Attachment 3--User Proxy Model Calculator_Updated.pdf

User Proxy Model Calculator for data file licensing (CPT®, ICD-10 and HCPCS) Hospital Setting: Use this page, if your setting is Hospital(s) only or a mix of Hospital(s) and Ambulatory Facilities.

(Method for calculating Users of Clinical EMR, Integrated Ambulatory EMR and Patient Billing System as required by CPT Internal Use License.)

STEP 1:

Identify products For the three product categories, check all which pertain to the product(s) you are licensing. If the product(s) you are licensing is an EMR used exclusively in Ambulatory Facilities, please refer to the next page.

Clinical EMR A product installed in a hospital that includes functions for clinical documentation, order entry, clinical data repository, provider order entry, physician clinical documentation, etc.

Integrated Ambulatory EMR A product installed in an ambulatory setting that includes functions for clinical documentation, order entry, clinical data repository, provider order entry, physician clinical documentation, etc., where the product is integrated with a Clinical EMR.

Patient Billing System A product installed in a hospital that automates institutional and professional billing for inpatient and outpatient services and discharged accounts receivable. It may stand alone or integrate with an EMR.

STEP 2:

Calculate your User subtotal For each of the product categories you selected in Step 1, multiply your organization’s number of Staffed Beds by the factor provided. For those product categories you did not select, enter zero.

STEP 3:

Calculate your Total User count Add all subtotals from Step 2 to arrive at your Total User count and record this as the number of Users for the purpose of your License. TOTAL USERS

*The total facility beds set up and staffed at the end of reporting period x 2 = Staffed Beds* Subtotal x 3 = Staffed Beds* Subtotal x 1 = Staffed Beds* Subtotal

©2017 American Medical Association. All Rights Reserved.

NAME OF INSTITUTION NAME OF REPRESENTATIVE

PRODUCT CATEGORIES

DATENAME OF ELECTRONIC PRODUCT(S)

User Proxy Model Calculator for data file licensing (CPT®, ICD-10 and HCPCS) AMBULATORY SETTING: Use this page, if your setting is exclusively Ambulatory Facilities.

(Method for calculating Users of Ambulatory EMR and Practice Management as required by CPT Internal Use License.)

STEP 1:

Identify product For the two product categories, check which one pertains to the product you are licensing. If the product you are licensing is an EMR used in a Hospital Setting, please refer to previous page.

Ambulatory EMR

A product installed in an ambulatory setting/clinic/ physician office environment that includes functions for clinical documentation, order entry, clinical data repository, provider order entry, physician clinical documentation, etc.

May stand alone or be integrated with a Practice Management product.

Practice Management (stand alone)

A product installed in an ambulatory setting/clinic/ physician office environment that provides the registration, scheduling, and billing functions for a physician office or clinic.

STEP 2:

Calculate your User Count For the product category you selected in Step 1, multiply your organization’s number of Billing Providers (FTE) by the factor provided to arrive at your total User count and record this as the number of Users for the purpose of your License. For the product category you did not select, enter zero. † A health care provider who renders medical services for which a fee is charged

©2017 American Medical Association. All Rights Reserved.

x 4 = Billing

Providers†

(FTE)

Total x 1 =

Billing Providers†

(FTE)

Total

OR

PRODUCT CATEGORIES

NAME OF ELECTRONIC PRODUCT(S) DATE

NAME OF REPRESENTATIVENAME OF INSTITUTION