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What steps must be taken take to qualify a diagnosis as an HCC? Provider Responsibilities for HCC/RxHCC Interesting Special Cases which are HCC or RxHCC diagnoses The following are the assessments from two visits this year on the same patient How to use the HCC/RxHCC Documentation and Tracking Tools in NextGen HCC/RxHCC Tutorial Use of the “HCC Reviewed Today” Button Documentation Qualifying a Diagnosis for Inclusion as an HCC or RxHCC Documenting the “HCC Last Evaluated” column Using the Chronic Conditions Evaluation Function to Evaluate a Chronic Problem for Inclusion as an HCC or RxHC Using the Disease Management Tools to Evaluate a Chronic Problem for Inclusion as an HCC or RxHCC Using the “Detailed Comment” Function to Evaluate a Chronic Problem for Inclusion as an HCC or RxHCC Using the Master GP to Evaluate a Chronic Problem for inclusion as an HCC or RxHCC Associating Medications with the RxHCC Risk Diagnosis in the EMR Medication Module Introduction to HCC Risk Table of Contents General Concepts about HCC/RxHCC Table of Contents In 2007, Medicare Advantage programs (HMO) were funded by CMS (Center for Medicare and Medicaid Services) using both demographics and the Hierarchical Conditional Codes known as the HCC Diagnoses.  2007 also became the year that RX HCC codes were added to complement the reimbursement for managing patients with other illnesses which while they did not rise to the level of complexity and cost-for-care, as the HCC diagnoses, they did qualify for a lower additional payment due to increased medication costs. The RxHCC designations cover many diagnoses which were not covered in the HCC.  As a general rule almost all HCC diagnoses are also RxHCC codes but all RxHCC are NOT also HCC.  Here are some examples of diagnoses which are not HCC but are RxHCC codes: Hypertension is not an HCC (i.e., 401.1 or  401.9, etc) but it is an RxHCC Osteoporosis another common illness is not a medical HCC but is an RxHCC CAD in itself is not a medical HCC, but it is an RXHCC.  Because CAD is a general term, it is imperative that if the patient has angina or an old MI, the chronic problem list should include angina or old MI as they are HCC diagnoses. CMS Website with additional information aboutHCC/RxHCC can be accessed Table of Contents Description of diagnosis code files:  Current model diagnoses.xls: Comprehensive list of all risk adjustment model diagnoses used for risk adjustment payments in 2004-2009.  Specifically, the file: Contains all diagnoses used in the CMS-HCC models and the RxHCC model (Prescription Drug Risk Adjustment Model), Indicates whether or not the diagnosis code is used for payment for 2004- 2009. Includes the associated condition category for the RxHCC model and/or the CMS-HCC model, and indicates the diagnosis code effective date. Note that additional diagnosis codes may be added for 2009 payments, depending on the list of diagnosis codes for Fiscal Year 2009 (effective date of October 1, 2008).  Also, please note that all codes used for 2007 payment will be used for 2008 payment but only those codes valid in Fiscal Year 2008 will be used for 2009 payment. Please see: http://www.cms.hhs.gov/ICD9ProviderDiagnosticCodes/01_overview.asp#TopOfPage and click on the related link, “Updates and Revisions to ICD-9-CM Diagnosis Codes”, for more information about updates to diagnosis codes. Future model diagnoses.xls:  Comprehensive list of all additional model diagnoses that plans are required to collect and submit.  These diagnoses, while not used for payment, are needed so that CMS can conduct analyses of future models that may include these diagnoses. Special Case of Hypertension – 55% of SETMA’s patients have hypertension Table of Contents Hypertension (HPT)  is not an HCC Risk Category diagnosis, but Hypertension with Kidney disease, and Hypertension with heart Disease are HCC Risk Categories.    In SETMA’s ICD-9 Codes list, the following are either HCC or RxHCC or both: H – will take you to HCKD which is hypertension with kidney disease HH – will take you to HHCKD, HPT with heart disease and kidney disease HHD – will take you to HHD LVH – HPT with heart disease w/o kidney disease ICD-9 Codes which are associated with Hypertension and heart disease but without renal disease can be found by typing “HHD” – which stands for Hypertensive Heart Disease.  Under this designation, you will find the following descriptions HHD LVH Benig CHF No HHD LVH Benign CHF HHD LVH Malig CHF No HHD LVH Malig CHF HHD LVH Unspec CHF No HHD LVH Unspec CHF This allows you to note in your assessment and in your chronic diagnoses those patients who by reason of the presence of LVH in the face of Hypertension with or without CHF, are at increased risk of a major cardiovascular event. When you have a patient with hypertension who also has microablumenuria, or elevated creatinine, or abnormal creatinine clearance as calculated by using the Renal Failure templates, you can use the following ICD-9 Codes to indicate the patient’s condition.  