March 2015
Face to Face: The Hottest Topic in Medicare Compliance
By HTS Guest Writer Jan Spears - Founder and President of MJS and Associates Medicare home health discharge record! to insufficient face-to-face providers breathed a documentation, the industry The industry took a deep small sigh of relief when continues to beg for relief! breath and raised some the Home Health Final new issues. How can the These questions, along with Rule 2015 was released home health agency’s the requirement for the in the fall of 2014 as CMS total reimbursement narrative at all, are ones removed the physician be dependent upon that the National Association narrative requirement from documentation maintained in for Home Care and Hospice the face-to-face encounter another provider’s (physician (NAHC) continues to grapple document maintained in the or hospital) medical chart? with in the U.S. District home health record. CMS, And how can the home Court in Washington D.C. however, did not remove The NAHC driven the responsibility the With denials for insufficient face-to-face suit filed in June attending physician narratives reaching crisis levels in many 2014 has cleared has in determining the the hurdle of a CMS home health agencies, and more than patient’s homebound motion to dismiss $250 million in denied dollars to the status or the rationale for medical necessity industry due to insufficient face-to-face which was denied for skilled services; documentation, the industry continues in January 2015. One of the three they just changed the to beg for relief. components of the location for where this suit filed against must be documented to the health agency assure CMS states that “CMS physician’s medical record that it is complying with violated the U.S. Constitution or to the acute hospital’s the regulatory guidelines and the Medicare Act by mandating the narrative failing to provide adequate, when it cannot impose reasonable, and clear guidance on the standards completion requirements in for compliance. In other another provider’s records? words, CMS must explain Moreover, with denials for what constitutes 'sufficient insufficient face-to-face narratives'.” narratives reaching crisis level in many home health On January 30th, CMS agencies, and more than $250 million in denied Cont. on page 3 dollars to the industry due
JUDGING YOURSELF
BY JONATHON KOVAR
“For if we would judge ourselves, we should not be judged.” I Corinthians 11:31
“The acting is better when you know your material is being judged.” Bob Newhart A friend of mine was applying for a high level management position at a multi-national corporation when he was asked, “What is the single biggest requirement to be a great leader?” As he was telling me this story, my mind immediately attempted to answer the question. Integrity. Hmm, maybe courage. Nah, probably vision. Or maybe even the ability to motivate others. Before I could come up with an answer that satisfied my own internal criteria, my friend continued his story. He said, “The answer is results.” After analyzing that answer for over a year, I still agree with him. We can brag about leaders or we can rail against them, but what ultimately determines their greatness is results. Not personality, not charisma, not vision, not courage. Results. Plain and simple, if you want to be a great leader, you need to produce results.
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Of course, results are also the most difficult accomplishment. It is quite easy to live up to other “leadership” traits, at least temporarily. We can go on a retreat, talk for days, and come back with “vision.” We can bring cake and ice cream to work one Friday and be considered “friendly.” We can throw away all the clutter in the office and be considered “focused.” But the one criteria for a great leader is results. Unfortu-
nately, results, unlike those other traits, are very, very difficult to attain. Last week, I asked a group of our management team to read “Good to Great” by Jim Collins. Most of you have probably heard of the book; it’s kind of a bible for business leaders these days. The Cliff’s Notes version is likely what most people are familiar with. The full book, replete with statistics and evaluations of great companies, though, is definitely worth the read. One take away from the book (among many others) is this idea that results ultimately decide the worth of a leader and results are based upon objective criteria. To be included in the list of great companies chronicled in the book, a company had to meet very high, objective standards. To me, that is where most small to medium sized businesses fall short. They fail to set high standards and they fail to judge themselves objectively. If you are running your business based upon a gut instinct that things are getting better or worse, you will trick yourself into believing you have no control. Many CEOs fret over money, staff, quality, etc., but they don’t actually judge themselves in those areas. You’ve heard “what gets measured gets improved.” Well, that’s true only if you are measur-
ing and judging objectively. We have a great talent for fooling ourselves. Don’t allow yourself to fall into the trap of believing that things will miraculously get better. Don’t allow yourself to get distracted by the shiny new object or current fire that needs to be put out. Your job as a leader is to produce results. That requires judging yourself. It’s kind of like how the book of James describes faith. Two people claim to have faith. One has no works, the other has lots of works. James basically says that when they are judged objectively, the latter has a more effective argument for proving his faith. He can simply say, “I can show you my faith by my works.” As a leader, it is easy for us to say we are doing a good job. We can maybe point out employees who like us or customers who brag about us. But, when trying to decide if you are a good leader, the only question to ask is “Can I prove I’m a good leader by my results?” If you do that, you won’t have to tell people you are a great leader. Like the man of faith, your works will do the talking for you.
