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Order Registration, Manual Entry

I. PRINCIPLE:

The Order Registration screen provides access to CLICS for manually placing laboratory test orders. In addition to entering orders, this screen provides a facility to modify patient demographics and/or patient insurance information.

The Lab Initiated Orders (LIO) function facilitates the entry of add-on, downtime or reflex orders for Mercy, Finley or Dyersville directly into the LIS. Entering an order with an “Ordering Acct:” of DV, M or F will instruct CLICS to send an order request to the associated HIS/EMR. Upon receipt of an LIO request, the HIS/EMR will send the requested order to CLICS whereupon CLICS will connect it to the manually entered order. This means separate order(s) entry into the HIS/EMR to enable results send-back is not required, entering them into CLICS will also setup the necessary linkages to facilitate sending results back to the appropriate HIS/EMR.

The Order Registration screen is divided into two functional areas. The top half of the screen provides access to patient demographic information. Insurance information can be viewed for verification and editing by clicking the [Insurance] button located in this section. The bottom half of the screen contains information related to the laboratory test orders (i.e.: the "bill to" account/insurance, the "ordering" account, the ordering physician, the tests ordered, etc…).

II. PROCEDURE:

  1. Open Order Registration:
    Click on the Order Registration button located on the Lab Palette or choose “Order Registration” from the Screens menu on the menu bar.
      
  2. Patient Search:
    1. Search by patient ID number:
      1. Type in the patient’s unique ID number into the Patient ID field and press ENTER.
      2. If information exists in the LIS database under this number, it will fill the "Order Registration" screen. If no patient is found, a message displays telling the operator to check the search criteria and try again, click [OK] to return to the refreshed patient search screen.
    2. Search by patient name:
      1. TAB to the Last Name field and type in the patient's last name (for common last names also type in the first name and date of birth to further restrict the search) then press ENTER. If no patient is found, a message displays telling the operator to check the search criteria and try again, click [OK] to return to the refreshed patient search screen.
        Note: If the correct spelling of the patient's last name is in question, type in only the first few letters. Example Schmidt vs. Schmit or Schmitt; type in only “Schmi” to display all.
      2. A listing of all patients in the LIS database who match the search criteria will display.
        Note: If the same patient is listed, inappropriately, under more than one ID number, print the screen. Highlight the names, indicate that the patient records are possible candidates for merge and send the screen print to the LIS Project Coordinator.
      3. Select the desired patient. Using the mouse double-click on the correct patient name. The scroll window will disappear and the selected patient information will fill the Order Registration screen.
        Note: If the patient is not found, refer to “
        Patient Registration” procedure to enter a new patient in the database. If the wrong patient is selected, return to the list of names based on the search criteria entered by, selecting Function on the menu bar and “Last Name Search” from the drop-down menu.
        Order Registration Screen

  3. Patient Demographics:
    Patient Comments Field:
    Any pertinent comments regarding the patient can be added to this field. The comments added will be saved with other patient demographic data and viewable in future entries on this screen, as well as Patient Registration, Patient Insurance, Order Maintenance and Archive Order Maintenance screens.
    Note: The comments DO NOT print on the requisition or any reports.
    1. Review the information found in the patient demographic record.
      Note: Once saved, the patient’s last name can only be changed by someone with a security level of 7 or higher (I.T. staff or Manager of Laboratory Services). Send any changes to the I.T. Project Coordinator along with supporting documentation.
      Note: When entering the patient address, enter either contributory address information in Address Line One or leave line one blank. Enter the deliverable address, i.e. Street or P.O. Box, in Address Line Two.
      1. If incorrect or incomplete patient demographic information is found, select (highlight) the appropriate field using the TAB key or the mouse.
      2. Type in the correct/new information.
        Note: Add social security number if it is supplied by the client but not already included in the demographic information in CLICS.
    2. Go to the Attending Physician field using the TAB key or the mouse.
      1. Open the doctor list: Using the mouse click once on the down arrow box to the right of the Attending Physician field.
      2. Insert the cursor in the search field and type in the first few (3 to 5) letters of the physician last name.
      3. Press the up/down arrow keys to select (highlight) the correct physician name on the drop-down list.
      4. Press the TAB key to accept the selected physician in the field and go to the next field.
      5. The Patient Type default setting is Outpatient. All UCL patients whether they come in person or samples are sent from a client account are Outpatients, TAB to the next field.
        Note: There are other options available that are used only when the patient is a hospital patient and ADT information on the patient is transmitted over the hospital interface.
      6. Type in the patient room number, if applicable, then TAB to the next field.
      7. Type in the patient bed number, if applicable, then TAB to the next field.
    3. Save (Ctrl+s) all changes before leaving the Patient Demographics section of the screen.
      Note: If new or modified information in the Patient Demographics section is not saved, the old information will fill the demographic fields in the insurance pop-up screen. A message will alert the operator when leaving this section that changes have occurred and that guarantor and patient insurance information should be checked and updated if necessary.
  4. Test Ordering:

