CIRTS Exception Reports Refresher Training. July 11, :30 AM-12:00 PM Senior Connection Center, Inc.

Transcription

1 CIRTS Exception Reports Refresher Training July 11, :30 AM-12:00 PM Senior Connection Center, Inc. 1

2 FACILITATORS Abbie Walters, Senior Contract Manager Kristina Melling, Senior Program Planner and Quality Assurance Data Manager Disclaimer: The facilitators above are NOT data entry experts and do not claim to be! They will offer information from the programmatic perspective and can assist in locating data entry gurus to help with input questions. Please don t make them feel inadequate by asking questions like which line of code should the delimiter be on? HUH? 2

3 GIGO CIRTS in CIRTS out Technical term # 1 3

4 CIRTS GIGO creates : o Missing information o Typos o Discrepancies CIRTS In o Exceptions o Work for you to analyze, explain, & correct 4

5 QUALITY IN QUALITY OUT 5

6 OBJECTIVES: Attendees should be able to: Know which CIRTS Exception Reports to regularly run, and how to use the CIRTS Tracking Log Analyze CIRTS Exception Reports to determine which client information is in error Correct CIRTS database so error can be removed Provide feedback to SCC staff about action taken and verification that exception is resolved 6

7 Performance Outcome Measures 1. ADL s 2. IADL s 3. Environment 4. Imminent Risk Referrals 5. APS Referrals 6. Caregiver Ability 7

8 Why do we have Outcome Measures? Helps determine if programs are successful Used to justify expenditures of public funds to Legislature and citizens Helps to identify effective providers Highlights best practices Helps to improve planning Can be a tool to help determine unmet needs 8

9 ADL Goal to have 65% of new service recipients who have maintained or improved their ADL score. Initial assessment in previous year is compared to reassessment. Measured in second year only. Reason for exception- ADL score increased 9

10 IADL Goal is to have 62.3% of new service recipients who have maintained or improved their IADL score. Initial assessment in previous year is compared to reassessment. Measured in second year only. Reason for exception- IADL score increased 10

11 APS Goal is to have 97% of High Risk APS referrals served within 72 hours (Case Management plus one other service). Reason for exception- No service record in CIRTS for Case Management and one other service within 72 hours of APS referral. 11

12 Caregiver Ability Goal to have 90% of caregivers whose ability to continue to provide care is maintained or improved at reassessment. Assessment in prior year to reassessment in current year. Measured annually. Reason for exception- score for caregiver s ability decreased from previous year s score. 12

13 Environment Goal to have 79.3% of clients with high or moderate risk environment scores improved at reassessment. Assessment in prior year compared to reassessment in current year. Measured annually. Reason for Exception: Environmental score did not improve. 13

14 Imminent Risk Goal to have 90% of clients served after designation of Imminent Risk. Reason for Exception: No service record in CIRTS for CM or other service after referral date. 14

15 So what can you do? Continue to review and analyze exceptions on a monthly basis Case Manager should review client s file before doing reassessments ensuring an informed evaluation of client s current condition Review CIRTS turnaround report to ensure no errors when compared to the original assessment Determine if the caregiver meets the Handbook s definition of caregiver 15

16 If unmet needs were identified: Could the client receive additional services? Does care plan support this need? Was the client added to all appropriate wait list for services? Should a referral be made to the ADRC s LTC Department? Could the client benefit from a referral to other community resources such as volunteer organizations, home improvement resources, nutritional counseling, etc.? 16

17 Outcome Measure Response Monthly explanations to SCC for all exceptions Excel format Comments should provide information why client is not achieving goal and what has been done to assist with unmet needs. Example: Due to client s advancing dementia her ADL's have all increased to needing some help. Client has been placed on the CCE & LTCC APCL list while receiving ADI services. 17

18 So how are we doing as a PSA? 18

19 Achievements from 07/01/ /30/2018: IADL: 67.31% ADL: % IR: 100 % CG Ability: % Please be diligent when analyzing each exception appearing on report. Environment: % APS: 100% 19

20 Assessment Due Report CIRTS Report #3 under Assessments 20

21 Assessment Due Report Continued Owner Id: Enter your Provider ID (e.g ) Start Date: Beginning of SFY (e.g. 07/01/2018) End Date: Last day of [most recent] prior month (e.g. 08/30/2018) Program Status: Select ACTV and APCL for a complete listing of all clients with late assessments. For OAA APCL only, you will need to run a AAA Report to determine which clients on the waiting list have an assessment due. 21

22 Assessment Due Report Continued Steps for Correcting Exceptions Ask, is the client still active? If yes, determine which assessment type needs to be completed and have the assessment entered in CIRTS within 7 business days. If there is a valid reason why an assessment was not completed, note the reason on the CIRTS Tracking Log. For example, Client has been in and out of the hospital and services are on hold. Upon client s return, assessment will be performed. If no, initiate the process of terminating client enrollment(s). 22

23 Assessment Due Report Continued This client appears to be missing a 701B. Client continues to receive services. By entering the assessment, the client will be removed from the report. 23

