1. CHAPTER 22 PENDING RESULTS

2. OBJECTIVES Process the incomplete charts using the Pending processors Process a referral using the Referral dashboard

3. KEY CONCEPTS Results pending Incomplete visits Referrals and referral reminders Surgery/procedure authorizations Appointments need authorizations Further review needed Charts needing review Employee health Open cases On-line open case aging Rehab services appointments to schedule Company log review

4. PENDING RESULTS When patient leaves facility medical treatment for visit is complete but there could still be results pending for tests, treatments not provided at facility Incomplete visits are defined as patient encounters which results are pending for x-rays, lab tests, treatments and opinions from referrals/specialists Important to track results of outside testing/treatments Physician needs to review results of these in timely fashion as the patient’s health care is important

5. PENDING RESULTS Patient’s health could be at risk is these results are delayed Every step in patient’s treatment could be perfect but misfiling test results or lack of notification to physician that results are back could cancel all of the positive effects of patient’s care MedTrak’s Pending module also provides functionality to manage billing issues, track referrals, manage authorizations and review company demographic changes

6. PENDING MENU To access Pending Menu sign in to MedTrak click Pending Menu tab at top of screen-Figure 22-1 Pending Menu provides access to the following: Incomplete Visits-consultations, occupational medicine, orthopedic visits Patient Responsibility Physicals-employee physical examinations, drug screens Rehab Services-for physical/occupational therapy Referrals-reminders

7. PENDING MENU Surgery/Procedure authorizations needed Appointments Further Review Needed Charts Needing Review Open Cases-tracks open workers 'compensation On-Line Open Cases Aging-monitors open time of workers 'compensation cases Held Cases-physician waiting on additional info before clearing them RS Appts to Schedule-manages appointment authorization for referrals to in-house rehab Company Log Review-reviews demographic changes to employers information

8. INCOMPLETE VISITS Typically within 1-2 days radiologist will finish reading x-ray(overread) and communicate results to facility When results arrive administrative staff member enters information in patient’s x-ray overread order in MedTrak You can do this by accessing MedTrak Main Menu and click Pending Menu Click Patient Responsibility button in Incomplete Visits section on Pending Menu Next screen is Incomplete Patient Responsibility screen-Figure 22-2

9. INCOMPLETE VISITS Initial view for this screen is alphabetical by patient’s last name to find a patient you can reset the view by date of service or by company is it is workers’ compensation All incomplete visits screens list patient names, their employers(patient responsibility) flags representing what is still incomplete for visit, date of service, type of visit(I-initial, R-return) and MedTrak employee initials of provider

10. INCOMPLETE VISITS Each Incomplete Visits screen uses FLAG to indicate what is still pending for visit These flags represent incomplete steps in processing patient’s visit Administrative staff member completes step represented by one of flags the flag clears from line and once all flags clear patient drops off processing screen Incomplete Visit table lists incomplete visit flags and what screens use them-Figure 22-3

11. FIGURE 22-3

12. INCOMPLETE VISITS To enter results of over-read by radiologist place cursor in command field for patient and click X-ray orders button Next screen is Radiology(x-ray) category of Visit Orders screen-Figure 22-4 This screen reflects information related to report from radiologist Enter date report arrived back at facility Scan radiologist’s report including narrative/summary and attach to patient’s case

13. FIGURE 22-4 & 22-5

14. INCOMPLETE VISITS In each Narrative and Summary fields enter “sr”(trigger for See report) Enter employee initials for radiologist in Radiologist answer field-Figure 22-6 If you do not know radiologist’s initials use F1 key in answer field to access help screen displaying all available radiologist for facility After entering data click Submit Answers button X-RAY OVERREAD order details screen refreshes with answers showing to right of questions-Figure 22-7

15. INCOMPLETE VISITS The remaining step in medical workflow is ordering physician to review narrative and summary from radiologist Click EXIT screen on X-RAY OVERREAD order details screen and return to x-ray section of Visit Orders screen-Figure 22-8 X-RAY OVERREAD order is still incomplete because ordering physician needs to review radiologist repot Click Exit screen on Visit Orders screen to return to Incomplete Patient Responsibility screen to process next results report that facility has received-Figure 22-9

16. INCOMPLETE VISITS Once physician reviews radiologist’s report the XR flag will automatically clear and patient visit will drop of incomplete processing screen Click Exit screen again to return to Pending Menu The medical workflow disciplines for over-read of x- ray called for administrative staff to prepare the x- ray to send to radiologist and then record results of read Final step is ordering physician to review report Do This! Pg. 268