    1. Bill To:
      Type in the LIS account code or the name of the account to be billed (e.g.: If the patient's insurance is to be billed type in "ins" for insurance.), press TAB to go to the Ordering Acct: field.
      Note: Whenever “INS” is typed into the Bill To field the patient insurance screen will display for review of information. If no insurance information on the patient is in Patient Insurance and INS is typed into the Bill To field, a message will display: “This patient has no insurance on file click [OK] to enter patient insurance or click [Cancel] to change the Bill To field to an account.” One of these has to be done to place the order successfully. If [OK] is clicked the Patient Insurance screen will display, if [Cancel] is clicked the focus will return to the Bill To field so the entry can be changed.

      1. Review the Guarantor and/or Guardian information displayed. If incorrect when compared to current information given, make necessary changes and SAVE the corrections. (Refer to “Guarantor/Guardian Information Verification” protocol.)
        Note: Guarantor address information, if previously in the database, will display on this screen, however, when relation to guarantor is selected, the information will either blank out existing (if other, dependent or spouse is chosen), fill or overwrite (if self is chosen) the data originally displayed.
      2. Review the patient insurance information displayed. If all information is correct close the Insurance pop-up screen and press Alt+b to go to the Bill To: field.
        Refer to the “
        Patient Insurance” procedure to enter or modify guardian, guarantor, insurance information or scan patient insurance card(s).
        1. If incorrect or incomplete insurance information is displayed (i.e.: provider, group, ID #, etc…) go to the appropriate field using the TAB key or the mouse.
        2. Type in the correct information. Guidelines for Billing Primary & Secondary Insurances
        3. Save the modifications (Ctrl+s keys), the Patient Insurance screen will close when information is saved and the Order Registration screen will redisplay.
        4. Press Alt+b to go to the Bill To: field.
    2. Ordering Acct:
      Type in the account code or the name of the account requesting the test (e.g.: "ma" for Medical Associates if the order is from Medical Associates, "op" or outpatient if the order is for an outpatient.). Press TAB to go to the Ordering Dr: field.
      Note: All skilled nursing home patient tests are billed to the nursing home account.
      Note: Whenever “M”, “F” or “DV” is entered into the Ordering Acct: field, CLICS will automatically send an order request to the respective HIS/EMR system.
    3. Ordering Dr:
      Type in the physician call number or first few (3 to 5) letters of the physician last name (e.g.: 031 or "ott" for Dr. Roger Ott, Sr., 434 or "ridg" for Dr. Garrett Ridgely). Press TAB to complete the entry and go to the Test Code field.
      Note: The Ordering Dr field is a required field and must be filled. If left blank, the automatic default will be “Undefined Physician”.
    4. Fax Report and Phone Results Indicators:
      Two indicator boxes are set up for use at the time of test ordering to indicate that a request was received to FAX the report to either the ordering doctor and/or ordering account. A Phoned Results indicator box is also available to indicate that a request was received to phone results; enter in Lab Comments to whom the results should be called. Click on the check box(es) to select the appropriate actions. In addition, three Custom FAX fields are available to FAX reports to locations other than the ordering doctor or account.
      1. FAX Report to Acct or FAX Report to Dr:
        When results are released the results will automatically be FAXed to the ordering account and/or physician FAX number in the database and the event will be recorded in the Called Result Documentation Log. The message “Auto Fax Selected” will display in Lab Comment.
        Note: These check boxes will appear inactive (greyed out) until an ordering account and/or ordering doctor are entered in the Ordering Acct and Ordering Dr fields. The check boxes will activate as the operator tabs out of the field and as long as the ordering doctor and/or account selected have a FAX number in the database.
      2. Custom FAX: As each Custom Fax field is selected an input field displays to the right so a FAX number can be manually entered. When results are released the results will be FAXed to the number entered and the event will be recorded in the Called Result Documentation Log. The message “Auto Fax Selected” will display in Lab Comment. Up to 3 custom faxes can be entered.
      3. Phone Results: If the Phone results indicator is selected, a comment is placed in the Lab Comment that results are to be called. Any call made is manually recorded in the Called Result Documentation Log. Refer to the “Phoned/FAXed Results Documentation, CLICS” procedure.
    5. Test Information:
      1. Test code:
        Type in the UCL test configuration code and the test name will automatically display, press TAB to go to the Priority field.
        Note: If the test configuration code is unknown, press the alt+t keys or right mouse click on the code field. The "Search by Test Name" pop-up window will appear:
        1. Type in the first few letters of the test name and press ENTER, a list of candidate test names will fill the scroll window.
        2. Using the mouse click once on the desired test name. The selected test code will fill the Test Code field and the test name will automatically display.
      2. Priority:
        Type in “s”, “e”, “r” or “t” (Stat, Expedite, Routine or Timed respectively) to select the appropriate test priority; press TAB to go to the Collection Date field.
        Note: The default priority is Routine.
      3. Collection Date/Time:
        1. Type in the appropriate date if different from the date displayed; press TAB to go to the Collection Time field.
          Note: Date default is the current date.
        2. Type in the "actual" collection time using the international or military format (e.g.: midnight = 0000, or 8:00 a.m. = 0800 or 8:00 p.m. = 2200), type in the four numeric characters only, press TAB to go to the ICD9/Diagnosis field.
          Note: If a collection time is not entered, the following message will display “You are about to order tests with a NULL collection time.” with “OK” and “Cancel” buttons.