24 PSA RESULTS 701A- 0 overdue assessments 701B- 1 overdue assessments 701C- 0 overdue assessments 701S- 4 overdue assessments 24

25 Assessments Due for OAA APCL (Wait Listed) Clients AAA Report (06P_ASSMoaadue) For Provider Reassessment 25

26 Assessments Due for OAA APCL Clients Continued Assessments Due for OAA APCL Clients 26

27 Assessments Due for OAA APCL Clients Continued Providing Explanation on CIRTS Tracking Log Explain the reason the client s reassessment is not completed, e.g. the client has been out of town and requested the assessment be completed at the beginning of next month. 27

28 Incomplete Assessments Report CIRTS Report #6 Under Assessments 28

29 Incomplete Assessments Report Continued Select your Owner Id and run the report. 29

30 Incomplete Assessments Report Continued Assessments entered in CIRTS for these clients are incomplete. Complete the assessments and the exceptions will be removed. If an assessment needs to be removed, contact SCC MIS staff for assistance. 30

31 ACTV, APPL, APCL Clients who have moved to another PSA Enrollment #5 31

32 Select your Provider number and run Report. 32

33 What is an example of a valid exception? Clients on report appear to have moved; please confirm and terminate as appropriate. 33

34 Active Clients Not Served in Time Range Monitoring # 1 34

35 This report will provide you with a list of clients that have not received service in the last 14 months, but who are currently enrolled as active in CIRTS. Run report for all locations and all programs. 35

36 Active Clients Not Served 36

37 Correcting Active Clients with no Services in Time Frame Client is Active, but has not received services in 14 months (or shorter time frame as indicated) Enrollment issue evident Need to terminate client send 10-day termination notice if not yet done. 37

38 This report results have been showing for the entire state. You don t need to explain exceptions not in your area. This report will assist you with ensuring all enrollment lines are properly updated. To help avoid exceptions, make sure a client s APCL or APPL line is closed when client is made active. Monitoring#6: Clients who are enrolled multiple times in same program 38

39 Monitoring #7 Clients Served Not Enrolled Run report starting with the beginning of the FY through end of last current month. This report will assist in determining if any client has been served without the proper enrollment line in CIRTS. 39

40 Example: Client received HDM after enrollment in CCE program ended. Provider needs to determine if meal provided was appropriate. If not, void meal(s). If meals were appropriate, enrollment span in CIRTS must be corrected. 40

41 Correcting Clients Listed as Served without Enrollment Is the client an active client? What service did client receive? Why is program enrollment not part of client s CIRTS enrollment record? Update CIRTS enrollment record 41

42 Monitoring#9 Age Verification Report 42

43 Run report for all of the agency s programs. Clients receiving services under 60 years of age Must use correct code in enrollment screen per NOI#

44 Correcting Age Verification Report Exceptions Determine if a code has been entered into the CIRTS enrollment screen to justify services provided to a person under 60 years for the program the client has received services in. Use CIRTS eligibility code UN60 Use CIRTS service code CNMLV (Congregate Meals Volunteers) to aggregately report meals served to volunteers regardless of age. 44

45 Age Verification Report If any consumer appears who should not have been enrolled and/or served, please let your Contract Manager and our MIS Department know so these records can be removed from CIRTS; thereby removing them from your report. 45

46 Data Inconsistencies Found When Comparing Vital Statistics Death Certificates with CIRTS Three CIRTS Reports under Monitoring #10 Open Enrollments, #11 Assessments After DOD, & #12 Services More Than 2 Months After DOD 46

47 Vital Statistics Reports Continued 47

48 Vital Statistics Reports Continued Reconciliation Actions Include Verify the client is deceased. Enter the client s date of death (DOD) on the CIRTS demographics screen. Terminate open enrollments in CIRTS for clients who have died. This includes APCL, APPL and ACTV enrollments. Enter the enrollment end date as the date of death and the termination code T_CD (client died). If a client is active in a program and on the waitlist of another provider, it would be helpful if the agency was notified of the client s death. 48

49 Vital Statistics Reports Continued Open Enrollments Report This report indicates clients reported as having died according to the DOH Vital Statistics Office and still showing as enrolled in a DOEA funded program. 49

50 Vital Statistics Reports Continued Ensure client s name is the same, SSN, DOB, etc. then, verify the client is deceased, then terminate enrollment. What if the client s name or SSN doesn t match what vital stats is reporting? 50

51 Vital Statistics Reports Continued Assessments After DOD Report Tip: By selecting delimited data as the output format, the information can be placed in an Excel spreadsheet. 51

52 Vital Statistics Reports Continued 52

53 Vital Statistics Reports Continued Steps for Correcting Exceptions For Assessments After DOD Report The data should be left in CIRTS if SCC paid for the service. Provide SCC with confirmation that the client is no longer receiving services and the reason why your agency did not document DOD previously. For services other than CM or CA reported beyond 60 days of the DOD, SCC must obtain additional information from your agency containing documentation of the reasons given, but do NOT adjust CIRTS service records at this time. 53

