December 2014
Resolutions and Revolutions
"Make the Revolution a parent of settlement, and not a nursery of future revolutions." -Edmond Burke, Reflections on the Revolution in France "This year, I am going to get in shape." - 60% of Americans each year I have had that New Year's resolution for a number of years, just like the majority of Americans. And, just like them, I've failed to keep it. By mid-January, it is too easy to get the ice cream out of the freezer, turn on the TV, and "relax" until my resolution is just a distant memory. I make similar resolutions for my businesses each year. "This year, I am going to cut expenses." "This year, I am going to focus on marketing." "This year, I am going to take a vacation." On January 1st, I fully intend
to accomplish those goals by the end of the year. On January 15th, I've forgotten what my resolutions even were! The problem with resolutions is that they are seldom teamed with revolutions. We make statements, as if expecting them to come true simply by uttering them aloud. Yet, as long as we keep the freezer stocked with ice cream, we will continue eating our words one spoonful at a time. So, as you make your list of New Year's resolutions this year, make sure you plan for the revolution required to fulfill
By Jonathon Kovar them. If you want to get in shape, maybe your revolution is against your work schedule, your grocery list, or even your friends. Losing weight often means losing a few hours of work (or sleep) each week to carve out time to exercise. More often, it means losing the environments that keep you from the healthy lifestyle you desire. The same is true for every other resolution on your list. So, what will it take to be successful in 2015? What areas of your life and business need a revolution? I can't help you get in shape physically (still working on myself!), but HealthTrust can definitely help you reach your business goals. Besides software, we have coaching programs that will help you maximize your sales and marketing and training programs to help you maximize your productivity. Plan now to make 2015 your best year ever, in all areas of your life. We are here to help. Long live the revolution! Jonathon Kovar is CEO of HealthTrust Software, an author, speaker, and healthcare attorney.
Your EVV Solution is Here
With HealthTrust and CM2000 Already Fully Integrated management, scheduling, compliance, billing, Electronic Visit Verification authorizations, and thousands of other tasks What Is EVV? required to be successful in homecare. This
Electronic Visit Verification is the use of an electronic device, such as a telephone, computer, or GPS, to record visit delivery information. In its most traditional form, a care worker enters a patient’s home and, using the patient’s home phone, calls a dedicated tollfree number and enters a personal identification number. The telephony system uses the patient’s phone number and the care worker’s PIN to record the time the visit began. At the end of the shift, another call is placed and the system records the end of the visit.
How Does EVV Help Me?
There are two major benefits to using EVV:
1. EVV helps eliminate fraud by verifying that the visit was actually delivered and by automatically recording the visit times. 2. EVV removes the need for manual time cards and time card entry, speeding up the time to bill.
The Texas Mandate (and other states)
Many Texas Medicaid providers are now mandated to implement an approved EVV system. By January 9, 2015, these providers must select an approved EVV vendor from a list of four and begin using the system between February and the end of April. By May 1, 2015, these providers must be using the EVV system to document visit times.
The Major Problem with EVV
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Most EVV vendors do not have robust agency management software systems. They specialize in EVV, not the other 99% of running a home health agency. This means that providers who use EVV must have another system for referral
means that you need to integrate EVV into your current software package. When visits are incorrectly recorded using EVV, which happens about 20% of the time, you must correct the visit in the EVV system as well as in the billing system. This can mean manually editing thousands of visits per month. In Texas, the task is even greater because you are required to also allocate “reason codes” detailing why the visit was incorrectly captured. Mismatches between the two systems can cause payment delays or denials and the extra manpower required to stay compliant can mean the difference between profitability or closing the business.
The HealthTrust Solution
HealthTrust Global has partnered with Care Monitoring 2000, an approved EVV vendor for Texas, to implement a fully-integrated solution unlike anything else on the market. With HealthTrust and CM2000, providers never have to leave the HealthTrust system to schedule visits, reconcile EVV information, and bill visits quickly and accurately. From within the HealthTrust program, providers can schedule all of their visits (PDN shifts included) and the system will automatically transfer those to the EVV program without any action on your part. We will transfer all patient and employee data too! Then, when the visit is completed using EVV, our system will automatically match the EVV record with your schedule, reconcile discrepancies, and present you with a list of matched visits. For any irregularities, our EVV Wizard makes it extraordinarily simple to manually reconcile visits within the HealthTrust system; never hav-ing to leave our patient management program! What will be a nightmare for other providers will be a competitive advantage for you! See "ARE YOU USING IT?" on page 8.