          Using the mouse, click once on the appropriate button to either continue with the order or return to the order entry screen so the collection time can be entered.
        3. Add-on Orders: If the new order is an add-on order, use the exact date and time of the original order so CLICS can “attach” the new test to the existing specimen.
      4. ICD9/Diagnosis:
        Type in ONE ICD9 diagnosis code per test ordered, if appropriate and press TAB.
        Note: An ICD9 code checker is used to verify that the code entered is valid (i.e. in the ICD9 database table).

        When tabbing from the ICD9 field:
        1. The ICD9 code checker will issue an alert if the code entered is an invalid code. Check the entry and make the necessary correction before proceeding. If necessary, call the physician office to verify the ICD9 code. After physician office hours, if a correct code cannot be obtained, remove the offending code and proceed with order. Leave the requisition for the day shift with a note attached that an invalid code was given and a new code must be obtained from the physician office. The code(s) can be added to the appropriate tests via Order Maintenance PRIOR TO BILLING; be sure to check the test status in Order Maintenance before proceeding.
          Note: There is a 4 day delay in billing following the printing of the cumulative report.
        2. The ICD9 field and the ABN button will turn yellow if the code checker determines that the ICD9 code entered does not pass medical necessity rules and it will turn green if an ABN form print is required for frequency.
          Click on either ABN button and a form will print with the appropriate tests. Explain to the patient that their insurance may not cover the requested test(s) and ask him/her to sign the ABN for authorization to bill them for the test. Refer to “
          Advance Beneficiary Notice (ABN), Guidelines for” protocol.
        3. List ALL ADDITIONAL diagnosis codes under Lab Comments for Insurance Dept reference.
      5. Quantity:
        The default quantity is 1. There is a 2 digit limit to this field. Test charges (crossmatch, unit screen, histology charges, microbiology charges, etc…) may, appropriately, be ordered with quantities greater than 1. The program will multiply the unit price by the quantity entered.
        Warning: Tests that require results entry are not to be ordered in a quantity greater than 1.
        If a quantity greater than 1 is entered a message box will appear when the test order is placed to alert the operator and asks for verification that the quantity entered is correct.
        1. If the quantity was entered in error, click [No] to return to the screen and correct the error. (No is the default.)
        2. If the quantity entered is correct, click [Yes] and the order will be placed.
      6. Price Override:
        1. Prices are not in the CLICS database; all pricing is in the Telcor billing system. If a price override of the Telcor system is required click on the “$” button to display the Price Override screen.
        2. Enter the price in the price field.
        3. A comment is required whenever a price override is performed; type in a brief explanation of why the price override was necessary. The date of override and user id of the person performing the override will append to the comment.
          Note: When ordering the “950 Miscellaneous Test” a price must be calculated and entered in the Price field. Refer to the current protocol for calculating prices. Prices can be changed after order placement via “
          Order Maintenance” screen.
