1 QA Reports & PPS Reimbursement Worksheet Provided by OCS EducationE-learning NetworkWelcome to the OCS e-Learning Network. This training will focus on the OCS QA Reports and Reimbursement Worksheet. Since we cannot cover all of the material in one hour, we will look at how to access and review the on-line reports. We will also talk a little bit about how you can use the information from the reports to assist you in building the roadmap for your agency.My name is __________________, and I will be the facilitator of this session. The session will be approximately ________________in length. You may use the controls within the media player to pause or resume the training session as needed. You may follow along using the PowerPoint presentation, which is available on our website at on the Home Health e-learning site.
2 Connection Series I – User Management and PMBS II – Inbox, Report Folio and Report Builder-How to Access On-line ReportsIII – QA Reports & PPS Reimbursement WorksheetIV – PatientViewV – Advanced Training & Roadmaps Report Interpretation and AnalysisThe Connection Series provides you with the following recorded and/or live sessions for you to participate in to help you in learning how to access OCS Connection, visualize the reports available for your agency and to assist you with understanding your data through report interpretation.
3 Agenda OCS e-Learning Network Understanding data transfer Performance Improvement ProcessQA & PPS Reimbursement Report ReviewProcess for implementationQ&AOur #1 goal in the Education Department at OCS is to help you use and understand the products and reports you have available in enhancing organizational performance improvement efforts. I will highlight OCS resources as well as discuss data transfer and the PI process to provide you some up-front clarification and understanding of these important details before we delve into the QA reports and Reimbursement worksheet. Finally, we will discuss how to help you in implementing these new reports into the process flow of your day to day patient management.For recorded ONLY: If you have any questions after this recording you will find our contact information at the end of this presentation.For LIVE ONLY: At the end of the call there will be time for Q&A
4 Our MissionTo contribute to client success by providing information that improves organizational performance and patient outcomes.At OCS our mission is to contribute to client success by providing information that improves organizational performance and patient outcomes. We consider the entire market our clients, so it is our mission to bring the industry information that will help you manage operations today and be ready to lead through the changes of tomorrow.
5 Data Transfer OCS Smartlink® Automatic transfer of data to OCS Daily or when the OASIS Export file is createdData transferred for QA & PPS Reimbursement WorksheetOASIS dataA very important part of using OCS is an understanding of how the information you receive in the QA and Reimbursement worksheets is gathered. OR how the data gets to OCS. The data transfer occurs daily or when you create the OASIS export file that you export to the state. If you are exporting your OASIS files to the state daily then you will have real-time information to help in managing your patients. We strongly encourage you to do this export daily if at all possible within your organization to assist in the real-time patient management. Realistically, based on the size of your organization this will be of benefit to you even if you export your files weekly.The data transferred is OASIS data.If you need additional information regarding the Data Transfer Method for your agency, please contact OCS Client Services.
6 Performance Improvement Quality Assessment and Performance ImprovementThe QA reports and Reimbursement worksheet that we are reviewing today are an integral part of the Performance Improvement process. With Performance Improvement a part of your every day life in home care the focus needs to be on a cycle of events that ultimately end with improved performance. Performance Improvement has evolved over the last several years from purely a QA function via chart audits and looking for specific areas that were not correct with documentation to today's world of PI or OBQI as engineered with the advent of OASIS. With the PI process we have learned to evaluate our data and make determinations about what needs to be improved upon in our organizations. PI plans and actions are then developed and implemented and over time we then analyze whether or not the actions/interventions of those plans are working. With the addition of the QA reports and the Reimbursement worksheet to OCS reports we see the PI process changing a bit to be inclusive of QA and PI activities together. If we look at the QA circle on the left QA reports and Reimbursement worksheet fits here as tools to analyze in real time for OASIS inconsistencies and management of the PPS reimbursement. When gaps are identified within these reports the information can be captured and evolved into the PI process for improvement organizationally…hence the PI circle on the right.When we begin PI work it is important to first identify areas for improvement with your quarterly reports. Once areas for improvement are identified it then provides direction to your every day work with the daily reports that you have with QA and RW. So bottom line the two processess now work together in the Performance improvement work of your organization. It is important that everyone involved understand the goals you have identified for improvement in order to understand how the daily interaction affects the overall improvement of your data and organizational goals.
