NFQA HELP INSTRUCTIONS - MONTHLY REPORTING

Transcription

1 NFQA HELP INSTRUCTIONS - MONTHLY REPORTING Once the registration confirmation is received, Skilled Nursing Facilities shall submit monthly: net patient revenues, as well as, Medicaid, Private, and Medicare patient days through the online data collection form found at: Login using the user name and password you created during registration. Then, click <Login>. user name and password click <Login> 1

2 Choose the reporting month/year from the drop down box. Your facility's information is already populated in the dark grey boxes. Please review this information for any discrepancies. Then click <Next>. C_AHCA Nursing Facility Quality As1essment Windows Internet Explorer OJ t ;:!h; fl f@'fg - t? X ::c FE Edi VeFroles Tlllll flop Facility Quality Assessment frli)h"'"!i'.,;ggtoojllllme iamjli..he JJ STREET Ct;.Sll:e.I (OCi\iA [}1411 P..OOT;< jljlemo'fraate CA_ 'RE_F/f;_M _:.:..._ Pra.idortl.dorj2o'll01G7 Ueo<>!Jmb<r"""l.,'(ll ;:;..- 2 P

3 Quality Assessment Worksheet: Enter the following information. Monthly net patient revenue: Monthly net patient revenue includes the total of all payer types (see statute for further definition of Net Patient Revenue). Enter this amount in the Monthly Net Patient Revenue box (NOTE: This field is optional). Data entry A: Total Medicaid Patient Days: Enter the total number of Medicaid days for the current month based on dates of service paid or payable by Medicaid. Data entry B: Total Private/Other Non-Medicare Days: Enter the total number of Total Private/Other Non-Medicare Days for the current month based on dates of service paid or payable by any other source that is neither Medicaid nor Medicare. Data entry F: Total Medicare Patient Days: Enter the number of Medicare patient days for the current month based on dates of service paid or payable by Medicare. Medicare resident days mean those patient days funded by the Medicare program or by a Medicare Advantage or special needs plan. The system automatically calculates Total Non-Medicare Days (C), Provider Assessment Daily Rate (D), Total Amount Due (E), and Total Patient Days (G). When data entry is complete, click <Next>. See following page for Screenshot. 3

4 Facility Quality Assessment b:...-t!..-j... - Assessment Repoo Enter monthly net-patient revenue here Assessment WO<I<$heet f,lont/jyloc81 C:-- -. OO.,_o: u n#u, ust Patienc Re.enue:1 "TelalMedicdPabenl03 1s B ToUJ.Paee Otner Uon-M&dkare Oa NOTE: This field is optional 57_, :J. 1s... C. Tctai JilediC3ll! O!iS I& Bl lr----- :5:1:2:: inputs each facility's daily assessment rate. 0.PrO'IIder Assessment Daily Rille I S1062 E.TOIIIAmoll'll Doe (C x Dll,---""56'-0,7:4-6-:--1:F Tati1JeOicatE Pa tflloa,;- 0 v.tc.t;ipal!entoi(l 'C F)J---m!PrP.IMI Jlocal nrnt 4,100%

5 Verification Page: Verify that the monthly data input for your facility is correct. If there is an error click <Previous>, which directs you back to the Assessment Worksheet. There you can correct any errors. Notice the Total Amount Due. This is the amount of your facility's monthly assessment. If all the information is correct click <Submit>...j httj>:// R " '1 X.(..:;:.::,v::..c:..fth:stal!!.flus/nfqaAssess IRil\X)'tasp _ Ed< Visw Fa.rrriEs Tools Hep Facility Quality Assessment Pleas& V'iHittthe eata!}q(ora sotmission FacA'ittName: Secood Street Gr<JupHome ".rtr:iess 381 S.E. 2t-10 STREET OCillA. Fl3:1 71 Pro,idar T; e: lther EDITE CIRE f.\cjljty Pr,ider tjumbec 2593u101 M ilicaidnurnl::ar: :00 Total amount due to AHCA by the 20th of the Mvn#'li; RevenueTo13t TotalNYIHAedicar& Dais:?riu \HJ..ssessment Rate 200, following reporting month 110! 2 TataiP:.mMtDue: Click <submit> -JLocal ntaret when verification is \ 100% complete. 5