Codes which associate  Hypertension with renal disease can be found by simply typing in “H” and the first diagnoses which pop-up will be: H/CKD Benign CKD 1-4 Or Unspe H/CKD Benign CKD 5 Or ESRD H/CKD Malignant CKD  V Or ESR You will often find that you will have in your chronic conditions: Hypertension Urine abluminuria Renal Disease H/CKD This will give you a clear idea of this patient’s condition and on those patients where we are paid by HCC Risk Categories you will increase our reimbursement. In those cases where the patient has hypertension, heart disease and renal disease, you will find these diagnoses by simply typing in “HH” and the first diagnoses which pop-up will be: HH/CKD Ben CKD 5 ESRD CHF No HH/CKD Benign CKD 1-4 CHF HH/CKD Benign CKD 1-4 CHF No HH/CKD Benign CKD 5 ESRD CHF HH/CKD Malig CKD 1-4 CHF HH/CKD Malig CKD 1-4 CHF No HH/CKD Malig CKD 4 ESRD CHF No HH/CKD Malig CKD 4 ESRD CHF HH/CKD Unsp CKD 1-4 CHF HH/CKD Unsp CKD 1-4 CHF No These codes indicate that the patient has Hypertension (H), Heart Disease (the second H), Renal Disease (CKD) and either has or does not have CHF.  In this case, you might have a patient with the following in the Chronic Conditions: Hypertension Urine albuminuria Renal Disease HH/CKD…CHF CHF Diastolic CAD LVH What Provider Documentation is necessary in order to qualify a diagnosis as an HCC or RxHCC for payment? Table of Contents Let’s start from the end and work our way back to the beginning.  Because all of the HCC and/or RxHCC are Chronic Conditions, the following would be required: They must be identified in the E&M coding event for that encounter and they must appear on the Chronic Problem list for that patient. Lab, x-rays and procedures should be appropriate to that condition, when required. Medications should be reviewed and appropriate medications for the condition should be present in the documentation for the encounter.  (It is possible in NextGen to associated a medication with a diagnosis.  We will have our staff complete this task on all GTPA patients.)* Physical examination should be specific for that condition – for instance if you state the patient has CHF and do not document the lungs and heart, it would not be a valid evaluation.  If you say the patient has cancer of the prostate and you do not comment whether they are currently in treatment or are in surveillance, that would not be valid. Documented History should be appropriate for that condition. Because HCC and/or RxHCC are chronic conditions, you do not necessarily have to have a Chief complaint, unless it applies. There are four ways in which to complete your documentation in the EMR to satisfy this need. These will be discussed below: Through the routine use of Master GP and the documentation functions present there. Through the use of the Chronic-Problem evaluation templates which launch from the Master GP Through the use of the Disease Management tools in the EMR Through the use of the “Detailed Comments” function which launches from the Assessment template by clicking the button entitled “Detailed Comments” which is found in the second column of the Assessment template. What steps must be taken take to qualify a diagnosis as an HCC? Table of Contents The diagnosis must be: Established as applying to this patient. Documented in the patient’s record in the Chronic Problem list Evaluated at least once in the year prior to the qualification as an HCC or RxHCC Reported to the HMO and via the HMO to CMS Provider Responsibilities for HCC/RxHCC Table of Contents Providers simply need to pay attention to the needs and condition of the patient and: Add any HCC or RxHCC which you diagnose to both your chronic problem list and to the acute assessment. Update your Chronic Problem list so that the HCC and RxHCC are displayed on your diagnoses. Evaluate each of the HCC and RxHCC at least once during the year. The best way to evaluate whether you have identified ALL of the HCC and/or RxHCC is to review: Scanned documents particularly under cardiology, master discharge summaries, radiology, specialty correspondence, pulmonary, echo’s, x-rays, etc. The patient’s past history template Laboratory results and medications Previous encounters. Going forward, once this “catch-up” task is done, it will be relatively easy to add HCC and RxHCC to your chronic problem list as you sign off on reports, correspondence, etc.  Also, we are carefully updating all HCC and RxHCC for all patients admitted to the hospital.  This is an on-going task.  In 2009, some of the HCC and RxHCC will change and some new ones will be added.  We will update our system with that information to continue to make it “easier to do it right than not to do it at all.” As mentioned earlier, our support staff will go through the EMR with all HMO patients and associated the diagnoses (ICD-9) codes with the medications which are used to treat the patient. Interesting Special Cases which are HCC or RxHCCdiagnoses Table of Contents SETMA’s ICD-9 code list has 6,832 ICD-9 Codes which are intuitively organized, covering 26 medical and surgical specialties.  