Medicare PPS Report Self Guided Tutorial 1
Tutorial Objectives After completing this tutorial, you will be able to: Identify the purpose of the Medicare PPS Report Access the Medicare PPS Report Customize the Medicare PPS Report 2
Overview: About the Report PointRight s Medicare PPS Report: Displays the assignment of Medicare assessments into RUG categories Presents changes and trends in facility Medicare program over time using categories and criteria from the RUG IV grouper Approximates number of resident days for each RUG group. PointRight analysis is a close approximation to the actual number of resident days for each RUG group; a more accurate analysis is not possible without analyzing your facility s UB04 records 3
Access the PPS Report The following slides will guide you through the steps to access the Medicare PPS Report Step One: Login to PointRight Step Two: Select the Report you want to see Step Three: Review the Report 4
Step One: Login to PointRight 1. Go to: www.pointright.com 2. Click Client Login 5
Step One: Login to PointRight (cont.) 3. Click the MDS Submissions & Reports link 6
Step One: Login to PointRight (cont.) 4. Enter your Log In information User Name Password The password is case sensitive! 5. Click Log In. 7
Step Two: Access the Medicare PPS Report Roll the mouse icon over the Products tab. The Products drop down menu displays. In the Products drop down menu, click Medicare PPS Reports. 1. Roll over the Products tab. 2. Click Medicare PPS Reports. 8
Step Two: Access the Medicare PPS Report (cont.) If you have access to multiple facilities, you can also click the facility name whose reports you want to see. 1. Left click on the name of the facility whose information you want to see. The drop down menu displays. 2. Click Products from the drop down menu to go to the Products page. 1. Click the facility name 2. Click Products 9
Step Two: Access the Medicare PPS Report (cont.) From the Products page, click the Medicare PPS Reports. 3. Click Medicare PPS Reports 10
Medicare PPS Facility Reimbursement Report 11
The Medicare PPS Report The Medicare PPS Report includes: Introduction Medicare Days Medicare Trend Rehabilitation Estimated Medicare 12
Medicare PPS Report: Introduction The Introduction page of the Medicare PPS report contains three sections: 1. Report customization options Select Report Period Select Rate 2. Information display Select a Tab to display the information you want to review 3. Wage Index Table Displays Wage Index information for the State and County 13
Medicare PPS Report: Introduction (cont.) Section 1: Choose your Report customization options, then click the Update button. Select the Report Period from the dropdown menu Select the Medicare Rate * Note: The Report Rate defaults to Local which automatically applies the local rate based your facility s address. If you prefer, choose one of the Federal Rates by clicking the radio button next to that rate. 14
Medicare PPS Report: Introduction (cont.) Section 2: Information Display Click a Category Tab to see information and Reports related to that category. The Introduction Tab is the default. The top paragraph of the Introduction summarizes the Medicare assessments and Rates used for the selected time period. Paragraph (1) explains payment rates used in the report calculation. Paragraph (2) summarizes the percent of assessments for which the number of Resident Days needed to be estimated. Paragraph (3) explains that the is dependent on the assessments that are submitted to PointRight. 15
Medicare PPS Report: Introduction (cont.) Section 3: The Wage Index Table displays the changes in your facility s Local Wage Index over time. Information includes the Fiscal Year Start Date, and the facility s designated Urban/Rural status. This information is updated by PointRight for each Fiscal Year. 16
Medicare PPS Report Medicare Days 17
Medicare PPS Report: Medicare Days Two Report view options: By Category By Category and Assessment Type The Medicare Days Report provides a detailed overview of Medicare Resident days. Click the Medicare Days Report tab to view the Report. Report Generation Date 18
Medicare Days: By Category Key features of this Report include: Text summary of the percent of billable days in the Rehabilitation RUG category Overview of the percentage of resident days for the selected month in each RUG category. Percentages are also displayed in the Legend next to the pie chart. Click each section of the pie chart to drill down to Resident details. 19
Medicare Days: By Category and Assessment Type Key features of this Report include: Display of resident payment days by RUG category and MDS assessment type. You can click each section of the bar chart to drill down to resident details. 20
Medicare PPS Report Medicare Trend 21