6 The remittance document is to be printed and submitted with payment. To go to the Remittance page, either click <Print Invoice Image> for pdf. format or click <Print HTML Invoice> for HTML format. t;. AHCA Nursing Facility Quality Assessment :-Windolnl;rne t.1;://il: ;,.;.,. :;;,; :e.fl nfqa ;,sass lfl'jxrl;;;flie Etla View F- iles Tools ExPtorr '0' - :, X P Hep Facility Quality Assessment print the Remittance Document in pdf. format Click here to view and print the Remittance Document in HTML. When Submitting NHQAF and ICFDD payments, in order to speed up the process of crediting your account, please include a copy of the invoice or some documentation regarding the reason and facility to which the payment applies. Additionally, AHCA has implemented electronic deposits of payments, which involves scanning the check or money order into the bank deposit. Because of this, please do not staple the check to any documentation, this will ensure that the payment can be processed as quickly as possible. 6

7 Remittance Document: Print out and submit with payment to the address located on the document. Remember, payments are due by the 20th day of the following reporting month (e.g. any NHQAF due before July 1, 2015 was due on the 15th of the month and any NHQAF due after July 1, 2015 is due on the 20th of the month). Delinquent payments are subject to fines up to $1,000 per day, liens against medical payment assistant, and/or licensure action. If you chose the <Print HTML Invoice> option you must click on <File> and then <Print> to print the invoice Click the printer icon to print. If you are unable to print please download the Microsoft Active X control You may also export software that pops up on the remittance form your screen. to a pdf. file and save it to your desktop. Then print it that way. Cha!l!eCr "'.- IJvo..IIH,;RI- GC'Vf?JU B """"lllticf,o fti:iiir!ii«"" H-lt;'Sm!on S..«:II!JIKI Facifity Quatiy AssessmentFee Invoice ebti1\imdllti'ipj)'io : for i-ltiticaiemni":kfen 2i11M;cnr;,,HS'I' Fr1m c,:.tt(':;/ll,ir icfoo IA mo:icfooassess:rf:!e lltr '"'10 ot»<xj8 C'lti!WOa!o!: 10fi1,l'CJI loport S<PTR Eill':'l! '.lcr, m FldlilyiJa,'ilf: : ettg.kl:..j me FaOiii»'m M I $.E_ (ht STREET o.:m." FL;m, If you have any questions, please contact the QAF staff at MaryJoAnn.Calabrese@ahca.myflorida.com 7

8 Remittance Document Continued: 'lc\0'('-l"'«,'-o. l("'.) (:._,... Cha!lle C1i.:s1 GOVI"FNOR sen.. HN<IIJI Cirr w.. fi/1 ij.,iijums Facility Quality Assessment Fee 1nvoice RcferenceiD: creagn Da: : Agenr!or Healt-1 Care Admini.Mr3tion 2727 Mchan D1i<e. MS" 14 n tanassee. FL njo Fir.onc amaccounor.-icfdo r! mo: ICFDD,\ssGS:;mont =ae Me-dicaidNUmblH otoo QJG 1CI Repoo 1\:lO ilfy'l:'ch: Fac:ll it}' hj arril;r secomrstreet Group Home Fad!it} Addrooo: JS41S.E. 2ND STF.EET OCALA, ft CO Pro tid-y Number 259)0107 Protider T 1a:;e :HTERMED!ATE CARE FACIU1Y -25 Ploas.;:utmlt you;- renttctnca and. -ronth)' fsg paynwm lo :he address abo.i Fal1urn to submit fuh paym ol by tho due date sh ll resut in pena>l!es and mtorest as statod ;,., Se t1on 4-') F Ianda Statutei: n )i-ol ;::hould have any question> rp.-g;trding. t hi.; form Of r'-'p-crling rilqulr om.9-nts ploa;e cont a ct F'1ance & Ac o,mting 85iM sn ro al Non-M di:are Oays S10.62 Provider A 5e53nle:l-1 Rate OQ SS,\ Current Amo nt -==-- y,. lhca 0 111Ae!:1 1 ht:p: 1'\h::'f! -r1y,ror 1ris c.,m 8

9 COMPLETE! 9