The BAD news... If you have Texas Medicaid patients that are receiving PAS or PDN services, you are mandated to have EVV! The GOOD news... HealthTrust Software is the only software that is fully integrated with EVV! If you already use our software, there is no need to go to the CM2000 site. Simply contact our sales team!
EVV Timeline Summary Provider agencies, including former users of Santrax, must select an EVV vendor by:
January 9, 2015
DADS current EVV services provided by Santrax Ends:
January 31, 2015
All Medicaid-enrolled service providers (Provider agencies) providing "covered services" in the home and in the community are required to be using an HHSC-approved EVV system to record on-site visitation with the individual or health plan member beginning:
Attendant services February 1, 2015 Private duty nursing services May 1, 2015
Providers will use the EVV system, refine their operational processes, and may use paper timesheets as supporting documentation during implementation:
Attendant services February 1 - April 30, 2015 Private duty nursing services May 1 - July 31, 2015
The use of paper timesheets to support billing for "covered services" ends:
Attendant services April 30, 2015 Private duty nursing services July 31, 2015
Providers must be in full compliance with EVV requirements effective:
Attendant services May 1, 2015 Private duty nursing services August 1, 2015
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2015 Brings O
From the desk of Becca Matlock HTS Strategic Advisor
Important Information from CMS regarding OASIS Transmission Submissions Effective January 1, 2015, OASIS transmission files must be transmitted to CMS via the national OASIS Assessment Submission and Processing (ASAP) System. This change will not affect the way that you create OASIS transmission files in HealthTrust Software. However, it will affect what you do with the OASIS transmission file once you
download the file from HealthTrust Software. You should also be aware that the transition to the new ASAP system will require there to be a period of time when you cannot submit OASIS transmission files to CMS. For more information regarding the OASIS ASAP system, go to https://www.qtso.com/ hhadownload.html
The CMS article listed below highlights the changes at http://www.cms.gov/Medicare/ Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/OASIS-C1.html Conversion To Assessment Submission and Processing (ASAP) System 1. Effective January 1, 2015, OASIS assessment data will be submitted to CMS via the national OASIS Assessment Submission and Processing (ASAP) system. 2. With the implementation of the OASIS ASAP system, Home Health Agencies will no longer submit OASIS assessment data to CMS via their state databases. 3. In order to transition data from the state databases to ASAP, the OASIS submission system shut down permanently at 6:00 pm ET on December 26, 2014. The OASIS ASAP system will be available at 12:00 am
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ET on January 1, 2015. a. From 6:00 pm (ET) on December 26, 2014 through 11:59 pm (ET) on December 31, 2014, no OASIS assessments will be accepted. b. The OASIS ASAP system will become available at 12:00 am ET on January 1, 2015. 4. OASIS assessment data files submitted on or after January 1, 2015, using the ASAP system must follow version 2.10 (which supports OASIS-C) and version 2.11 (which supports OASIS-C1) of the OASIS data submission specifications.
OASIS Changes OASIS C1
The OASIS version will be changing to OASIS C1 effective January 1, 2015. HealthTrust will be releasing the new version on or before 12/31/14. The current OASIS version will remain in the software even after the new version is live due to there being outstanding OASIS assessment visits for 2014 that will not be passed in the software until 2015. If the M0090, Date Assessment Completed is 12/31/14 or before, the software will use the OASIS-C data set. If the M0090, Date Assessment Completed is 01/01/15 or after, the software will use the OASIS-C1/ICD9 data set. We recommend that offline Point of Care users sync or update their program files before completing any OASIS assessments for dates of service on or after 01/01/15.
OASIS-C1 Implementation
1. A modified version of OASIS-C1 (referred to as “OASIS-C1/ICD-9 Version") has been created. In this version of OASIS-C1, the 5 items that use ICD-10 codes (e.g. - M1011, M1017, M1021, M1023, M1025) were removed and replaced with the corresponding ICD-9 based items from OASIS-C (e.g. – M1010, M1016, M1020, M1022, M1024). The OASIS-C1/ICD-9 Version underwent an “emergency” Paperwork Reduction Act review by OMB and was granted approval on October 10, 2014.
2. The current OASIS data set (OASIS-C) will remain in effect until 11:59:59 pm on December 31, 2014. 3. The OASIS-C1/ICD-9 version will go into effect at 12:00 am on January 1, 2015 and shall remain in effect until ICD-10 is implemented or until another disposition is made by CMS.