Jonathon Kovar is CEO of HealthTrust Software, an author, speaker, and healthcare attorney.
"FACE TO FACE" - cont. from page 1 responded with the release of a “voluntary face-to-face template� for physician use in his or her own record. The template is available in an electronic and paper format and can be downloaded from NAHC at http:// www.nahc.org/NAHCReport/nr150129_1/. The paper form is divided into two sections. The first section, which is primarily demographic information, can be completed by the home health agency. The second portion can be completed by someone within the physician’s practice as delegated. Only the attending physician can sign the form. The challenge will be to convince physicians that this additional workload is necessary for his home health patients. If the physician bills for plan of care review or care plan oversight, the face-to-face document is required for his reimbursement as well, so he can suffer some monetary loss, but not nearly what the HHA stands to lose in denied payment. The hurdle of how to manage the ongoing problem with pre-2015 denials may have some relief if CMS follows through with a plan to have its contractors re-focus audits of the face-to-face to the revised 2015 standards. While they intend to continue audits for prior dates, they have indicated to NAHC that the focus on exclusive denials based on the face-to-face will be reduced or eliminated. If this occurs, new denials may be reduced; however, the problem with what has already occurred will continue to be an issue for NAHC to battle in court. In the meantime, providers should download the voluntary form and educate, educate, educate the physicians on how to complete it appropriately. One bit of good news: CMS is allowing an
ICD-10 is right around the corner. We will be releasing our ICD-10 training
agency to provide documentation from its record to the physician to assist in preparation of the face-to-face template. This can consist of portions of the completed OASIS, content within the 485 plan of care, or other summaries as the agency determines appropriate. CMS has further stated that revisions the physician may make to his own face-to-face documentation will not hold home health billing. MJS & Associates, LLC strongly recommends that home health agencies appeal every face-to-face denial through at least the second level of appeal (reconsideration) to establish a clear path of resistance to a regulation that is burdensome to the home health and physician industry at best, and restrictive to those patients who need home health but have not received it because of physician rebellion to the burden. Stay tuned to the latest from your state and national associations! Guest writer Jan Spears is the founder and president of MJS and Associates, one of the top healthcare consulting firms in the nation. Mrs. Spears has more than 30 years experience in home health administration including ownership of a multi-million dollar home care operation in Texas during the mid 1990's that was the first agency to integrate the OASIS assessment tool into home care practice as a demonstration site for CMS. She worked closely with CMS in the development of the OASIS data collection format in preparation for the implementation of a prospective pay reimbursement program for Medicare. She has authored several publications including Home Health Agency - Policies and Procedures, "Care Guides for Home Health Practice under PPS", and "Crosswalk for Compliance - An Effective Huide for Integrating OASIS Elements to Clinical Documentation."
ICD-10 NEWS
and testing schedule by early April. Stay tuned to the newsletter for details
and exciting news about our ICD-10 plan. 3
HealthTrust's Taylor Kovar and Becca Matlock Lobby at the Texas Capitol for Home Care Left: Home Health lobbyists including Becca and Taylor (back row) with Senator Robert Nichols. Bottom left: Representative Travis Clardy and Becca Matlock. Bottom right: Nichols and Becca.
In February, we attended the Texas Association for Home Care & Hospice Committee Meetings in Austin, TX. It was great seeing many of you all at the meetings. While in Austin we also participated in the TAHCH March on the Capitol day. We were able to meet with several of our state leaders and share with them the top home care priorities 4
for this Legislative Session. The priorities that we discussed were: 1. Adequate funding in the budget to support home care reimbursement rates. 2. Sunset and Health and Human Services. 3. Improving quality and access-to-care in the Managed Care mode.
