Presentation is loading. Please wait.

Presentation is loading. Please wait.

QA Reports & PPS Reimbursement Worksheet

Similar presentations

Presentation on theme: "QA Reports & PPS Reimbursement Worksheet"— Presentation transcript:

1 QA Reports & PPS Reimbursement Worksheet
Provided by OCS Education E-learning Network Welcome 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 Reports III – QA Reports & PPS Reimbursement Worksheet IV – PatientView V – Advanced Training & Roadmaps Report Interpretation and Analysis The 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 Process QA & PPS Reimbursement Report Review Process for implementation Q&A Our #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 Mission To 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 created Data transferred for QA & PPS Reimbursement Worksheet OASIS data A 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 Improvement The 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 reports Know who is responsible for data elements Track and trend your information Involve all staff! To enhance the Performance Improvement Process, some tips for success include: Utilize the OCS Roadmap Tools, which are available on our website Establish a process flow within your organization – who, what, when and how often? Who is responsible for analyzing the data How is your agency going to track and trend the information available Get 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” projects Determine key elements of focus With 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
( LOGIN INBOX REPORT FOLIOS REPORT BUILDER Availability Quarterly or YTD Case Mix+ PPS Case Mix** PPS Statistics** PPS Utilization** Quality Tracking+ Select Clinical Indicator+ Joint Commission Indicators Utilization Data Summary+ PatientView # Executive Summary (Qtrly) Heads Up Display (All)* + P4P Preparedness++ Financial Management Benchmark Process Management Benchmark Disease Management* QA Reports # & PPS Reimbursement Worksheet # Executive Summary Bubble Graph OASIS KEY * Denotes Risk Adjusted Reports ** Denotes PPS Data ONLY # Real-Time Reports + All Payors that agency has submitted ++ Calculations based from CMS P4P Demonstration Project 9

10 Process Flow Making the information work for you!
Embed in agency process flow Who, what, when, why What are your priorities? What do you want to do with the information? Track & Trending your data Involve the entire organization With 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.

11 QA Reports

12 Log into So let’s get started…first you need to log into click on Client Login.

13 Access OCS Connection You 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 Reports There 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 information Data verifications Patient outcome status Organized and graphical format Available Reports: Patient-level Verification Report Adverse Events Report Transfer Report Recertification Report Discharge Report PPS Reimbursement Worksheet Empowers managers with powerful real-time patient-level information, including data verifications and status change in an organized and graphical format Automated and available “real-time” - Patient status alerts Inter and Intra assessment Clinician 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 assessments Over 1,200 edits and verifications Includes clinical warnings Ensures data accuracy, improves care plans and reduces rejected claims Includes clinician and team names Drills-down into patient level factors that contributed to decline Analysis and reporting by clinician and patient

18 QA Folio – Adverse Events
Quality Assurance Adverse Events Report: Highlights declines and/or adverse event occurrence Analysis 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 Hospitalization Analysis 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 recertification Provides 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 discharge Identifies patients discharged to emergent care, by type

22 PPS Reimbursement Worksheet
Real-time episodic financial insight showing what reimbursement you can expect and why Helps agencies understand which diagnoses were used behind the case weight numbers. Helps better understand patient assessments as related to PPS Helps with audit process Real-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 will enable you to efficiently focus your time and attention on: Planning for potential changes in an episode’s reimbursement based on episode timing and therapy Identifying and correcting data completeness and accuracy problems that may impact reimbursement Creating plans of care and reviewing those plans for appropriateness Reviewing diagnosis coding practices Training 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 and case 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.

23 Back to that process flow!

24 Process Flow Chart Suggested Process Flow Daily Review Who/When?
Weekly Review Here is a suggested Process Flow for your Agency with QA Reports Daily – Patient Level Verification PPS Reimbursement Worksheet Transfer Outcomes Discharge Outcomes Recertification Outcomes Weekly Review: Adverse Events Who/When? Who/When?

25 QA Reports Step One Are 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 Event Do you want to review daily/weekly? Example: Pt. Level Verification Report Review 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 Network Anytime! Anywhere! Self-Paced On-line trainings Recorded WebEx presentations Access Training Calendar Group WebEx Presentations OCS 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 Guide OCS Report Builder Data Guide OCS Client Services Call TECH (8324) Live Chat The OCS-Website: Additional training courses and educational seminars Important information Software updates Include resource info for each application listed in presentation

29 For More Information OCS Education Sue Blockberger-Miller RN BSN
OCS Director of Education Leslie Knudsen-Wells, RN BS Performance Improvement Educator

Download ppt "QA Reports & PPS Reimbursement Worksheet"

Similar presentations

Ads by Google