Rules-based systems, such as Huron's RulePro^®, identify activities that should be performed under designated circumstances.

In simple terms, a rules-based system identifies activities that should be performed, or rules that should be followed, under designated circumstances. Huron's RulePro^® software--a contemporary rules-based system for healthcare organizations--identifies the certification and/or compliance activities (rules) that must be completed for patient encounters that have particular characteristics.

For example, a patient encounter where the:
• Primary insurer = Blue Cross
• Group number = 65309
• Planned procedure = Cholecystectomy
may require certification before the procedure is performed.

As another example, a patient encounter where the:
• Primary insurer = Medicare
• Diagnoses = No indication of iron deficiency
• Primary procedure = Iron binding capacity
may need to have a notice printed and signed by the patient before the test is performed.

Healthcare organizations must comply with a large and growing number of insurance, managed care, and government regulatory requirements that can be identified and controlled through a rules-based system.

In addition to identifying activities that must be performed, a rules-based system can also help assure that the rules are met in a timely manner. For example, RulePro^® provides an "Unmet Rules Report" that details patient encounters for which certification has not yet been obtained.

Huron Systems, Inc.
3300 Washtenaw Avenue, Suite 280
Ann Arbor, Michigan 48104
734.973.7300

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