CareWatch: One Stop Shop. 22 | 8/9/2015 | © eHealth Data Solutions 2014 User Group Petersen Health...

CareWatch: One Stop ShopCareWatch: One Stop Shop

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2014 User Group2014 User Group

Petersen Health Care- Who Are We?Petersen Health Care- Who Are We?

•71 long term care facilities› Four Missouri homes› Largest long term care provider in Illinois

• 67 homes

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•Four Regions› Licensed nursing home administrator as

regional director› 1-2 regional nurses› Dietician› Regional marketing coordinator› Nurse liaison in hospitals

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•Three Reimbursement Specialists› Supervise 92 MDS coordinators› Average 3,000 Medicare MDSs per quarter for

31,000 Medicare days› Average 2,600 MDSs submitted for Illinois

Medicaid RUGs per quarter

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Two Most Important Reimbursement Two Most Important Reimbursement Functions of Reimbursement SpecialistsFunctions of Reimbursement Specialists

•Education› MDS coordinators› Administrators & DONs› CNA ADL documentation

•Quality Improvement› Review of Medicare MDS/RUG› Medicaid MDS timeliness› Documentation reviews

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MDS Coordinator EducationMDS Coordinator Education

•Includes Answers on Demand and CareWatch

•MDS, CAA & Care Plan & Medicare › Side by side training with reimbursement

nurse› Side by side training with a mentor MDSC › Three day classroom training

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CareWatch Administrator Use:CareWatch Administrator Use:One Stop ShopOne Stop Shop

•Administrator Education› Timeliness Checks

• MDS 3.0 Assessments Due › Transmission Checks

• MDS Transmission Enterprise Report • MDS Transmission Watch

› Default Rates• Reimbursement Analysis- RUG Potential

› 5 Star Ratings & QI/QMs• Transmission Watch- CMS Reports

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CareWatch DON Use: CareWatch DON Use: One Stop ShopOne Stop Shop

•DON Education› Late Loss ADL Checks

• ADL Watch- review› Restorative Checks

• Restorative Watch- preview & review› Survey Prep

• 672/802• Survey Watch- CMS Survey Report –enter state/zip• 3.0 Details

› Hospital Readmissions- Readmission Watch

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CareWatch Reimbursement Specialist: CareWatch Reimbursement Specialist: One Stop ShopOne Stop Shop

•Medicare QA Mid-Month & End of Month › Census compared to MDS insure a RUG› All therapy RUGs are checked against therapy

program › Billing is done out of the home office

• RUGs are reviewed by the billing specialists in UBWatch prior to billing• Transmission is verified by billing specialists in

Transmission Watch prior to billing

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CareWatch Reimbursement Specialist: CareWatch Reimbursement Specialist: One Stop ShopOne Stop Shop•RUG Reimbursement Analysis

› MDS 3 Assessments Due- review for past due & set dates for next month--assess these now to place on restorative programs so tracking is in place before look back starts

› ADL Watch- review as a team to be sure residents are coded accurately & to identify those who are declining

› Restorative Watch- to be sure restoratives are being captured & to identify those who should be in programs

› MDS 3.0 Details- to choose any MDS section to view accuracy & frequency of reimbursed item

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CareWatch Reimbursement Specialist: CareWatch Reimbursement Specialist: One Stop ShopOne Stop Shop•RUG Reimbursement Analysis

› Reimbursement Analysis-RUG Potential 66- Medicare RUG analyzed and improved by clicking on the “Rule Count” and making appropriate changes in the resident’s care

› Reimbursement Analysis-RUG Potential 48- Medicaid RUG analyzed and improved by clicking on the “Rule Count” and making appropriate changes in the resident’s care within the Medicaid rules for reimbursement

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CareWatch Reimbursement Specialist: CareWatch Reimbursement Specialist: One Stop ShopOne Stop Shop•Illinois Medicaid Review-average over

2,500 MDS per quarter› First quarter “live” there were 21 defaults =

0.84%› Almost $53,000 cost for the quarter

•½ MDSs not successfully transmitted & ½ resident not D/C from HFS system or not matched in the HFS system

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•RUG reimbursement analysis adjustments•BOM required to compare:› Prepayment report against census each

month •MDSC required to review:› Suspended assessments› HFS provided roster report & insure validation

report was present for an MDS in the quarter for each person on roster

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CareWatch Reimbursement Specialist: CareWatch Reimbursement Specialist: One Stop ShopOne Stop Shop•Second Live Quarter-average 2,600› 17 defaults = 0.65%› Still a $50,000 cost for the quarter

•12 MDSs not successfully transmitted› Several not transmitted successfully and

several rejected and not re-transmitted

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•RUG reimbursement analysis adjustments•Reimbursement specialist list to admin & MDSC:

› Any MDSs left in Suspended Assessments› Transmission Enterprise Report- review for late

transmissions & rejected MDSs that have not been replaced

•Both MDSC & reimbursement specialist review:› HFS provided roster report & go into- Resident

Information- History- to insure “Transmission Complete” during quarter

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Illinois Medicaid RUG AnalysisIllinois Medicaid RUG Analysis

• Reporting of analysis of RUGs is helpful in comparing among other facilities and comparing past performance to present performance

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•We are waiting to see the positive impact of the changes we have implemented using the Enterprise Report and the “double” check using the Resident History

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eHealth Data Solutions:eHealth Data Solutions:PHC’s One Stop ShopPHC’s One Stop Shop

• What we like best about eHDS: Adaptability!• We have asked to see on the Transmission Watch page

the actual type of MDS that has been transmitted- please give eHDS your positive feedback if this would be helpful to you too!

• Included for you from this presentation:› Navigating the CW Website› Medicaid Facility Analysis Template› Medicaid RUG 48 Calculator

ANY QUESTIONS?ANY QUESTIONS?

THANK YOU FOR YOUR TIME & ATTENTION!THANK YOU FOR YOUR TIME & ATTENTION!

CareWatch: One Stop Shop. 22 | 8/9/2015 | © eHealth Data Solutions 2014 User Group Petersen Health...

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Transcript of CareWatch: One Stop Shop. 22 | 8/9/2015 | © eHealth Data Solutions 2014 User Group Petersen Health...