In the HCC/RxHCC list published by CMS there are a total of 5,243 HCC and RxHCC diagnoses.  SETMA has 1752 HCC and 1362 RxHCC codes (Total 3314) which are associated with our ICD-9 Code list and which are automatically published on the Master GP when an ICD-9 code is chosen. Altered Mental Status  see AOC Altered Mental Status Amputations – including toes Attention to all ostomies Aneurysms Halitosis Choking Sneezing Mouth Breathing Death Sudden Unattended Decubitus Decubitus and Ulcers of the skin and extremities are HCC Risk diagnoses Difficulty walking due to deranged joints Drug Depend and addiction including alcohol Fluid and electrolyte balance Generalized Pain see Pain Generalized Hypcalecemia Hypercalcemia Hyperkalemia Hypermagnesemia Hypernatremia Hypokalemia Hypomagnesemia Hyponatremia Hypovolemia Impaction Insulin Pump Complications (this refers to mechanical complications of function) Joint Ankylosis – all RxHCC Joint Calcification – all RxHCC Joint Derangement – all RxHCC Joint Disorder Unspecified – All save one RxHCC Joint Effusion – All RxHCC Joint Infection – All RxHCC Joint Loose Body – All RxHCC Joint Pain – All save one RxHCC Joint Replacement – none HCC or RxHCC Joint Stiffness – All RxHCC Met Cardiometabolic Risk Syndrome Monitor Insulin Long Term Curr Neuropathies, peripheral Ostomies:  tracheostomy, gastrostomy, ileostomy, colostomy, enterostomy, csytostomy, etc. Phosphorus PVD – peripheral vascular disease Renal Artery Stenosis Self-Inflicted Injuries Spondylosis.  The most commonly used one will be 72190 Ulcer Valve Heart Valve Replacement but Valve Replacement Mitral Aortic is not Vegetative state Persistent se AOC Vegetative State Persistent The following are the assessments from two visits this year on the same patient Table of Contents Evaluate the Assessments and the Chronic-Conditions list from a standpoint of HCC Risk Categories.  The difference in reimbursement would be enormous. This patient was a walk-in this morning. He was seen in the office rather than being sent to the ER.  Before we dismiss the 1/29/08 visit because of its acuity, it is possible to properly treat the patient’s acute problem which was done, while paying attention to his chronic conditions and thus his HCC Risk June 6, 2008 Assessment Fredrickson Type IIa Hyperlipoproteinemia - Chronic Hypotension Unspecified - Chronic Fluid Balance Dehydration - Chronic CHF Unspecified - Stable Renal Stage III Chron Disease - Chronic Sodium Hyponatremia Hyposmolal - Acute H/CKD Benign CKD 1-4 Or Unspe - Chronic HHD/CKD Benign CKD 1-4 CHF - Chronic Chronic Conditions Prostate BPH Atrial Fibrillation Hyperten Benign Essential HHD/CKD Benign CKD 1-4 CHF Hx Tobacco Use Coumadin Long-term Current Use Lipid HDL Deficiency Familial H/CKD Benign CKD 1-4 Or Unspe Renal Stage III Chron Disease Colon Polyps Fredrickson Type IIa Hyperlipoproteinemia CHF Diastolic Chronic Xerosis, Skin Sleep Apnea Asbestosis February 29, 2008 Assessment Abscess, Cellulitis Other Site - Acute Vac, Tetanus Diphtheria Td Chronic Conditions Prostate BPH Atrial Fibrillation Asbestosis Sleep Apnea CHF Xerosis, Skin Colon Polyps Hyperlipidemia NOS Hyperten Benign Essential Urinary Nocturia Hx Tobacco Use Coumadin Long-term Current Use How to use the HCC/RxHCC Documentation and Tracking Tools in NextGen Table of Contents Use of the “HCC Reviewed Today” Button Documentation Qualifying a Diagnosis for Inclusion as an HCC or RxHCC Documenting the “HCC Last Evaluated” column Using the Chronic Conditions Evaluation Function to Evaluate a Chronic Problem for Inclusion as an HCC or RxHC Using the Disease Management Tools to Evaluate a Chronic Problem for Inclusion as an HCC or RxHCC Using the “Detailed Comment” Function to Evaluate a Chronic Problem for Inclusion as an HCC or RxHCC Using the Master GP to Evaluate a Chronic Problem for inclusion as an HCC or RxHCC Associating Medications with the RxHCC Risk Diagnosis in the EMR Medication Module HCC/RxHCC Tutorial Table of Contents To review the HCC/RxHCC tool in SETMA’s EMR, go to AAA Home Click on Master GP Midway down the GP Master template, you will find the list of Chronic Conditions To the right of the Chronic Conditions are three columns entitled: HCC Risk Category – this designates that a diagnose is either an HCC, RxHCC or neither, in which case the box will be empty. (Note:  Most HCC diagnoses are also RxHCC, but not all, while most RxHCC are not also HCC.) Last Evaluated – this designates the date when this problem was specifically evaluated. HPI 1-2, HPI 3-4 etc. – this provides a template whereby the provider can specifically address each of the diagnoses in the Chronic Problem List. The content of that first column, entitled HCC Risk Category, appears automatically when a diagnosis is selected from SETMA’s ICD-9 Code list. Note that in the 18 diagnoses which appear when the provider types in “HHD”, one is neither an HCC or RxHCC,  eleven are HCC and 6 are RxHCC.  