Hi-Tech Software and the Triple Check Process

Transcription

1 Hi-Tech Software and the Triple Check Process Contents How Hi-Tech Software Assists the Triple Check Process... 1 Census... 1 Stay Tables... 2 Hi-Tech Helps you Avoid Incorrect Assessments... 3 Diagnosis Codes... 4 MDS Scheduling and Completed Review... 5 MDS/Care Plans > Scheduling/Pre-Asmnt > Medicare... 5 Key Date List... 6 Reporting > MDS > Key Date List... 6 MDS / Billing Diagnosis Review... 7 Reporting > MDS > MDS/Billing Diagnosis Review... 7 Therapy Logs... 8 Other Considerations... 8 MCR B Stay Tables... 9 Admission Procedures > Stay Tables > Edit Medicare B Data... 9 How Hi-Tech Software Assists the Triple Check Process Internal communication is the foundation of a successful Triple Check process. Let s review processes within Hi-Tech that will help ensure the accuracy of the MDS and Billing information that you submit, and promote consistent information within your residents charts. Census Nursing communicates (usually to the business office ) changes in a resident s census status: Admitted, Discharged, Bed Hold, Change of Payer, Change in Level of Care, Unit, Room and Bed. Census transactions must be processed daily to ensure the accuracy of MDS Scheduling. When census changes are not processed timely, and nursing staff must process the change to maintain an accurate record, this increases the possibility of duplicate and inaccurate stay records. Inaccurate stay records may lead to MDS assessments being completed outside the observation period and interfere with the resident being selected during the billing process. G:\HITECH\Webinars\Webinar Docs\TripleCheckProcess.doc Page 1

2 Stay Tables The Stay record includes key Census items, Diagnosis Codes and the MDS Skilled Assessment Schedule. Example: Figure 1 displays the two Stay records for the two admissions described below. Theresa Appleton was admitted August 18 th. When Figure 1: Stay Records for two Admit Dates Census was processed, her stay table was created and the MDS Skilled Assessment Schedule was established. See Figure 2. She was admitted to the hospital on September 9 th. Note the Discharge Date in the Stay Record and the effect on Days Covered. Upon readmission on September 11 th, the accurate and timely process of Census created a second stay and a new assessment schedule was created. See Figure 3. Figure 2: Admit Date 8/18 Stay Record Details and MDS Schedule Figure 3: Admit Date 9/11 Stay Record Details and MDS Schedule If the related Census Transactions had not been processed timely: Her MDS schedule would have indicated a 30 day between September 13 th and 19 th ; she was back in the facility, and it is possible that an incorrect assessment could have been created. A COT Assessment would have been considered on September 9th. NOTE: Any Diagnosis codes added after the new stay is created will automatically be associated with that new stay. To adjust Diagnosis codes related to prior stays, edit that stay table. G:\HITECH\Webinars\Webinar Docs\TripleCheckProcess.doc Page 2

3 Hi-Tech Helps you Avoid Incorrect Assessments If you create an assessment that does not fit within the assessment schedule, Hi-Tech will display a message such as: ARD not within 30 day observation period. At the bottom of the panel, click on View PPS Schedule to view the assessment schedule related to the current stay. This warning is of value only if the resident s stay record is current and holds accurate information. The resident s Medicare bill is created from information within this same stay record. G:\HITECH\Webinars\Webinar Docs\TripleCheckProcess.doc Page 3

4 Diagnosis Codes Each Stay Record holds diagnosis codes related to that stay. Maintain the codes through Edit Medical Record > Diagnosis. For a previous stay, edit the codes through the Stay Table. The diagnosis codes for the Stay record will transfer to the electronic claim when the bill is created. They are also available within the MDS 3.0 so accurate codes can be included on each assessment. Diagnosis codes added after the new stay is created will only be associated with that new stay. The sort order of the diagnosis codes within the resident medical record determines the order the diagnosis codes transfer to the resident billing electronic claim. When you add a new, more important diagnosis, verify that the sort order reflects the priorities. Examples: Theresa s original diagnosis codes are represented below. Note that the Hospital Admit Diagnosis is repeated under Diagnosis Codes. The Hospital Admit Diagnosis is represented here for reference purposes and will be included when the resident electronic claim is created. If the Hospital Admit Diagnosis is also a current diagnosis for the resident, add it under Diagnosis Codes. The diagnoses were sorted as they were entered. Note Sort order from 01 to 05. In the example below, Theresa was re-admitted, and her hospital admitting diagnosis was She is being admitted to the facility with an aftercare diagnosis of V That code needs to be represented as primary diagnosis for this stay. Note the sort order of 01. It is not necessary to re-sort all of your other codes unless appropriate. NOTE: Each facility should follow their practice regarding adjusting the Onset Date for each diagnosis when the stay is considered a new admission. Because this stay is considered the same Span of Illness as the previous stay, the Onset Dates were not adjusted. ICD10 functionality will require an Onset Date with each diagnosis. G:\HITECH\Webinars\Webinar Docs\TripleCheckProcess.doc Page 4