New OASIS Transmission File Format
Beginning January 1, 2015, there will be a new option when creating OASIS transmission files. This new option has been developed due to the new data specifications for OASIS assessment transmissions. The new option will be seen by going to PPS > Create OASIS
Transmission File. There will be a checkbox that will by default be selected that says “CREATE FILE USING THE 2015 FORMAT”. Currently the file format created is a "dat” file format. The new option will create a zipped folder with individual "xml” files. You will
need to save the zipped folder to a location on your computer that you will then upload to CMS.
Becca Matlock has worked in numerous capacities at HealthTrust since joining the HTS team in 2011, including Sales, Onboarding, and overseeing the Customer Support Division. She now focuses on research so that HTS can continue to offer innovative and compliant software to our users. Before coming to HTS, Becca worked for 6 years in billing support at MJS and Associates, one of the top healthcare consulting firms in the nation.
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A Compassionate Care Lea Ann Holt - DON After working for three different agencies, Lea Ann Holt knew what she was looking for. “I worked for one company that was unethical, one that was corporately driven and was all about numbers, then one that was very ethical but not competitive. I want A Compassionate Care to be both competitive and ethical at the same time.” For all intents and purposes, it looks like her dream is well on its way to becoming reality. A Compassionate Care is owned by Jeremy and Billy Jean Johnson, recipients of the East Texas prestigious “Community Impact Award” through their work in the founding of The Dream Center in Lufkin, Texas. The Dream Center is a Christian ministry which exists to serve the homeless and low-income residents.
A Compassionate Care had its beginning in 2007 and Lea Ann started as their DON in July. Because the QA process was missing in their old software, she convinced the Johnsons that they needed to make the move to HTS. “Using the old software was very time consuming because there was no QA. Because of that we were under-documenting. The QA process with HTS has really helped as far as reviewing 485's and OASIS. It is a lot smooth-er with HTS.” Lea Ann says the whole transition process has been smooth and that HTS onboarding trainer Lindsey Amos has been super. “She even
The Johnsons appear to have the golden touch when mixing ministry Daughter and fellow animal lovand business. er 9-year-old daughter Macy, and They believe basketball playing 14-year-old son both are a great Rylee. combination called me back when her in home health. Leanne says water pipes busted in her ministry is a natural part of her house.” work, sometimes in very tangible ways. “On Christmas Eve Lea Ann gives a lot of credit of our nurses used the company the success of A Compassioncars as we went door to door ate Care to the nine nurses she to feed needy families with the directs. “They are great. They Dream Center.” give great patient care.” Proof 6
of that comes from a recent Joint Commission survey. The surveyor was from New York and not only did she show up unannounced but she came the first day they were going live with HealthTrust. Even with all the stress, the surveyor gave extremely high marks to the company and its nurses. “The Joint Commission has even higher standards than Medicare, and to hear that she thought our nurses gave great patient care was wonderful.” According to Lindsey Amos, the success of any company rides on the teachable attitudes of their staff. “Lea Ann and her staff were awesome! During the training process they listened, were open, took advice, and really tried to learn the software." Lea Ann wanted to make sure her nurses were comfortable with the transition. Lindsey said even though some of their scenarios were different, they dealt with them well.
Cont. from left Lea Ann loves her company so much that she says she will stay there until she is able to retire and live her second dream - to become a farmer.
She shares her love of animals and her cows, chickens, pigs, and five dogs with her 9-yearold daughter Macy. Helping her entrepreneurial husband,
caring for her animals, going to 4H meetings, and going to son Rylee’s basketball games is how she spends her down time...if they call that down time.
Mark Harvat - HTS Development Manager "We couldn’t be happier." That’s the general sentiment around HTS about the hiring of Mark Harvat as Development Manager. With a background in accounting, technology consulting and a small business owner himself, Harvat brings a wealth of experience to the HealthTrust team at a time when it is sorely needed. Jonathon Kovar, CEO of HTS, met Harvat while he worked for Accurate Home Healthcare doing financial reporting and systems implementation. Jonathon and Mark actually worked together to build much of the HTS payroll system. Fully anticipating HTS’s future growth and the need to exceed homecare programming expectations, Jonathon hoped that Mark would work for HealthTrust from that point on. Since his hiring six months ago, Mark’s challenges have varied but he says that every day he
feels better as he gets more comfortable with the team, staff, projects, and systems. He says his primary task is keeping everyone busy and balancing the variety of needs that hit his desk. Demands to develop new features to keep the product competitive while maintaining the ability to help current clients prosper are vital to HealthTrust’s growth and popularity.