When you select  a diagnosis, if it is either HCC or RxHCC, that designation is automatically placed into the column entitled “HCC Risk Category”. The HCC/RxHCC designations appear on the: Master GP SETMA’s ICD-9 Code list where the HCC and RxHCC are displayed beside the ICD-9 codes Assessment Template “Assessment into Problem List Pop-up” (see below for how to use this function) And on the following templates, the HCC and RxHCC appear in a different color: E&M Code This is illustrated below: Use of the “HCC Reviewed Today” Button Table of Contents At the bottom of the GP Master, you will see a button entitled “HCC Reviewed Today.” This button and the date beside it, gives you the opportunity to denote when you last did a thorough review of the patient’s entire record and identified all of the HCC and RxHCC codes which apply to this patient.  When you click on the button, a pop-up appears which states: If you have gone through the patient’s entire record, identifying and validating all HCC and/or RxHCC diagnoses, then you may click “OK” and it will indicate to day’s date as when you last checked that patient’s chart thoroughly for HCC and/or RxHCC diagnoses. The following will further support the accurate identification, validation and verification of HCC/RxHCC codes: These charts will be reviewed at least once a year by our support staff and in some cases they will be reviewed more often. Every time a patient is in the hospital, the HCC/RxHCC lists will be updated. When you received correspondence from specialist or the results of procedures, you should update the HCC/RxHCC according to the validated and verified diagnoses. With these steps the accuracy and completeness of SETMA’s HCC and RxHCC coding will be supported and sustained by: Provider attention to the ICD-9 Codes they select during a patient encounter. Providers adding additional diagnoses when they review tests and procedure results such as lab work, echo reports, etc. Hospital Service team adding diagnoses to the chronic problem list when a patient is discharged from the hospital. Documentation Qualifying a Diagnosis for Inclusion as an HCC or RxHCC Table of Contents Four steps are needed to meet the requirement to have CMS recognize a diagnosis as an HCC or RxHCC code in the treatment of your patient; they are: Establish that this diagnosis applies to this patient.  There are several steps to this process:  identify the diagnoses, verify, and validate it. Document the diagnosis in the patient’s record in both the encounter assessment for the day in which it was added and in the Chronic Problem list on the patient’s chart. Evaluate the problem at least once in the year prior to its qualification as an HCC or RxHCC. i.e., evaluate the problem in 2008 for inclusion as an HCC or RxHCC in 2009.  Remember, there are four ways in which you can support your evaluation of each problem: By use of the Chronic Condition evaluation templates which launch from the Master GP By use of the Disease Management Tools which launch from AAA Home. By use of the “Detailed Comment” function which launches from the Assessment Template by clicking the button entitled “Detailed Assessment” in the second column of the Assessment template. By use of the Master GP Functions in a routine evaluation making certain to address history, physical, assessment, lab and procedures which relate to a particular problem. Report the diagnosis to the HMO and, via the HMO to CMS The steps described above fulfill the requirements for steps one and two. The third step (Evaluate the problem at least once in the year prior to the qualification as an HCC or RxHCC) is met by using the two other columns which appear next to the Chronic Problem List and which are entitled “HCC Last Evaluated” and “HPI 1-2” In order to qualify as an HCC or RxHCC diagnosis, your evaluation must have: a history (most often contained in the review of systems) and a physical examination relating specifically to that particular problem. In addition, when it is appropriate: laboratory test and/or along with any consultations or treatments documented. Finally, your evaluation should document: The diagnosis’ status Medications ordered, reviewed or changed Of course, these are steps you already take in treating a patient. Documenting the “HCC Last Evaluated” column Table of Contents There two ways in which the third column, entitled “Last Evaluated,” can be populated; one is manual and the other is automatic. Manually, you can add the date of the encounter in which you completed a patient evaluation, which gave attention to the history, physical, lab and procedures related to a specific HCC or RxHCC. Simply click in the space in the “HCC Last Evaluated” column, next to the Chronic HCC or RxHCC condition you have evaluated.  