VNA
Care Steps for use in building patient care plans. |
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Provide contractual guarantee that care plan
system complies with current (and will comply with future) HCFA, OASIS,
JCAHO, Medicare and Medicaid requriements. |
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Automatically retrieve suggested nursing
interventions and expected outcomes after entry of diagnoses and problems.
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Support tracking of dates interventions are
performed.
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Allow agency to define layout of printed care
plan on agency designed forms without programming. |
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Support documentation of what type of services
were performed during visit. |
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Automatically update the care plan as indicators
are met, approaches are completed, etc. |
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Support electronic capture and transmittal of
HCFA OASIS patient data sets to state agency (or other entity) required by
HCFA.
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Provide ability to check new med orders for
interactions with previous IV and med orders. |
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Automatically check new IV admixture orders for
conflicts with patient's allergies. |
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Automatically allocate Medicare and Medicaid
contractual allowances. |
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Show FTE's and labor hours per unit on a
units-of-service statistical report. |
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Interface to payroll system. |
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Support on-line entry of IV prescriptions data
including frequency, compounding, billable drug and supply items.
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Support use of mnemonic codes to speed IV order
entry.
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Allow on-line changes to IV orders without
having to re-key all order information. |
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Calculate total volume of IV admixture or TPN
including base solution and additives. |
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Allow user to define label format without extra
custom programming charges from system vendor. |
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Provide ability to track hospice routine and
acute care days, respite and continuous care. |
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Support per diem billing for billing at flexible
rates of daily hospice services between specific dates. |
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Support billing for hospice physician services.
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Print donation / pledge reminder notices.
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Track and report volunteer time and estimated
cost savings.
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Maintain hospice data including: mailing list of
family and friends for bereavement letters. |
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Store multiple agency-defined bereavement letter
formats for different purposes. |
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Support per visit billing for hospice patients.
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Track rentals and items in repair and
maintenance records.
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Print ABC (80/20) analysis of the top 20% of
items used by quantity or dollar volume. |
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Provide on-line inquiry into all purchase orders
for a particular item. |
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Support "window" type access to vendor master
files without leaving the P.O. edit screen.
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Allow "one-keystroke" on-line receipt if all
line items and ordered quantities on P.O. are received.
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Print receipt exception report of variances from
P.O. in item number, quantity, or units of measure. |
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Print authorization warning report of patients
near authorized limit of visits and hours, showing payor and authorization
data.
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Provide exception reporting of cases requiring
attention for actual visits exceeding planned on Plan of Treatment
HCFA-485.
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Print actual versus planned visits report to
monitor staffing levels and scheduling accuracy, and also to help identify
problem areas.
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Print monthly referral summary report showing
number of patients referred by source for last 30, 60, and 90 day period
with YTD totals by referral.
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Print monthly employee time analysis report
totaling times for visit related activities (e.g. charting, travel) by
patient.
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Print cross-reference report that compares schedule,
payroll, billing, and clinical notes data for discrepancies and/or errors. |
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Provide ability to perform plan of treatment, care plan, and clinical notes
functions from patient homes with portable (e.g. notebook, laptop, handheld)
computers.
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Provide functions to minimize data entry during
charting (e.g. pop-up menus, check boxes).
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Provide table look-up functions for ICD-9 codes,
medications and other extensive reference data.
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Provide handwriting recognition technology for
translating notes into text. |
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Allow help screen text to be modified or added
to by agency for user specific procedures, instructions, etc. |
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Calculate wages on multiple pay rates per
employee, per day and per period. |
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Support cafeteria benefits programs allowing
pre-tax deductions.
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Provide option for intermittent employees to
accrue or not accrue benefits. |
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Print annual employee benefit statements listing
value of benefits paid and used for each employee. |
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Maintain staff profile data including: planned
absences.
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Maintain patient order data including: language
requirements.
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Provide automated scheduling functions that
match patient orders to available staff considering all staff profile and
patient order characteristics.
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Support on-line maintenance and display of staff
schedules, including on-call schedules. |
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Print cancellation statistics report totaling
cancellations by reason. |
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Track daily and weekly overtime limits for
employees and display warning if limits are exceeded. |
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Provide on-line map capability to plot and print
route to patient's home. |
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Provide on-line help screens to assist novice
users in all applications. |
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Provide access to system maintained data element
definitions within report writer software. |
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Provide data management design that supports
integration and sharing of data among all applications. |
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Provide ability to down load data into popular
PC spreadsheet, database and word processing file formats. |
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Support interface to light pens for initiating
system functions by touching screen with light pen. |
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Supply all computer program source code on media
(e.g. tape, CD) to user. |
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Provide future software releases and updates to
all applications as part of regular software maintenance fees.
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Provide commitment to support HL7 (Health Level
7) healthcare industry system integration standards. |