17. FURTHER REVIEW NEEDED MedTrak alerts ordering physician that over-read x- ray by radiologist is back and ready to review by placing an entry in Physician’s Further Review Needed processor Click Further Review button on Clinic Status screen or click Further Review Needed button on Pending Menu-Figure 22-10 Screen displays MedTrak employee initials of staff of facility who have action items that need further review

18. FURTHER REVIEW NEEDED These items could involve one of the following: X-ray over-read results Lab results Referring treatment results Questions concerning billing Any other question about a case from another staff member To review chart place cursor in Command field next to physician’s MedTrak employee initials and click Submit button Next screen to appear is Further Review Needed/Staff screen-Figure 22-1

19. FURTHER REVIEW NEEDED To review X-RAY OVERREAD order place cursor in command field next to it and click Show Order button On X-RAY OVERREAD order details screen review radiologists report by opening up scanned document that administrative staff attached to patient case Enter MedTrak employee initials in Reviewed By answer field-Figure 22-12 Click Submit Answers button, X-RAYS OVERREAD order details screen refreshes with physician’s name to right of Reviewed By question After reviewing screen click Exit Screen button to return to Further Review Needed details processor-Figure 22-13 Click Exit Screen button again to return to Pending Menu Do This! Pg. 271

20. REFERRALS TO SPECIALISTS When physician refers a patient to specialist to have scheduled test he/she places order for a referral In a referral order the physician documents these: Body parts needing examination or treatment Any special notes specialist should know about patient How soon visit must happen Whether referral is for evaluation only or evaluation and treatment or for specialist to take over patient care

21. REFERRALS TO SPECIALISTS Once physician place referral order appears on Referred Dashboard for scheduling/processing by administrative staff Click Pending Menu tab on MedTrak main Menu then Dashboard button in Referrals section of Pending Menu-Figure 22-14 Next screen is Figure 22-15-Referral Dashboard The totals on this screen represent total number of referrals that are: pending, approved, denied, scheduled, completed, and reviewed Do This! Pg. 273

22. REFERRALS TO SPECIALISTS To display individual referrals on Referral Dashboard click on number which displays: Location Status View Search Date ordered Patient name Type of referral Referral status Select

23. REFERRALS TO SPECIALISTS From this screen, use buttons to: Select Visit Log Case Visit Notes Reminders Pending column displays Referrals screen for patient- Figure 22-16 an asterisk next to number on Referral Dashboard indicates referral needs immediate attention Place cursor in command field next to patient order and click Select button-Figure 22-17 first detail screen displays individual questions that need answering to process and complete referral

24. REFERRALS TO SPECIALISTS Referral order screen displays: Header-referral order name, date ordered, clinic location, company name, patient name, reason for visit Function field-allows access to many other functions Order details-physician questions Administrative staff(clerical) questions-Referral step Referral step Referral notes Reminder Consultation/Specialist

25. REFERRALS TO SPECIALISTS Appointment Date Appointment Time Medical records Scheduling Clerk Consultant Report Return Date Consultant Summary Answering this question moved referral to Completed column on Referral Dashboard Physician questions-reviewed by-answering this question moves referral to consultant report using Further review Needed processor

26. REFERRALS TO SPECIALISTS Figures 22-19 and 22-20 and 22-21 Do This! Pg. 278 & 279

27. AFTER THE REFERRAL VISIT After patient’s referral visit referral specialist will report back to referring physician When report arrives back at facility and administrative staff member enters information in referral order for patient in MedTrak Figure 22-2Referral Dashboard Figure 22-23Referrals Figure 22-24Orthopedic Consultation Figure 22-25Orthopedic Consultation Figure 22-26Referral Dashboard Do This! Pg. 282

28. FURTHER REVIEW NEEDED MedTrak alerts ordering physician that report from orthopedic consultant is back and read y for physician to review by placing an entry on physicians Further Review Needed processor Figure 22-27Further Review Needed Figure 22-28Further Review Needed/Staff Figure 22-29Orthopedic Consultation Figure 22-30Further Review Needed/Staff Do This! Pg. 285

29. CLOSING THE REFERRAL Since physician has reviewed the consultant’s report referral is now in Reviewed column on Referral Dashboard Administrative staff can now close referral Access referral access Referral Dashboard off Pending Menu Click on number in Reviewed column for facility location –Figure 22-31 On Referral screen listing from Reviewed column close referral and clear it from Referral Dashboard enter “clos” in command field-Figure 22-32 Press Enter key Referrals screen refreshes with referral cleared off screen-when done Exit screen and return to Referral Dashboard to continue processing others Do This! Pg. 287

30. PRINTING THE PATIENT’S CHART You will need to print patient’s chart for incomplete visit documentation to turn in for your assignment Do This! Pg. 288