A pop-up will appear which states: If you have not completed an evaluation which is specific to this diagnosis, click “cancel” and either evaluate the problem another day, or complete the evaluation on this date; then return to this field to denote your work. Once you have clicked “OK,” today’s date will be added indicating that this problem was evaluated today. NOTE: Soon, another function will be added such that when you complete this step, the ICD-9 Code associated with the HCC/RxHCC which you evaluated will be added to your E&M Template for this visit. The “HCC Last Evaluated” field can be automatically added if you use the Chronic-Condition-evaluation pop-up, which is launched by clicking in the third column, which is entitled, “HIP 1-2” etc. In addition, when you use this function that Chronic Condition will automatically be added to your E&M Evaluation. Using the Chronic Conditions Evaluation Function to Evaluate a Chronic Problem for Inclusion as an HCC or RxHC Table of Contents The Chronic Conditions Evaluation Functions are found to the right of the Chronic Conditions as displayed on the Master GP template. When you click the HPI button in the fourth column next to the Chronic Conditions, the pop-up will have two Chronic Conditions on it. You may evaluate one or both of these chronic problems. There is some redundancy which cannot be eliminated in the use of this function but it will make certain that your evaluation is specific to the problem with which you are dealing and that you have fulfilled the requirements for evaluating this problem. The pop-up has a place for you to address the following elements of the Chronic Condition under consideration: Review of Systems Physical Examination Status Symptoms Pertinent Negatives Compliance Plans Instructions Follow-up The ROS and Physical Examination which you completed under the GP Master functions will automatically populate the Chronic Conditions evaluation function and will appear on your note for each of the systems you open in your evaluation of a Chronic Problem. Soon, If you use the Chronic Condition evaluation function, each of the Chronic Conditions you so document will automatically be added to your E&M code without your having to do anything else. Using the Disease Management Tools to Evaluate a Chronic Problem for Inclusion as an HCC or RxHCC Table of Contents SETMA has designed Disease Management Tools for: Angina Asthma Headache Lipids CHF Hypertension Cardiometabolic Risk Syndrome Weight Management Chronic Renal Disease Weight Management The use of any of these Disease Management Tools will provide all of the documentation which is required to satisfy the evaluation of an HCC or RxHCC. Once the disease management tool is completed for any of these conditions, the provider can manually update the “HCC Last Evaluated” with confidence. Eventually, we will have that update be automatic. Tutorials for each of the Chronic Disease Management Tools can be found one of three ways: Clicking on the “T” next to name of the Disease Condition on AAA Home You can then select the specific functionality or disease management tutorial which is desired. Or by going to SETMA’s Intranet and clicking on “Clinical.” If you would like to study any of these Tutorials from a book, you check one out for loan for two weeks. Using the “Detailed Comment” Function to Evaluate a Chronic Problem for Inclusion as an HCC or RxHCC Table of Contents The “Detailed Comment” was developed for the Hospital-daily-progress-note function in NextGen, but is also available to be used with the clinic note.  At present, there are sixteen conditions for which we have developed “categories” for evaluation of chronic conditions. To find the “Detailed Comment” function, go to the Assessment Template in the Master GP Suite of templates by clicking on Assessment in the SETMA navigation list. This step launches the Assessment Template.  At the top of the second column of this template, there is a button entitled “Detailed Comments”. Depressing this button launches the following screen: In the left hand column, the conditions on the Acute Assessment of the current encounter will appear.  If there are more than 8 diagnoses, the additional ones can be found by clicking on the “Additional Diagnoses” button at the top right of the template Under the title “Categories”, if you click in the empty box beside the diagnoses you wish to evaluate for an HCC or RxHCC, you will launch a pop-up with the current 16 conditions for which the evaluation tool exists. If you then select the “Category” which corresponds with the HCC or RxHCC diagnoses which you are evaluating, a template will appear which will allow you efficiently to complete the evaluation of the condition. For instance, if you are evaluating Diabetes, and if you click on the diagnosis of Diabetes in the list of conditions under “Category,” the following will appear: You can then quickly and effectively evaluate that problem and that evaluation will appear on your chart note.  