5 MDS Scheduling and Completed Review MDS/Care Plans > Scheduling/Pre-Asmnt > Medicare This report lists Scheduled or Completed Skilled assessments. Completed: You can choose to view Medicare only, or all payers following the Medicare assessment schedule. Include the Submission date, and verify receipt on your submission validation report. Notice the assessments with no Submitted date. They have an INS (insurance) other than 4 (MCR) so represent Medicare Replacement Plans and should not be submitted to CMS. Scheduled: Reviewed the Scheduled report to determine the assessments that are due. G:\HITECH\Webinars\Webinar Docs\TripleCheckProcess.doc Page 5

6 Key Date List Reporting > MDS > Key Date List This report includes the dates related to each assessment, including the days between completion and submission. Notice G Mason who has a Medicare Replacement Plan (also called Medicare Advantage Plan). An assessment dated 08/01/14 with Reason (Admission and 5-day PPS) does not have a date under Date Submitted. Do not submit PPS assessments that are created for non-medicare insurance purposes. In Section A of the MDS record, check Do NOT submit the MDS Assessment. The record will not be selected during the MDS submission process. A second assessment dated 08/01/14 with Reason (Admission and non-pps assessment) was submitted, see the date in the Date Submitted column. G:\HITECH\Webinars\Webinar Docs\TripleCheckProcess.doc Page 6

7 MDS / Billing Diagnosis Review Reporting > MDS > MDS/Billing Diagnosis Review This report includes the stays within the select period of time, and displays the diagnosis codes represented within the resident Stay Record, these will transfer to the electronic claim, as well as the diagnosis codes represented on the resident s MDS 3.0 for that same period of time. Do the diagnoses reported represent the care provided and being billed for? G:\HITECH\Webinars\Webinar Docs\TripleCheckProcess.doc Page 7

8 Therapy Logs Actual minutes are expected to be reported, and during audits it is expected that not all recorded therapy time will end in 5 or 0. Review your therapy logs and consider if actual minutes are being recorded. Other Considerations The above reports will assist with your triple-check process, but are not all-inclusive. You should also review the following: If you are not using electronic signatures for your MDS 3.0, have they been signed? Do you have a valid Physician certification and recertification? o o If signatures are not legible, do you have a signature log? Are all Physician Orders current and accurate? Is the Therapy plan of care current and appropriate? Does your documentation support skilled services? o Does appropriate staff understand why the resident qualifies as a skilled resident? Many residents admitted for therapy also qualify for skilled nursing services, so verify that you have documentation to support the skilled nursing care being provided, including Nursing Notes and Therapy Notes. G:\HITECH\Webinars\Webinar Docs\TripleCheckProcess.doc Page 8

9 MCR B Stay Tables Admission Procedures > Stay Tables > Edit Medicare B Data This stay table holds detail for Medicare B and Medicare Replacement Plans (covering Part B services). Review Onset Dates and Occurrence Codes, these will transfer to your electronic bill. Review the Diagnosis related to the therapy provided. This diagnosis will also transfer to your electronic bill. If no diagnosis codes are included in the Part B Stay, diagnosis codes from the Stay record will transfer to the electronic claim. The Physician field should indicate the Physician who signed the Therapy Plan of Care. If there is no Physician indicated, the claim will include the Primary Care Physician recorded in the resident s medical records. G:\HITECH\Webinars\Webinar Docs\TripleCheckProcess.doc Page 9