7 Tips For Success Utilize the OCS Roadmap Tools Have a well established process flow to utilize OCS reportsKnow who is responsible for data elementsTrack and trend your informationInvolve all staff!To enhance the Performance Improvement Process, some tips for success include:Utilize the OCS Roadmap Tools, which are available on our websiteEstablish a process flow within your organization – who, what, when and how often?Who is responsible for analyzing the dataHow is your agency going to track and trend the information availableGet staff involved, even at the clinician level
8 Tools To Help You! OCS Roadmaps Help you navigate OCS Connection Provide a template for specific “working” projectsDetermine key elements of focusWith all of these things in mind…data transfer and performance improvement for your organization we want to make things as easy and efficient for you. One strategy for PI improvement is the use of the OCS Roadmaps, or guides for your use with OCS Connection. ***IF they have CONNECTION. These roadmaps provide you a pathway thru the OCS reports to help you in setting up your agency specific roadmap for PI.The next slide depicts the roadmap for OCS Connection and where you find the QA reports. As you begin your PI process and dependent on the project you may be working on you will want to create your agency specific roadmap to help you in tracking and trending the appropriate data. If you would like to know more about Roadmaps and their utilization you can access the Roadmap training yada yada….
9 OCS Connection Roadmap (LOGININBOXREPORTFOLIOSREPORT BUILDERAvailabilityQuarterly or YTDCase Mix+PPS Case Mix**PPS Statistics**PPS Utilization**Quality Tracking+Select Clinical Indicator+Joint Commission IndicatorsUtilization Data Summary+PatientView #Executive Summary (Qtrly)Heads Up Display (All)* +P4P Preparedness++Financial Management BenchmarkProcess Management BenchmarkDisease Management*QA Reports # &PPS Reimbursement Worksheet #Executive SummaryBubble GraphOASISKEY* Denotes Risk Adjusted Reports** Denotes PPS Data ONLY# Real-Time Reports+ All Payors that agency has submitted++ Calculations based from CMS P4P Demonstration Project9
10 Process Flow Making the information work for you! Embed in agency process flowWho, what, when, whyWhat are your priorities?What do you want to do with theinformation?Track & Trending your dataInvolve the entire organizationWith all of this info to think about we are now ready to review the QA reports. As we just discussed with the PI process the successful use of the QA reports is embedding their use in your day to day work flow.
12 Log intoSo let’s get started…first you need to log into click on Client Login.
13 Access OCS ConnectionYou can select your login for Connection from the drop down box, or over on the right hand side in the green box.
14 Adding A User (cont.)Login using your User name and password. Your agency may have received a Medicare Provider log in. The first thing you need to do is create your own user’s specific account. That way you and you alone can get PHI. Here at OCS the security of your data is one of our top priorities. In conjunction with recent updates in our security measures, we are changing the way you will be logging into the Connection site to view your reports. The generic “numbered” accounts will be going away completely very soon and will be replaced with a personalized login just for you. This change will allow you to better restrict and monitor access to the Connection reports, and is important because some of the new reports will contain sensitive PHI data that needs to be monitored closely. Please call ASAP so we can give you your new login information.Now let’s walk through the steps.
15 Access To QA ReportsThere are three main tabs for OCS-Connection: Inbox, Report Folios and Report Builder.The Report Folios contains the Quality Assurance Reports, which include the PPS Reimbursement Worksheet
16 Quality Assurance Folio Provides “real-time” patient-level informationData verificationsPatient outcome statusOrganized and graphical formatAvailable Reports:Patient-level Verification ReportAdverse Events ReportTransfer ReportRecertification ReportDischarge ReportPPS Reimbursement WorksheetEmpowers managers with powerful real-time patient-level information, including data verifications and status change in an organized and graphical formatAutomated and available “real-time”- Patient status alertsInter and Intra assessmentClinician analysis and reporting (clinician information may not be available for your agency, contact OCS Client Services for additional information)
17 QA Folio - Patient-Level Verification Quality Assurance Patient-Level Verification Report:Provides detailed patient-level errors and warnings for OASIS assessmentsOver 1,200 edits and verificationsIncludes clinical warningsEnsures data accuracy, improves care plans and reduces rejected claimsIncludes clinician and team namesDrills-down into patient level factors that contributed to declineAnalysis and reporting by clinician and patient
18 QA Folio – Adverse Events Quality Assurance Adverse Events Report:Highlights declines and/or adverse event occurrenceAnalysis and reporting by clinician and patient
19 QA Folio – Transfer Quality Assurance Transfer Report: Identifies Emergent Care and Acute Care Hospitalization events at the patient level as reasons for HospitalizationAnalysis and reporting by clinician and patient