        4. Click OK to save the override, Cancel to leave the Price Override screen or Delete to remove the price override.
      7. Adding a Lab or Report Comment:
        Note: When leaving the test order line, if the INS is typed into the Bill To field and the patient has no insurance information in Patient Insurance, the following message will display again: “This patient has no insurance on file click [OK] to enter patient insurance or click [Cancel] to change the Bill To field to an account.” ONE OF THESE HAS TO BE DONE TO PLACE THE ORDER SUCCESSFULLY. If [OK] is clicked the Patient Insurance screen will display, if [Cancel] is clicked the focus will return to the Bill To field so the entry can be changed to and account (OP or the submitting physician office account).
        1. Using the mouse, click once on the “Comment” button or press Alt+c. The comment boxes for that test order will display. Comments are added on a test configuration-by-test configuration basis (i.e.: if a comment is to appear for each test configuration ordered, it has to be entered separately for each one).
          There are two types of comments:
          • Lab comments: print on the requisition and are for laboratory use only.
          • Reported comments: print on the report for physician use.
            Note: If the comment being added belongs on both the requisition and the report, the comment will have to be added to both the Lab Comments and Reported Comments fields; the copy/paste feature may be used.
            (i.e.: select the desired text and copy the text (Ctrl+c), insert the cursor into the other comment field and paste the text (Ctrl+v)).
        2. TAB to the appropriate comment box and type in the desired comment for this test or using the mouse, click on the “Canned Comment” button to display the list of predefined comments.
          Note: "Canned Comments", is a list of predefined, frequently used, comments. Using the mouse, click once on the desired canned comment and the selected comment will be inserted into the selected comment field.
        3. Press ENTER or using the mouse, click once on the “OK” button to close the comment screen.
        4. The comment button will highlight light blue when Lab and/or Report Comments have been added to the test. In addition, if all comments are removed from a particular test, the comment button will no longer be highlighted.
      8. Additional Tests: More than one test configuration code can be ordered at the same time.
        1. To order additional tests press the Alt+a keys or using the mouse, click once on the “Add Test Row” button for each additional line needed.
          Note: If extra lines are added that are not needed, delete the line(s) by double-clicking on the blank line(s). A message will display “Are you sure you want to delete this test?” Select [Yes], [No] or [Cancel].
        2. Proceed as before with steps D.a.-g. for each additional row added.
          Note: The collection date/time typed into the first test row will be automatically copied to each additional row added; they can be modified as needed.
      9. Pre-accession:
        1. If the order has already been manually assigned an accession number, type the number into the “Preaccession” field and press TAB.
        2. If the test is not pre-accessioned press TAB, leaving this field blank. The LIS will assign a unique accession number when the order is registered.
      10. Client Order No.:
        Note: This field only displays when an account is entered in the Bill To and/or the Ordering Acct fields that utilizes a Client Order Number.

