Instinct and Cornerstone work together to simplify the check in/out process as well as easily capture and send missed charges, ensuring the Instinct Invoice and Cornerstone PVL are synced.
Table of Contents
✔ Checking Patients In/Out
The check-in/out process for patients in Instinct is driven by Cornerstone.
Check-In Through Cornerstone
Once a patient has been checked in to Cornerstone, they will automatically appear on the Instinct OP Board within 1-4 minutes. The grey arrow under the ‘In/Out’ column on the Status Board lets you know they were checked in via Cornerstone as opposed to a manual check in via Instinct (manual check ins will not have the sync icon). If there is a Summary/Reason for visit or Doctor selected in Cornerstone while checking the patient in, these will transfer to Instinct.
To maintain a consistent workflow, it is ideal for the front desk team to complete as much information on the Instinct Status Board as they can after checking a patient into Cornerstone. This helps the medical team know who is checked in, why they are here, which doctor they are assigned to, any specific alerts, and more!
Check-Out Through Cornerstone
If a patient was checked in via Cornerstone, the only way to remove them from Instinct is the check them out of Cornerstone.
Force Check Out
This feature can help to “Force Check Out” a patient who is no longer checked in to Cornerstone, but is still appearing on Instinct due to a lag in your internet connection. Please note that this should only be used if the patient has been checked out of Cornerstone completely but is not being removed from Instinct. If you click ‘Force Check Out’ for a patient who is still checked in to Cornerstone, they will reappear in Instinct after a few minutes because Instinct is still identifying them as being checked in.
To Force Check Out a patient, click the 3-dot menu next to the patient’s name on the Status Board and select “Force Check Out”.
If a patient is being force checked out and has a similar name as another patient, Instinct will suggest merging the patient records. Please ensure that the suggested patient is indeed a duplicate before merging, as merges cannot be undone!
💸 Invoice
The Cornerstone PVL and Instinct Invoice will sync information to make sure charges are being properly audited.
There are 3 different icons that can be found on the Instinct Invoice:
- Download Icon = Items entered directly on the Cornerstone PVL that Instinct downloaded here to keep predicted billing accurate
- Sync Icon = Items completed in Instinct and already on the Cornerstone PVL
- Orange Flag = Missed charges not yet included on the Cornerstone PVL
Missed Charges – Instinct will automatically “flag” items with an orange triangle that are missing or not yet entered on the Cornerstone PVL. To hide any synced/downloaded charges and only show missed charges, toggle the “Only Show Missed Charges” button.
Missed Charges can be handled a few ways:
- Void it if it was incorrect (via 3-dot menu to the left of the invoice line item)
- Add this item to the Cornerstone PVL which will cause it to “sync”
If you enter a flagged item on the Cornerstone PVL with the same code and quantity, within 30 seconds, the flag will change to a sync icon.
“Send Missed Charges” button at the bottom of the invoice will send all missed charges from Instinct to Cornerstone. This will save time so you do not have to manually enter items line by line.
You also have the option to enter charges directly into Cornerstone that may not be in Instinct (such as a TPLO plate). That item will be brought into the Instinct invoice with a download icon as shown below.
Voiding items on the Instinct Invoice
Synced items on the Instinct Invoice indicate a billable treatment was completed in Instinct and also added to the Cornerstone PVL (so they are in-sync with each other). If a synced item on the Instinct invoice is voided, it will be removed from the Instinct Invoice but does not automatically remove it from the Cornerstone PVL. Since this invoice item is still on the PVL but not on the Instinct Invoice (because it has been voided), it will download to the Instinct Invoice and be displayed with the download icon. To remove this downloaded item from the Instinct Invoice, simply remove it from the PVL.
Only Show Missed Charges
Before checking out the patient, resolve any missed charges with your medical team. If no missed charges exist, you will see a Piggy Bank and you can proceed to check out the patient through Cornerstone.
👩⚕️ Workflow at Discharge
- Confirm there are no ‘Missed Charges’ and address if so (the piggy bank will indicate all charges have been sent) 🐖
- Apply the ‘Ready To Go’ icon (this can be used to show no further charges are to be sent/the invoice audit is complete)
- Convert the PVL to an invoice and continue discharge process
- Check the patient out of Cornerstone to close Instinct visit
🔍 Troubleshooting and ProTips
- Make sure the Product in Instinct exists in Cornerstone with the same PIMS ID, otherwise, sending missed charges may fail.
- Make sure you enter the code and quantity exactly as they appear on Instinct.
- Do not change the quantity of any synced items on Cornerstone PVL. If changed, Instinct will update the item as a missed charge on the Instinct Invoice (and potentially send to the PVL again).
- If using an Omnicell or Cubex drug cabinet, please make sure the quantity matches in Instinct. For example, if the Instinct order says 0.62mls and you remove it from a drug cart as 0.6mls, the charges will not sync in Instinct.
- Make sure the Dr. initials exist in Cornerstone and match in Instinct (initials are also case-sensitive). Also, doctor’s initials shouldn’t include Emojis because Cornerstone won’t recognize it.
- IH Laboratory Orders:
- Complete the treatment in Instinct indicating you have the sample for the test (the charge for this test will then be on the Instinct Invoice as a missed charge).
- Next, initiate the lab work on your machine which will add a charge to the Cornerstone PVL.
- The PIMS ID and quantity should match, resulting in the missed charge on Instinct to sync with the charge added to the Cornerstone PVL.
- Patients are no longer checking in/out and invoice items are not sending/syncing:
- This is most likely because IDEXX Sync (the program that connects Cornerstone to Instinct) is not working at your practice. This means that check in/out cannot occur automatically and invoice flags will not be accurate. If you suspect this, please contact your practice administrator to confirm (and fix). You can ask them to “restart the Datapoint Services” on your server (not the server itself, just restart the Datapoint Services). If that doesn’t work they may need to reach out to IDEXX to get it working. Their standard support hours are 7:00 AM – 4:30 PM Central Time on Monday through Friday. Email: DataPointSupport@idexx.com // Phone: 888-557-6521.
- If Cornerstone is down:
- If Cornerstone is not working, you can always manually check in a patient in Instinct to get a treatment sheet built. Once Cornerstone is back online, the check in/out and invoicing will sync up.
- If a new patient arrives when Cornerstone is down you can create a new patient in Instinct with a temporary patient/account ID. When Cornerstone is back online you would then check them in as you normally would. After doing this, you would have two of the same patients in Instinct: 1 with the temporary ID created in Instinct and 1 with the actual ID checked in via Cornerstone. To resolve this, you’d merge these two patients together and reopen the treatment sheet from the temporary ID so you don’t have to create it again.