Sandata Pulls Out from the HHSC's Electronic Visit Verification Initiative According to DADS, Sandata Technologies, LLC, has withdrawn its participation in the Health and Human Services (HHSC) Electronic Visit Verification (EVV) initiative. There are now three HHSC-approved EVV vendors: Care Monitoring 2000 who is already fully integrated into HealthTrust Software, DataLogic (Vesta), and MEDsys. Sandata will continue to support EVV services through
May 31, 2015, for all provider agencies currently required to use the EVV system. This includes provider agencies required to use the Santrax system under the DADS EVV initiative, as well as former DADS provider agencies that transitioned to managed care on September 1, 2014. Providers that selected Sandata for the provision of EVV services under the HHSC EVV initiative must select one
of the three remaining HHSC - approved EVV vendors by submitting a new, completed Medicaid Electronic Visit Verification Provider Selection form no later that Friday, March 20, 2015. If you are still using Sandata please call HTS immediately at 877-422-4555, select the support option, and ask for Robert.
More Important EVV Initiative Changes
From Guest Writer Kyle Caudell - Government Relations Manager, CM2000 Care Monitoring 2000 is a global leader in Electronic Visit Verification (EVV) solutions. As an approved vendor in Texas for the Health and Human Services Commission EVV Mandate, CM2000 offers innovative EVV solutions to make the transition to electronic timesheets seamless and easy for your administrative personnel and nurses in the field. We are delighted to be integrated with HealthTrust. We look forward to our partnership with you!
CM2000 by either selection date, you are on pace to be trained and implemented by April 16, 2015. In addition, for those providers that failed to select a Vendor by the January 9, 2015 or the February 10, 2015 selection date, HHSC will randomly assign them to one of the three remaining EVV Vendors. For those providers who are going to be randomly assigned to an EVV Vendor. HHSC will notify those providers of their EVV Vendor in April.
Many things have recently changed with the EVV initiative. There are a few key dates in mind:
March 20, 2015—Last Day For Sandata Clients to Reselect to New Vendor
April 16, 2015—The New “Go Live” Implementation Date As for the new implementation timeline, there have been many changes. For those providers who selected an EVV Vendor by the January 9, 2015 or February 10, 2015 selection dates, your go live implementation date has moved from March 1, 2015 to April 16, 2015. That means for those of you who selected
For those providers who selected Sandata as their EVV Vendor they will now have the opportunity to reselect one of the three remaining EVV Vendors. Those providers need to complete their new selection by March 20, 2015. Go to: http://www.dads.state.tx.us/EVV/EVV_ VerificationSelectionForm.pdf to view the new Medicaid EVV Provider Selection Form. Cont. on page 10 5
Moxie KnOwledgeable HuNgry for life GIver ExperienCed InnovAtor MONICA LEWIS -
PATIENT CARE SERVICES - NURSES NIGHT AND DAY Leadership and learning are indispensable to each other. - John F. Kennedy Millions saw the apple fall, but Newton was the one who asked why. Bernard Baruch MOXIE: "fortitude and determination." Change is never easy, even when it’s the right thing to do. Monica came into a mature agency and changed things up. When she was hired as the Director of Patient Care Services for Nurses Night and Day she paved the way for them to go completely paperless. KNOWLEDGE IS POWER: Monica believes you should learn something new every day. She will never forget learning how to master validation in an expeditious way. That knowledge alone allowed the company to let go of 5 employees and become better equipped for future growth.
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HUNGRY: For life! She is a dancer, a traveler, garnener, a mom of a Broadway performer and a soon to be lawyer. But she doesn’t have much of a bucket list. “I would like to work from home using the fully implemented HealthTrust
system…or work while relaxing on the beach!” But other than that she says, “I want to live life as if I could leave any day. I won’t leave a bucket list behind.” GIVER: Her best advice is “Every day make sure
you give something away to a minimum of 3 people: one for the Father, one for the Son, and one for the Holy Spirit. That could be a smile, some food, or advice to help them along their journey.” EXPERIENCED: private duty, home health, director of a Alz-
heimer’s unit, long term care, clinic director, Katrina evacuation director, Hospice agency starter, hospital nurse. INNOVATOR: With her and the company’s holistic approach – they are now reaping the benefits. At a time when most privately owned home healthcare companies with a 30 year history are beginning to fold, Nurses Night and Day is expanding into Hospice. Monica Lewis is all these things. So who does she look up to? Her boss and administrator of Nurses Night and Day, Glena Parkinson. “The streets should be named ‘Glena’s Charity. She has given out more than people can imagine. There are countless people that she has employed. She is always putting others first. And for that we are all thankful. We pray for her consistently to have health and strength.”
