Cerner® Integration

HEI Global Health’s expertise with Cerner Millennium® and its associated software solutions and architecture is unparalleled in the consulting industry. Armed with the depth of knowledge that can only be accumulated through years of experience, HEI can prepare your organization to thrive in today’s health care information technology environment.

Our associates have directly contributed to Cerner Millennium® implementations in the United States, Canada, the United Kingdom, France, Spain, Germany, Australia, United Arab Emirates, Qatar and Saudi Arabia, allowing us to provide a uniquely global perspective to any project, regardless of geographical region or clinical venue.

Our solutions within the Revenue Cycle domain complement Cerner throughout the workflow cycle.

Integrated applications, additional functions and custom components provide enhanced functionality within the Patient Accounting and Patient Access solutions. They are a fully integrated part of Cerner’s Revenue Cycle solution, therefore, removing the need for separate third-party applications and additional interfaces.

Eligibility Checking/Pre-Registration

Our solution fully integrates into Registration. The ability to determine eligibility before or at the time of registration greatly increases the collection of funds from insurance, decreases claim rejections, and overall collection periods by reducing unnecessary denials.

Registration/Revenue Cycle Integration

Our solution readily displays any Patient Balance, Copay, Coinsurance, Deductible, and Maximum out of Pocket. We provide visual alerts to the Registration Clerk, so the outstanding balance may be collected at the time of service.

Patient Liability Estimation in Registration

HEI’s Patient Liability Estimator (PLE) is an application that allows the user to produce an accurate Out-of-Pocket estimate to present to the patient. The estimate is based on previously placed orders, appointments, or other manually entered billable items and payer contracts.

Medical Necessity Checking

Non-Covered Checking can be performed in PowerOrders, and in the Scheduling Appointment Book applications to determine if the services provided will be reimbursed by the patient’s insurance carrier.

HEI’s Medical Necessity Checking notifies clinician that an order is non-covered based on payer contract. The notification displays in PowerOrders, Scheduling Appointment Book, and in Registration/Patient Liability Estimation. The determination is based on orders, appointments, and payer contracts. Our solution:

Compares CPT Code to ICD Codes to determine if payer deems it medically necessary

Displays Advanced Beneficiary Notice ABN icon on order

The ABN gives details, including non-covered reason

The ABN acknowledges financial responsibility, including estimated price

The ABN prints for patient to sign

History is easily accessible

Contract Management

The Contract Management system is managed by HEI’s robust, flexible Configuration Portal tool which allows:

Management of Payer and Insurance contracts

Flexible rule builder to handle complex payer requirements

Determination of copay/coinsurance amounts

Calculate Per Diem, Fee Schedules, % of charges

Calculate DRG (Diagnosis Related Group) Reimbursement

Alerts user for required Prior Authorizations

Pre-Authorization

Pre-Authorization provides the Payer with all information required to determine coverage. It can be done at the encounter level, as well as the procedure level and is based on orders placed through scheduling.

General Ledger Interfacing

Custom logic allows an increased number of segments being reported in the General Ledger and Patient Accounting to suit Regional requirements. All GL information is viewable in the Cerner Patient Accounting system.

Claim Generation

Our Claim Populations rules provide the ability to populate claims per Regional and Government requirements. This solution can query data items from all upstream Clinical and Revenue related applications.

Claim Scrubber

Validates draft claims against pre-defined sets of Claim edits driving reductions in Claim Denials and Resubmissions; and increases the likelihood of first time payments and quick reimbursements.

Custom Bill Views

HEI has custom Invoice and Claim views enabling users to see an easily readable view of the Invoice or Claim Data.

Custom Reports

Often billing system standard reports do not meet the requirements of clients. Our Custom Reports enable clients to get to the financial data necessary to effectively manage accounts. Local, regional, national, and international levels each have reporting requirements for which our team can provide the solution. HEI develops custom reports for Cerner’s Patient Accounting enabling Revenue Cycle Department to better manage and maintain its workflow.

Schema Extensions

HEI provides a unique and custom series of extended functionalities and customizations of Cerner standard Revenue Cycle code to meet business and regulatory requirements. To capture all data adjustments for claims and reporting, HEI provides custom Claim Level data schema that extends the Cerner Gold Standard Reporting data warehouse.

Using this extended schema in Cerner’s Revenue Cycle database tables, all the claim fields and calculations are stored at the time of claim generation and can be used for claim reporting.