Closing the Loop: From Data Entry to Payment ... · Closing the Loop: From Data Entry to Payment...
Transcript of Closing the Loop: From Data Entry to Payment ... · Closing the Loop: From Data Entry to Payment...
Closing the Loop: From Data Entry to
Payment Reconciliation
Topics in Contracting Web-Conference
October 21, 2015
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Agenda
• Introductions
• Data Cycle Review
• Data Entry
• Data Transfer to Public Health Solutions
– Payability Guide
• Data Recognition
• Automatic Data Flagging
• Manual Flagging of Services Based on Site Visit Findings
• Feedback to Service Providers
• Handling Data Discrepancies
• Payment Processing
• Closeout
• Best Practices
• Resources
• Q&A
Data Cycle
Data Entry Data
Transfer to PHS
Data Recognition
Automatic Flagging
Feedback to Service
Providers
Payment
Manual Data
Flagging
Data Entry
Data Transfer to
PHS
Data Recognition
Automatic Flagging
Feedback to Service
Providers
Payment
Manual Data
Flagging
Data Entry
• Contractors in all performance-based service categories use eSHARE (web-based data system developed and operated by New York City Department of Health and Mental Hygiene-NYCDOHMH) to enter data.
• Services reported must be entered by COB on the 15th of the following month (or the next business day, if a weekend or holiday).
Example: September’s services need to be entered into eSHARE no later than October 15th.
Exceptions during Closeout
• NYCDOHMH’s policy on data entry: Contractors should report all services provided under a contract even if the reported services are above projected targets for the contract period and/or even if the reported services are not payable because they exceed client-level limitations.
Data Entry Data
Transfer to PHS
Data Recognition
Automatic Flagging
Feedback to Service
Providers
Payment
Manual Data
Flagging
Data Transfer to Public Health Solutions
• Data are transferred monthly to PHS in an extract file
(meaning there is no ‘submit data’ process per se).
• Service data is uploaded to PHS’ payment system, where it is
automatically quality-reviewed for payability standards.
Payability Guide
• Developed by Public Health Solutions (PHS) and NYCDOHMH to provide
guidance on submitting data for all performance-based contracts (Ryan White
and HIV Prevention)
• Emphasizes requirements for payment, certain requirements for contract
compliance, and information on other data reporting and evaluation requirements. • Updated generally quarterly (PHS sends a Contractor Newsflash when the Guide
is updated)
• Available on the PHS/CAMS website:
www.healthsolutions.org/hivcare/documents/requirementsguide.pdf
healthsolutions.org/hivcare
Forms, Resources &
Procedures
Manuals and Guides
Data Entry
Data Transfer to
PHS
Data Recognition
Automatic Flagging
Feedback to Service
Providers
Payment
Manual Data
Flagging
Data Recognition
• First stage of automatic data processing: records from eSHARE are assessed against minimum data standards.
– DOHMH distributes mapping documents that articulate which eSHARE record types correspond to which PHS payment points.
– The Payability Guide specifies certain ‘Payment Processing Rules’ which are prerequisites for recognition. (Example: ‘A confirmatory test that does not have an earlier HIV antibody test entered in eSHARE under the same Form ID will not be processed for payment.’)
• Data processing at this point also creates certain payment points that are based on sets of eSHARE records. (Examples: Care Coordination PMPD; TCC client graduation; Condom monthly distribution fee.)
• Those records which pass, and those which are created, are given a Service Type Code, appear on the MIR, and are counted in monthly payment vouchers.
Data Entry
Data Transfer to
PHS
Data Recognition
Automatic Data
Flagging
Feedback to Service
Providers
Payment
Manual Data
Flagging
Automatic Data Flagging
Recognition of Services Automatically by Software Routines
• Duplicate items (services) (or possible duplicates) are marked, as are items requiring
data corrections or violate programmatic rules. For each service category, the kinds of
issues reviewed automatically are different.
Note that the automatic review identifies both definite duplicates and possible duplicates.
• Definite Duplicate - More than one item of the same PHS service type for the same
client on the same day, and that service type is such that no programmatic or clinical
scenario could make it valid to provide more than one service. (Permanent Housing
Placement would be an example.)
• Possible Duplicate - More than one item of the same PHS service type for the same
client on the same day, but it is programmatically possible that the second service is a
valid separate service. (For example, some individual counseling service types could
occur more than once on the same day.) Possible duplicates which are really separate
services must be “attested” during closeout in order to avoid recoupment.
Data Entry
Data Transfer to
PHS
Data Recognition
Automatic Flagging
Feedback to Service
Providers
Payment
Manual Data
Flagging
Manual Data Flagging of Services Based on Site Visit Findings
Prior to Site Visit Contract Managers/Contract Coordinators select records
from a recent MIR for review
During Site Visit PHS staff note any issues (recoupable or non-recoupable
discovered with service tracking & documentation)
During Exit Interview PHS staff review any necessary recoupment and/or
corrective actions
After Site Visit
PHS staff enter issues (if applicable) into the PHS payment
system, attached to each specific item’s record.
PHS sends a Site Visit Report including a recoupment
summary (if applicable) detailing the number of units and
dollar value to be recouped, which matches services in the
Summary of Issues Noted section in the next MIR.
Correction/Recoupment/Validation Reasons Resulting From Site Visit Findings
Data Entry
Data Transfer to
PHS
Data Recognition
Automatic Flagging
Feedback to Service
Providers
Payment
Manual Data
Flagging
Master Itemization Report (MIR)
• Produced from the monthly eSHARE extract
• Provides an itemized listing, as well as a summary, of services recognized by PHS’
payment system (those which meet minimum threshold for correct data) .