Also the ROS section will be automatically populated with your previous ROS, as will the vital signs and the appropriate laboratory results. Having completed the evaluation of this “category,” you can return to the Master GP template and put today’s date in the “HCC Last Evaluated” box.  Eventually, we will make that notation automatic as well. If there are multiple HCC or RxHCC codes which you wish to evaluate; you just repeat this process for each one. Using the Master GP to Evaluate a Chronic Problem for inclusion as an HCC or RxHCC Table of Contents It is obvious that it is possible to do a global evaluation of a patient utilizing the elements of the Master GP suite of templates.  Such a global evaluation, if it contains the elements of history, physical, assessment and plan for each of the HCC and/or RxHCC codes, will suffice for the requirement of documenting such an evaluation. Associating Medications with the RxHCC Risk Diagnosis in the EMR Medication Module Table of Contents Introduction In NextGen’s Medication Module, it is possible to associate the patient’s medications with the specific diagnosis for which the medication is prescribed. Some day, I suspect, the standard of care in medicine and perhaps even the law of medicine will require this to be done. The idea behind RxHCC is that the conditions so designated have an increased cost of care because of the chronic need for one or more medications to treat the condition. One of the problems with this association, as far as the functionality of NextGen is that once the visit in which the medication prescribed is locked, in order to create this association, you must renew the medication. Thus, it is helpful, when it is possible, and I understand and accept the fact that we are already asking for a great deal to be added to your workflow, it is ideal to make this association at the time that you add a medication for the treatment of an HCC or an RxHCC diagnosis. Steps to Completing the Association of a Medication with a Diagnosis From the Master GP template click on the Assessment button in SETMA’s list of navigation buttons. At the second column on the Assessment template midway down the screen, you will see a button entitled “Assessments Into Problem List.” When you click on the “Assessments Into Problem List” button, the following screen appears: As you can see this displays both the Acute Assessments and the Chronic Problems and identifies the diagnoses which are HCC and RxHCC, as well as those which are not, in this last case by the absence of a designation. At the top of the pop-up which is launched by this step, which is entitled “Copy Assessments to Problem List Module”, you will read the following note: In order to increase efficiency, I would recommend transferring only HCC and RxHCC diagnoses to the Problem List Module.  Once you have done this, you can review the Problem List Module by clicking on the center icon at the right hand bottom of the Main Tool Bar.  This is the icon which has a “scroll with Dx” in the center of it. When you click on this icon, it will display your Diagnostic Problem List. There are two categories on this list:  unresolved and resolved.  There are also five buttons to the right of the screen: New – this allows you to add a diagnosis as a new problem from this function but I recommend the custom solution SETMA has devised. Save – this makes your selection permanent Clear – this removes the status, severity, onset, diagnosed, resolved field at the bottom right of the Problem List template Renew – this is used to reactivate a problem from the “resolved” column to make it “unresolved” again Delete – this deletes a selected diagnosis from the Problem list. Once you understand the function of the Problem List feature, you are ready to take the step of associating medications with the problem for which they were prescribed. Click on the Medication Module icon, which is the bottom left icon of the nine icons at the bottom of the Main Tool Bar. In the top window, you will see a list of the medications the patient is on.  At the very bottom, you will see a window which is entitled “Problem.” If the visit in which that medication was prescribed is not locked, to the right of that window there will be an ellipses (this is the three dots in a row, such as …). If the ellipses is not present, click on the “Renew” medication button and the ellipses will appear. Click on the ellipses button and a pop-up appears which is entitled “Select Problem.” Find the diagnosis which is being treated by this medication and highlight it. Then click OK.  You will see that diagnosis appear in the Problem window We are able to report this information and with it completed in the EMR, it will make an audit on HCC and/or RxHCC, so far as the medications are concerned, a breeze.

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