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This help topic describes functionality that may not be part of the feature set in use at your company.

 

View, Edit or Add Compliance Rule

Compliance rules are a way to evaluate patients' compliance status based on payer requirements.  A Payer is an insurance company or a benefits manager responsible for reimbursement.

The Add Compliance Rule feature allows Administrators to add compliance rules to the system regarding payer reimbursements.

The Edit Rule feature allows Administrators to edit Compliance Rules, Rule Sets, and Reminder Sets. Rule sets are a way to manage health, usage and equipment rules for different patient sets.

Warning: Care Orchestrator is not a substitute for direct patient monitoring.

Note: Users can only add new Compliance rules to the system. Existing Health and Usage rules can be updated in the system, but new rules cannot be added for these rule types.

Note:  Health and Usage rules can be enabled and disabled at the organization level.  Rules should be customized to meet the needs of your location.

Note: There is no direct association between a Payer and Compliance Rule. For example, a patient can have a Compliance Rule selected, but no Payer assigned.

Note: Health, Usage, and Compliance Rules do not apply to EverFlo  oxygen data.

See Compliance Determination for more information about compliance.

Compliance rules consist of configurable When and Then statements. For example:

When:

• A patient's device usage meets or exceeds 4 hours per day (Usage hours per day)
• on 70 percent (Usage percentage threshold)
• of 30 consecutive days (Number of consecutive days)
• between day 1 (Compliance period start day)
• from First therapy date (Start of compliance period)
• and day 90 (Compliance period end day)

Then:

• Mark patient compliant. (Automatically selected)
• Add a task to view the compliance report with a priority of Medium (Optional)
• Repeat compliance evaluation every 225 days. (Optional)
• Auto-dismiss all Patient Not Compliant tasks, when patient becomes compliant. (Optional)

The start of compliance period can be First therapy date, Date of first device assignment or Setup date.

• First therapy date is the earliest day of therapy as determined by data download (such as via SD Card or modem download)
• Date of first device assignment is the earliest device assignment date (issued on date) of any devices assigned to a patient.
• Setup date is the assigned Setup Date for the patient.

Note:  When the assigned compliance rule has a start date of Setup Date and the setup date is modified the compliance status will be reset and recalculated based on the new setup date.

If the Repeat compliance evaluation every x days option is selected, Care Orchestrator will track a patient’s Ongoing compliance. This optional feature allows for enhanced compliance evaluation. The evaluation periodicity can be changed by administrators at any time.

The ongoing compliance evaluation window begins after the patient first achieves compliance (Initial Compliance Date). During this time, the Ongoing Compliance Date will be “Pending.” The Ongoing Compliance Date will be populated when the patient achieves compliance during the next repeat compliance evaluation. These dates are visible in Patients report and the Patient details.

View Compliance Rules

To view compliance rules:

1. Click Administration, Settings and Rules and Reminders.
   Rules and Reminders display.

2. Click Compliance to display compliance rules.
   Available Compliance Rules display.

Edit Compliance Rule

To edit a compliance rule:

1. Click the Edit button located near the rule.

   The Compliance Rule displays in edit mode.

2. Update the When and Then options as needed.

3. Click the Save button to save the edited rule in the system.

Add Compliance Rule

To add a compliance rule:

1. Click the Duplicate button located at the right of a Compliance rule.  
   
   Note: Choosing a rule that is closest to your desired rule will require you to make fewer changes. Trilogy Compliance Rules apply to Trilogy Evo devices.
   
   New Compliance rule is added that is a copy of the selected rule.

2. Edit the rule as described above. 
   
   Note: Make sure to name the Compliance rule so that all users can identify it in the system.

 For each Compliance Rule, a Patient Not Compliant Rule can also be added. See Add Patient Not Compliant Rule.

Edit Rule Sets

To edit a rule or reminder set, see Edit Rule Sets,

 

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