Regulatory Compliance

Regulatory changes (HIPAA, 5010 and ICD-10, MS DRGs, RACs, NPI, P4P, etc.) continue to challenge the IT infrastructures currently in place at most healthcare provider organizations. Legacy patient financial systems just can’t keep up.

The Medical Necessity checking function within InsightCS® is another integrated component which enforces business rules up-front, at the earliest contact with
the patient, as opposed to being addressed downstream.

If the check fails, an ABN form can be printed for the patient to sign and scanned into the patient’s permanent record immediately. Any subsequent charge activity, while recorded, is specifically excluded from the claim.

The system features an embedded the Medicare Secondary Payer (MSP) form within Patient Access with intelligent prompts when scheduling or registering Medicare patients. Our security model restricts access by utilizing role based criteria, for application and field level security to protected health information.

The system records every transaction in a single relational database for ease of auditing purposes. Decision support tools are available to assist in readiness exercises for the Recovery Audit Contractor (RAC) program.