• Compares actual services to projected services.
• Presents information about services recognized by the payment system that have
been found to be problematic.
• Sent monthly to Program Managers with a separate notification to the Senior
Administrator and Fiscal Manager.
MIR Review
Section I: DATA INCLUDED contains information about when the MIR was run and
the most recent data extract file that affected the service count.
MIR
Section I-A: PHS INFORMATION SYSTEM ACCOUNTING DISCREPANCIES
UNDER INVESTIGATION
Notes any discrepancies that may arise in the aggregation of item-level data into PHS
payment system. This section is for informational purposes only and is usually blank.
Any discrepancies are investigated and corrected by PHS..
MIR
Section II: YEAR-TO-DATE TOTALS BY SERVICE shows, for each service type,
the year-to-date total count of services, and their value, recognized by PHS’
payment system, and compares them to year-to-date projections.
MIR
Section III: Summary of Issues Noted (SIN) Report
• Summarizes service records that have been recognized for payment but have
subsequently been marked (automatically or as a result of Site Visit findings).
MIR
Section IV: MONTH TOTALS FOR SERVICES SUBMITTED AND RECOGNIZED
Displays monthly total counts of services and their value recognized by the PHS’
payment system, and compares them to monthly projections. Some of these services
may have already been paid, while others may be in the queue awaiting payment.
Section V: ITEMS RECOGNIZED. Shows item-level data. The client ID, date of service,
service type & units of service are included. Items identified as problematic are shaded in
color & the nature of the problem is noted.
MIR
MIR
Section VI: GROUP ATTENDEES RECOGNIZED shows the Client ID numbers
and Collateral ID numbers associated with each Group Event ID..
Care Coordination
Client Trajectories Monetary Value Report
Lists each client in order of client ID and shows the trajectory periods in
different Care Coordination tracks from the start of the current contract
period.
Care Coordination
Income Predictor Tool
Care coordination contractors are paid for Per-Member-Per-Day enrollment
and for meeting minimum thresholds of service. Income Predictor Tools
helps agencies predict monthly and annual program income .
Handling Data Discrepancies
In instances where you believe that items (services) submitted for payment have not
been recognized by PHS, please follow these steps:
1. Find specific examples that DO NOT appear on the MIR.
2. Verify that the examples have been properly entered in eSHARE. Please consult
the Payability Guide sections on Requirements and Special Issues for that service
type, with special attention to “Payment Processing” rules; these rules articulate the
minimum threshold of data quality without which an item will not be processed for
payment.
3. If the examples appear to be properly entered, send them with the client ID number,
date, and service type via email to your PHS Contract Manager.
Handling Data Discrepancies
Note: eSHARE data is the basis of payment; however, payment logic resides in Public
Health Solutions’ information systems, not in eSHARE.
Please contact your PHS Contract Manager (not NYCDOHMH) about apparent payment
discrepancies. If necessary, PHS staff will reroute questions to NYCDOHMH eSHARE staff.
Data Entry
Data Transfer to
PHS
PHS Data Recognition
Automatic Flagging
Feedback to Service
Providers
Payment
Manual Data
Flagging
Once the PHS payment system receives data:
– Your PHS Contract Manager reviews the data and contract status.
– If all prerequisites are present, payment is approved, entered into the PHS payment system and forwarded to PHS’ fiscal department
Factors that can prevent a payment from being approved include, among others:
Non-executed contract or renewal Lapsed insurance Non-submission of required monthly reports Audit report
PHS aims to pay contractors within 30 days of receipt of data and all required reports
Note: PHS processes payment for services that meet a basic threshold of data correctness. However, services included in payment may subsequently be assessed as non-payable, as previously described
Payment Processing
Closeout
Closeout
• Occurs towards the end of the contract year to reconcile services reported and
determine a final payment.
• Final opportunity for contractors to reconcile and submit additional services or correct
services reported.
• Two data entry deadlines – around the 7th of the month and around the 20th of the
month (as opposed to the 15th).
• Additional MIR is sent between the two dates to review data and make corrections
• Closeout Reports:
– Initial closeout MIR
– Potentially Payable Services (PPS) Report
– Attestables Report
– Final MIR
Potentially Payable Services Report (PPS)
• Service records that initially fail to meet requirements needed for payment (not
recognized and not on MIR) are included in the end-of-year Potentially Payable
Services (PPS) report.
• Generated before closeout & lists all services that could have been recognized for
payment.
• Contractors receive this report a month or so before closeout and are given time to
make adjustments in eSHARE which might render a service payable.
Example of PPS Report
Attestables Report
• Possible duplicate reported services (and other issues)
• Require contractor feedback
Best Practices
• When your organization receives the monthly MIR, Program and Fiscal staff should meet and discuss each contract’s spending (drawdown), performance and data quality.
• Be in frequent contact with your PHS Contract Manager for contract-related concerns, and your NYCDOHMH Project Officer for technical assistance about the service model.
• Understand your service category’s payment rules! Review the Payability Guide if you are unsure.
– PHS notifies you with a Contractor Newsflash communication when updates are made to the Payability Guide.
Best Practices
Resources
Resource Contacts
Problem Resource
Alleged discrepancies between client-
level data from eSHARE and MIR or
Care Coordination Trajectory Report
PHS Manager of Data Systems:
Nagla Bayoumi (646) 619-6628 or
Need for an MIR outside of the
regularly scheduled mailing from PHS Your PHS Contract Manager
General MIR questions Your PHS Contract Manager
eSHARE questions/problems eSHARE Service Desk: 212-766-4357 (Monday-Friday 8am-6pm, Saturday 10am-2pm)
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