        Order number that may be submitted by the ordering account with the order information. The Client Order No. is required for some interfaced clients, is used for the interface only and will not appear on any requisition or report.
        Note: The Cascade Clinic will be the first account to provide UCL with this information. This number will tie their order back to the Cascade Clinic’s information system so results can be returned.
      11. Uncollected: If the test being ordered is not collected (i.e.: a future order) press the Alt+u keys or using the mouse, click the uncollected check box. This places an x in this box indicating a future order.
        Note: Routine orders designated, as future orders, will not print on a requisition until the appropriate print time is reached. Stat, Expedite and Timed orders will print on a requisition immediately.
    6. Enter the Order:
      After all appropriate information is entered, press the Alt+o keys or click on the [Enter Order] button to enter the order.
      Several events are triggered by the Enter Order command:
      1. Check of Bill To information when Insurance is designated:
        When the [Enter Order] button is clicked, if the INS is typed into the Bill To field and the patient has no insurance information in Patient Insurance, the following message will display again: “This patient has no insurance on file click [OK] to enter patient insurance or click [Cancel] to change the Bill To field to an account.”
        ONE OF THESE HAS TO BE DONE TO SUCCESSFULLY PLACE THE ORDER.
        1. Click [OK] and the Patient Insurance screen will display. Complete the insurance information.
        2. Click [Cancel] the cursor will return to the Bill To field so the entry can be changed to an appropriate account (OP or the submitting physician office account).
      2. Check of ICD9 codes for compliance:
        1. If the ICD9 code checker determines that the ICD9 code entered does not pass for medical necessity, the ABN button to the right of the Comment button will light up yellow as will the offending ICD9 code. The Order Entry event will trigger a message to display that says the ICD9 code entered is not compliant based on medical necessity and instructs the operator to call the physician office for a new code and to obtain a signed ABN from the patient.
          Refer to “
          Advance Beneficiary Notice (ABN), Guidelines for” protocol.
          Note: If the patient refuses to sign the ABN, this is noted on the ABN and witnessed. Tell the patient that we cannot order the test. A copy of the ABN indicating refusal to sign is given to the patient. DO NOT ORDER THE TEST.
        2. If an ABN button is lit yellow on one or more tests when the order is entered a message will display asking whether a signed ABN was received. Click [Yes] if a signed ABN was obtained or [No] if the signed ABN was not obtained. An appropriate comment, depending on the answer chosen, will be added to Lab Comments on the appropriate test(s).
  5. When all patient orders are complete, exit the Order Registration screen by pressing the Ctrl+F4 keys to close the screen.

       

    1. 04-18-95 M. English
    2. 11-13-97 M. English (Revised: Sequence of fields in Insurance section II.3.C. & ClinScan Info Entry II.4.H.)
    3. 3-13-98 M. English (Revised: Addition of “Note” following section II.2.D.)
    4. 12-2-98 M. English (Revised: Removal of ClinScan instructions, clarification of patient address lines)
    5. October 1999 S. Hosch (Revised: II.2.B & b-d., addition of cancel buttons on saves)
    6. March 2001 M. English (Revised: CLICS version; section II.: 1., 2.B.c.note, 3.C.note, 4.D.d-g.)
    7. December 2001 M. English (Revised: guarantor/guardian verification”)
    8. May 2002 M. English (Revised: II.4.D.g.1.)
    9. December 2005 M. English (Revised: for HIPAA compliance changes & PB version 8.0)
    10. April 2008 M. English (Revised: CLICS version: section II.2.B.c. & 5.D.j.)
    11. November 2008 M. English (Revised: II.5.A,B,D.: for FAX indicator addition & client ord no changes)
    12. June 2009 M. English (Revised: II.3.C., 4.D., E.e.)
    13. October 2009 M. English (Revised: II.4.D.a-b. autoFAX message, E.c.3. add-ons)
    14. December 2009 M. English (Revised: for ABN printed form)
    15. May 2010 M. English (Revised: Telcor changes, price override)
    16. June 2010 S. White (Revised: included guidelines for billing primary & secondary insurances)

       

Comprehensive Review:

       

    L.I.S. Director:

    Technical Director/CIO:

       

Interim Review:

October 2010 M. English (Revised: screen shot for addition of country to pt address)
November 2010 M. English (Revised: for additional custom fax fields)
December 2010 M. English (Revised: removed reference to client order number field.)
January 2011 M. English (Revised: updated insurance screen image)
November 2011 R. Theobald (Revised: I.; II.4.B.Note; for lab inititated orders functionality)

Guidelines for Billing Primary & Secondary Insurances

If patient has:

Primary

Secondary

Medicare (ex. 480113865A)

Medicaid (Title XIX)
IA Medicaid (ex: 2843583A)
WI EDS Fed Corp (ex: 3912832881)
IL Public Aid (ex: 152764551) 9-digits not SSN
Medicaid is always billed last

Medicare

Blue Cross/Blue Shield (ex: XQM430204974)

Medical Associates HMO

Medicare

MA Community Health Plan (R#)

Medicare

Medicare

JD UHC of River Valley (ex: JD30926202)

All Skilled Nursing Home Patient tests are billed to the nursing home account.
If the patient has one insurance only (ex: BC/BS, Sisco, JD UHC, bill that insurance as Primary.

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