Post on 23-Dec-2015
CareWatch: One Stop ShopCareWatch: One Stop Shop
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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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Petersen Health Care- Who Are We?Petersen Health Care- Who Are We?
•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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Petersen Health Care- Who Are We?Petersen Health Care- Who Are We?
•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
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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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CareWatch Reimbursement Specialist: CareWatch Reimbursement Specialist: One Stop ShopOne Stop Shop
•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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CareWatch Reimbursement Specialist: CareWatch Reimbursement Specialist: One Stop ShopOne Stop Shop
•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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CareWatch Reimbursement Specialist: CareWatch Reimbursement Specialist: One Stop ShopOne Stop Shop
•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!