Medicare PPS Report: Medicare Trend Key Features of this Report include: View and compare all assessments in the same bar graph, or click the desired tab to view a specific assessment type. Data displays for all assessments in each category for the past 24 months. You can click each section of the chart to drill down to resident details. 22
Medicare PPS Report: Medicare Trend (cont.) Medicare Trend graphs can be customized by: Y Axis Select the measurement to display on the Y Axis. Graph Type Select the graph type. Click the Update button to view the graph with the new selections. 23
Medicare PPS Report: Resident Drilldown Resident Drilldown page This page displays all the residents in the category you clicked on in the chart or graph. Medicare billed days are shown for the month listed in the chart title. Click a resident s name to view their complete MDS history, including all the Medicare days regardless of the month selected. Click an ARD to review a copy of the MDS. 24
Medicare PPS Report: Resident Drilldown (cont.) This is an example of resident MDS history detail. Click the ARD to review a copy of the MDS. 25
Medicare PPS Report: Medicare Trend (cont.) You can track your facility s Change of Therapy OMRAs using the OMRA COT tab. Click the bar to see complete details 26
Medicare PPS Report Rehabilitation Tab 27
Medicare PPS Report: Rehabilitation The Rehabilitation Report includes two parts: The Summary tab displays a summary of Rehabilitation assessments for the selected time period The Required ADL and Therapy Minutes tab displays the qualifying criteria for the Rehab RUGS 28
Medicare PPS Report: Rehabilitation Summary The Summary graph displays all the Rehab and Rehab +Extensive RUG groups in reference to the ADL index of the MDS. Click to see details Use this graph to check your ADL accuracy and make sure you are capturing the appropriate RUG for each Resident. Blue indicates ADL index one point away from the next lower RUG. Red indicates ADL index in the middle for this RUG. Green indicates ADL index one point away from the next higher RUG. Y Axis options can be customized to display Resident Days or Assessment Counts. 29
Medicare PPS Report: Rehabilitation Criteria The Required ADL and Therapy Minutes tab displays the qualifying criteria for the rehab RUGS (provided as a resource only). Example: For the RMC category, an ADL index of 11 16, and at least 150 minutes of provided therapy are required. 30
Medicare PPS Report Estimated Reimbursement 31
Medicare PPS Report: Estimated Medicare Reimbursement The Estimated Medicare Report displays estimated Reimbursement and Per Diem. Report is updated in real time with new MDS submissions. Reimbursement Tabs: By RUG (displays by group) Report explanation is at the top of the page The Table displays estimated reimbursement for the month by RUG group By Category (displays by category) Report explanation is at the top of the page The Table displays estimated reimbursement for the month by category 32
Medicare PPS Report: Estimated Medicare Revenue and Per Diem The Revenue and Per Diem report displays the changes in Medicare reimbursement over time. The graph displays a 24 month trend comparing the total estimated reimbursement (blue line) and the estimated average per diem rate in dollars, by month (red line). Roll your mouse over a point on the graph to see a popup with details. Click a point on the graph to view resident details for every resident assessment with payment days during that month. Estimated Medicare dollars display on the left axis. Estimated Per Diem dollars display on the right axis. 33
Printing Medicare PPS 1. Roll the mouse icon over the Print tab, and select Print Report from this Page 2. View Medicare PPS as a printable report 3. Click the Print button in the report window to print. 34
Tips for Success Review RUG distribution in the pie chart and bar chart to determine staffing needs and assign resources Insight into Medicare RUG distribution assists the IDT in RUG prediction and control Apply reports to your Medicare compliance program Drill down to identify potential issues with Therapy and ADL coding Individual, concurrent and group minutes are easily audited Use the Medicare Trend to track changes in the Medicare caseload Look at SOT/EOT OMRA and COT OMRAs to ensure expected RUG changes occur Helps prevent file rejections Review Medicare reimbursement in real time Use the Estimated Medicare table to compare your facility s 12 month history of RUG days to the current month s performance 35
Need Help? Use the Ask a Question page to submit a question to our online Help Desk. 1. Select Ask a Question from the Help menu. Type your question here. 2. Type your question in the text box and click the Submit button. 36
Contact Us! PointRight Inc. 420 Bedford Street, Suite 210 Lexington, MA 02420 www.pointright.com (781) 457 5900 (phone) (781) 674 2254 (fax) To speak with Client Services select Option 1, then Option 2 oremail: techsupport@pointright.com 37