20 QA Folio – Recertification Quality Assurance Recertification Report:Highlights declines/improvement/stabilization at a patient-level for key quality and performance measures the time of recertificationProvides an inter-assessment view of clinician and patient level data
21 QA Folio – Discharge Quality Assurance Discharge Report: Identifies on a patient and clinician level, declines/improvement/stabilization at a patient level for each of key quality measures at the time of dischargeIdentifies patients discharged to emergent care, by type
22 PPS Reimbursement Worksheet Real-time episodic financial insight showing what reimbursement you can expect and whyHelps agencies understand which diagnoses were used behind the case weight numbers.Helps better understand patient assessments as related to PPSHelps with audit processReal-time identification of the primary/ secondary diagnoses, domain scores, and NRS severity score contributing to the overall case weight and reimbursement per assessment.The OCS Reimbursement Worksheet is a patient-level report that provides detailed PPS information at the start of each episode of care. The information in this report will help you better understand the 2008 PPS c alculations and drivers of reimbursement. This understanding willenable you to efficiently focus your time and attention on:Planning for potential changes in an episode’s reimbursement based on episode timing and therapyIdentifying and correcting data completeness and accuracy problems that may impact reimbursementCreating plans of care and reviewing those plans for appropriatenessReviewing diagnosis coding practicesTraining staff on how the new PPS rules and logic work using real examples**A Reimbursement Worksheet is produced for each traditional Medic are (M = yes) SOC, ROC and Recertification assessment. The assessment information in each report is organized into six sections.Agency and Patient Demographics: Provides agency, clinician and patient identifiers, as well as assessment type and dates.PPS Summary: Provides key PPS information at the start of the episode, or the request for anticipated payment (RAP). Use this section to understand things such as the anticipated payment, episode category, expected therapy visits, HHRG/HIPPS Code assignment andcase weight and NRS amount.Impact of Episode Timing and Therapy Visits: Displays anticipated reimbursement scenarios based upon all possible combinations of episode timing and number of therapy visits.Clinical Domain: Displays the answers to each of the OASIS items that contribute to the Clinic al Domain points and the C-sc ore in the HHRG, as well as the clinic al points earned by each item. This includes the principal, secondary and case mix diagnoses submitted for the assessment and the total points associated with these diagnoses.Functional Domain: Displays the answers and points earned for each of the six M0-items assigned to the PPS Functional Domain and F-score in the HHRG. Summarizes the total points assigned to the assessment for the Functional Domain.Non-Routine Supplies (NRS) Add-On: Displays the number of NRS points assigned to each of the ten M0-items included in calculating the NRS add-on reimbursement. Summarizes the total points assigned to the assessment for the NRS add-on.
24 Process Flow Chart Suggested Process Flow Daily Review Who/When? Weekly ReviewHere is a suggested Process Flow for your Agency with QA ReportsDaily – Patient Level VerificationPPS Reimbursement WorksheetTransfer OutcomesDischarge OutcomesRecertification OutcomesWeekly Review:Adverse EventsWho/When?Who/When?
25 QA ReportsStep OneAre any of the QA reports a priority for your review?How often do you want to review?Who will look at reports?Example: QA Adverse EventDo you want to review daily/weekly?Example: Pt. Level Verification ReportReview warnings daily?
26 Summary Use your roadmaps! Prioritize your work! Establish a good solid process flow for OCS reports!Utilize the OCS e-Learning Forum on eDGE for further assistance!
27 Resources OCS Website OCS e-Learning Network On-line trainings OCS e-Learning NetworkAnytime! Anywhere!Self-PacedOn-line trainingsRecordedWebEx presentationsAccess Training CalendarGroup WebEx PresentationsOCS eDGE (electronic Discussion Group & Education)Education of our clients is a key focus for OCS towards your success with the products and services you have with us to allow you to use them in the best manner that fits for your organization. In order to facilitate your learning we have the OCS e-Learning Network which is a Portal to the trainings, educational offerings, resource guides and roadmaps that we now have available for you. Here at OCS we wanted to encourage an environment of open communication between OCS staffers and clients. On the eDGE you will find out about all the newest happenings here at OCS, as well as have the opportunity to ask questions and get support. We want to hear what you have to say! Please visit our website at once you have completed this recording and find those areas of interest for you.
28 Additional Resources The OCS-PPS Reimbursement Worksheet RIG OCS Connection Report Description GuideOCS Report Builder Data GuideOCS Client ServicesCall TECH (8324)Live ChatThe OCS-Website:Additional training courses and educational seminarsImportant informationSoftware updatesInclude resource info for each application listed in presentation
29 For More Information OCS Education Sue Blockberger-Miller RN BSN OCS Director of EducationLeslie Knudsen-Wells, RN BSPerformance Improvement Educator