RIHAB GUESMI - HTS SOFTWARE INTERN She is 20 years old, is 5,743 miles away from home and is working at HealthTrust Software.
doesn’t look that big but the software is!” Rihab says knowing the software from Before Rihab Guesmi left her Tunisian home the front end is very last year to come to Texas, she was accepted different than working into the one of the best engineering schools with it from the back end. “For in Northern Africa. However, she put that two weeks I interacted with it from a user’s on hold because she was also offered a perspective. I thought it was complicated one year scholarship from the U.S. State but not difficult. But then, as a programmer, Department to attend a university in the with the view from the back end, I was States. The State Department was looking overwhelmed. It’s really complicated, but for excellent students who were unique and they are doing a good job maintaining and adaptable to new environments. Rihab fit updating it.” the bill. She graduated from high school with honors and then attended a pre-engineering Her year in Texas is rapidly coming to a school where she studied advanced science, close and she has mixed emotions about math and mechanics courses. She aced going back home in May. “I have grown to the national exam that came after and really like the people, Nacogdoches, and the West in general. I have made good friends and really like it here. But I miss my family and friends. So I am was accepted in the excited to engineering school. see them again.” Now, she wants to be a software engineer. Thankfully, 5,743 miles is not So when most college as far as it used to be. With students are looking the internet and technology, for more ways to be Rihab’s hope and dream is entertained in their off to work with HTS developers time, Rihab is going to remotely, all the way from work at HTS. “I love it. home. It’s really great to work As far as Rihab knows, there there,” says Rihab. But it is no home health software wasn’t a walk in the park. in Tunisia - yet. But HTS and “I was really surprised the Rihab do have big dreams. first time I used the software! The company Above pictures: While in the US, Rihab has experienced much: Disney World with friends, a Texas ranch, San Francisco and the Golden Gate Bridge, and Christmas.
Photos from left page: Monica's son Delius Doherty (back row,third from left) in the Broadway musical "The Book of Mormon". Group: - Glena Parkinson, Marline Hernandez. back - Audrey Puente, Joyce King, Jennifer Gonzalez.
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It's in the software....
ARE YOU USING IT? New Forms Page
A new Forms page has been added into the system under the Reference menu. This page allows company forms to be uploaded to the system or removed if necessary. The only
group options for Forms is now VIEW and EDIT. If the user only has VIEW access, they will not be able to upload new documents or remove existing ones, but they will be able to
view existing documents. If the user has EDIT access, they will have full access to upload, view, and remove documents.
SOFTWARE TIPS From Your Customer Service Reps
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1. Online point of care: When using online Point of Care, only have one HTS tab open. Having multiple HTS tabs open while using the online Point of Care can cause a yellow screen to appear when validating a visit, which can result in lost data if not handled properly. If you get a yellow screen after validating, close the visit and contact HTS support. Opening the visit again can result in lost information that cannot be retrieved. (This happens on a daily basis and the majority of support calls have been because of this lately.) 2. Offline Point of Care: When using offline Point of Care, make sure that your device is connected to only one network connection. Being connected to multiple networks can cause
syncing issues. Your device will sometimes attempt to connect to more than one connection during a sync, which can cause the sync to fail. Making sure your device is only connected to a single network connection can prevent this issue. 3. Add an event: In order for a user to be able to add an Event to a patient's chart, the group that the user belongs to will need to have Access to ADD patients in the Group Settings. 4. Changing the patient assigned to a visit: Patients can only be changed on a visit that is in Scheduled or Unconfirmed status. Patients cannot be changed on Confirmed visits. In order to change the patient assigned to a Confirmed visit, the Status will first need to be changed to Unconfirmed, either
from Charge -> Charge Menu or from the Schedule. Then, List can be clicked in the top left-hand corner of the Schedule so that the charge can be selected and the patient can be updated. 5. Training videos: All updated training videos can now be found by going to Help> Support> Online Training Videos. 6. Voiding a referral: If you enter a referral and then need to void it, complete the following steps: Patients -> Referral Menu -> Select Referral -> Referral tab -> Patient Status -> Change this from IN REFERRAL to VOID -> Submit. Note that once a Referral has been voided, it cannot be recovered unless Support is contacted.