54 Vital Statistics Reports Continued Services More Than 2 Months After DOD Report 54

55 Vital Statistics Reports Continued The person on the report has a different name and DOB and may have been wrongly reported in the Vital Statistic data, so the person must contact Vital Statistics to make a correction. For the purpose of the explanation on the CIRTS Tracking Log, document the person was provided the contact information for the Vital Statistics Office. 55

56 Vital Statistics Reports Continued Vital Statistics Contact Information Ken Jones Deputy State Registrar Florida Department of Health Bureau of Vital Statistics P.O. Box 210 Jacksonville, Florida (904)

57 Vital Statistics Reports Continued Services After DOD For case management (CM) or case aide (CA), providers are to ensure that a PSA code is entered in CIRTS. The PSA code means Case Closure-Billing after date of death was appropriate and allowable in order to close the client record. Details on this process are included in the NOI # CIRTS Data Integrity 57

58 Vital Statistics Reports Continued Steps for Correcting Exceptions For Services Provided After DOD The data should be left in CIRTS if SCC paid for the service. Provide SCC with confirmation that the client is no longer receiving services and the reason why your agency did not document DOD previously. For services other than CM or CA reported beyond 60 days of the DOD, SCC must obtain additional information from your agency containing documentation of the reasons given, but do NOT adjust CIRTS service records at this time. 58

59 CIRTS Data Clean-Up Report CIRTS Report #18 under Monitoring 59

60 CIRTS Data Clean-Up Report Continued Clients on this report have enrollment lines that appear to be incorrect due to conflicting enrollment lines. 60

61 CIRTS Data Clean-Up Report Continued 61

62 CIRTS Data Clean-Up Report Continued Steps for Correcting Exceptions Update CIRTS with termination lines for all programs if client has passed away. Notify other Providers who may not be aware that the client has terminated, so they will know to terminate their provider enrollment lines. 62

63 Monitoring#18: Possible Duplicate Client Report 63

64 Need to determine which spelling and/or SSN is correct and have CIRTS corrected. 64

65 Active MLTC Clients who are ACTV, APCL, APPL in Another Program, Monitoring # 20 Clients must be terminated from APCL, APPL and ACTV status. Remember 10 day termination notice must go to active clients. How long can a client remain in MLTC and receive SGR/OAA services at the same time? Which programs can individuals receive while being active in MLTC? This would be a valid exception on the report. 65

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67 Monitoring #17 MLTC Enrollees Receiving Services in Another Program 67

68 Active Consumers Receiving an APS Referral CIRTS Report #4 under Enrollments 68

69 Active Consumers Receiving an APS Referral Continued It is important to know when an active client has received an APS Referral. Ask, Are the client s needs being met? 69

70 APS Repeat Referrals in a Time Range CIRTS Report #3 under Monitoring 70

71 APS Repeat Referrals in a Time Range Continued Report shows active clients receiving multiple APS referrals during a time frame. Important to run to help ensure clients needs are being met. 71

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73 OAA only providers may leave at this time 73

74 ACTV SGR Clients with No Care Plan, Monitoring # 19 Report shows clients who are active but CIRTS does not show a Care Plan. Leave Program Blank to capture all potential clients who need a care plan entered in CIRTS 74

75 2018 Individual = $2, Individual = $2,205 Couple = $4,410 75

76 Medicaid Waiver Report Now separate tab in CIRTS Tracking Log Complete on a monthly basis Confirmation that lead agency staff contacted client and provided information regarding SMMC LTC and referral to SCC 76

77 HCE Consumers Over Income/Asset Limits, Monitoring # 17 Reports clients that appear to be over income and/or assets limits for program eligibility. Individual monthly income: $2,250 Couple Monthly Income: $4,500 A couple s income should only be entered when both are HCE clients. For example, if both the husband and wife are HCE clients, then the couples income would be entered. If one of the spouses is the HCE caregiver, their income is not counted. 77

78 APS ARTT Exceptions APS-ARTT Exceptions Reports can only be generated by SCC Staff. Per the Master Contract, SCC sends this report and lead agencies have three days to respond. 78

79 ARTT Referrals Not Acknowledged as Received or Rejected Contains referrals in the ARTT that have NOT been identified as received or rejected. Referrals in the ARTT for whom referral packets have been received should be acknowledged as received on the Aging Network tab. Includes referrals sent two or more days ago. 79

80 Referral Received or Rejected must be checked. 80

81 Incomplete ARTT Referrals Must complete: "Action Taken by Provider" field (#30) or "Staffing or Additional Comments" field (#31), "Service Provider's Signature" (#36), and for High risk referrals- the "Schedule Staffing Date" (#37). Must be entered into ARTT within 72 hours from time referral packet is received for "high-risk" referrals and within 10 business days for M and L risk referrals. 81

82 ARTT Referrals in ARTT But Not CIRTS and Vice Versa The ARTT Referrals in ARTT but Not CIRTS or ARTT Referrals in CIRTS but Not ARTT Check SSN in ARTT VS. SSN in CIRTS. Was APS marked as the referral source in CIRTS? Does it have the correct APS Referral date? 82

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84 Compare SSN in CIRTS vs. ARTT 84

85 You can check for possible ARTT referrals by name, SSN, Abuse report number, etc 85

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