March Software Release Guide
FEATURED ENHANCEMENTS
•Users are now able to edit Case Conferences. VIEW, ADD, EDIT and VOID privileges are determined bythe user's security group options in incident reports section of Group Settings. •A new Forms page has been added into the system under the Reference menu. This page allowscompany forms to be uploaded to the system or removed if necessary. The only group options for Formsis now VIEW and EDIT. If the user only has VIEW access, they will not be able to upload new documentsor remove existing ones, but they will be able to view existing documents. If the user has EDIT access,they will have full access to upload, view, and remove documents.
ADDITIONAL ENHANCEMENTS AND RESOLUTIONS DATE 1/20/15 1/20/15 1/20/15 1/20/15 1/20/15 1/20/15 1/22/15 1/27/15 1/30/15 2/4/15 2/5/15 2/5/15 2/5/15 2/9/15 2/9/15 2/9/15 2/9/15 2/9/15 2/9/15 2/12/15 2/12/15 2/12/15 2/12/15 2/12/15 2/12/15 2/12/15 2/12/15 2/12/15 2/16/15 2/17/15 2/17/15 2/17/15 2/18/15
ENHANCEMENT/RESOLUTION Left parenthesis being left in the phone number field has been resolved Authorization accessibility issues have been resolved Employees that do not have a status in the Financial Tab now pull to the drop down list You can now search for a physician after they have been voided Physician is now pulling from the Referral >Services tab if one is listed Date and Time are now both displaying when printing the Physician’s Order PDF Issue with information not pulling from Flowsheet has been resolved Two week time sheets for Home Aide workers now functional Fax cover sheets are now functional M1309 No longer blank After deleting a line item client is now able to edit the charge attached to the claim H-Fax issues resolved Map of visits can be viewed from Google Chrome now Status can be edited on communication notes that have already been signed The Provider drop down now shows the correct order When scheduling a charge you can no longer schedule a start date that is after the end date M1309 now says “checked” If M1306 is equal to 0, then all items M1307 through M1320 must be blank “This webpage cannot be found” error when printing has been resolved Changing the status of an order no longer blanks out information DME/Supplies can now be added to PDN Eval visits Inconsistency with date a patient was created has been resolved Duplicating information on Plan of Care has been resolved • The graphs under the Clinical > Vital Statistics tab populate correctly. • The option under the Misc > Misc tab has an export button for Honeywell Issue with warning when submitting a charge: “WARNING. THE DOS IS NOT WITHIN THE LAST 5 DAYS OF THE EPISODE” has been resolved Issue with red X being clicked to delete supplies has been resolved Related agents are now being excluded Now able to submit Point of Care for Home Health Aides DME supplies issue resolved Issues with M fields appearing on Inpatient History page when they shouldn’t be has been resolved Issue with Agent name not displaying in Edit Agent box of drop down list has been resolved • Duplicates are no longer appearing for the options under the Linking tab of the Add/Edit Task screen • Referrals are no longer showing up under the Patients option of the Linking tab • Applicants are no longer showing up under the Agents option of the Linking tab Patient/Caregiver initials now appear on the print out of the Nursing Addendum
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Congratulations on HTS's Newest Edition:
Dhruv Parla 7lbs. 1 oz., 20.5 inches Born January 27, 2015
The proud parents: Ramya Nadegouni and Praneeth Parla
EVV Initiative Changes: Cont. from page 5 Hurry—Register for a Demo Hurry and register for a demo of our product. We host demos three times a week for Texas clients. We have a demo Tuesdays 2PM CST, Wednesday 12PM CST, and Fridays 10AM CST. To register for an email, either call us at 1-855-209-2345. Update On Alternate Devices HHSC released the Small Alternate Device request form Tuesday, March 10, 2015. That form will be on MCOs/TMHP websites and the website for the Texas
Department for Aging and Disability Services. That form will also be on our website at CM2000.com Furthermore, there is also a pamphlet documenting the process for the requesting and fulfilling of orders for the small alternate devices. Here at CM2000, our CodeConfirm! devices are what your nurses in the field will be using as your Small Alternate Device. Once our providers complete and submit that form, we will begin accepting orders for CodeConfirm! devices.
please call HealthTrust to seek support.
Finally, if you have questions 7