Mark says HTS’s size enables it to be ready for the challenges of this ever morphing industry. “We vary from the larger home
healthcare vendors in many positive ways. We can be more flexible and quick on our feet… more responsive and capable.” Mark says the largest software providers may have more resources to throw at projects once they decide to do something, however they are usually slow to react to industry changes. On the other hand, HTS provides customized solutions at a reasonable price with a quicker turnaround. “HTS will continue to be a great organization with many opportunities and as we grow; the challenges and demands are going to get bigger and bigger.” Mark is no stranger to bigger and bigger challenges. Not only does he serve as treasurer for the USA Waterski Foundation, but when most of us in our middle aged years are hanging up our water skis, (if we ever put them on…) Mark is still donning his to compete. And that’s what he does for relaxation. 7
It's in the software....
ARE YOU USING IT? EVV With CM2000 This screen allows you to match unplanned visits as well as edit visits that require a reason code.
The agent module generates each agent’s 800 number that will be used for the agent to call in and call out for EVV tracking purposes.
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New Requirements for Face to Face Encounters Go Into Effect January 1
The Centers for Medicare & Medicaid Services (CMS) held a long-awaited National Provider call on the revised home health face-to-face encounter requirements for certifying Medicare home health patients. The revisions go into effect January 1, 2015. The CMS officials presented an overview of the requirements for home health eligibility, along with the revisions made in the final rule relative to the face-to-face encounter. CMS reiterated that the narrative requirement will no longer be required for initial certifications beginning January 1, 2015. CMS did emphasize that a brief narrative is required for certifications and recertifications for patients receiving skilled nursing for Management & Evaluation of the Care Plan. Although the narrative has been eliminated, all other aspects of the face-to-face encounter are still required, such as the encounter must occur no later than 90 days prior to or 30 days after the start of care; is related to the primary reason for home health service; and is performed by a physician or an allowed non physician practitioner. CMS will apply the face-to-face encounter requirements anytime a new start of care Outcome and Assessment Information Set (OASIS) is required. CMS confirmed that they will review the certifying physician’s record to ensure documentation supports eligibility for home health services. Agencies must obtain the physician's record if the agency’s claim is targeted for medical review. Additionally, the presenters provided various examples of progress notes and discharge summaries and highlighted what CMS will be looking for when reviewing the medical record to support eligibility for home health services. As currently required, acceptable documentation would include the physician detailing why a patient needs skilled services and reason(s) for a homebound status. If the physician’s documentation does not substantiate a patient’s eligibility, CMS will permit the agency to fill in the “gaps” by providing the physician with information that supports the need for skilled services and a homebound status. The physician would be required to sign any documentation received from the agency and
incorporate it into his/her own medical record Although agencies are not required to obtain the physician’s documentation prior to billing, CMS recommends that agencies obtain as much information as soon as possible from the physician to ensure eligibility requirements have been met. CMS also stated that they plan to initiate probe reviews for physicians who have a pattern of referring patients that do not meet the home health eligibility requirements. However, they did not provide details on how this would be implemented. During the Q&A session of the call, CMS addressed several questions relating to the specifics of acceptable documentation needed to comply with the revised requirements. •The agency could incorporate their findings that support eligibility for home health services in the POC for the physician to sign. What is unclear is whether or not the agency will be required to include portions of the assessments that support these findings. •The face-to-face narrative document currently used by physicians will not be required to document home health eligibility. CMS will look at the physician’s record for support of home health eligibility and must include the actual visit note from the encounter or a discharge summary if the patient is admitted to home health after an acute post-care facility stay. •CMS indicated that the physician’s encounter note would need to only include the date of the encounter, be related to the primary reason for home health, and be signed and dated by the certifying physician. The agency could fill in the “gaps” by supplying the physician with information from their assessment that supports eligibility, but it must corroborate with the physician’s documentation. It is still unclear what CMS will accept as sufficient corroborating documentation from the physician. The National Association for Home Care & Hospice (NAHC) has serious concerns about some of the information conveyed and positions taken by CMS. Specifically, NAHC is concerned Cont. on page 10 9
Cont. from page 9 about the depth of documentation that CMS is expecting from physicians. NAHC is also concerned about the standard that documentation from the HHA alone is insufficient to support the physician certification and that it can be used only if it corroborates other documentation not prepared by the HHA. Lastly, CMS did not address or even seem to appreciate the burden it will be
for both physicians and agencies to obtain the physician’s record. And what are agencies to do if the physician does not cooperate? NAHC will continue to work with other stakeholders and communicate with CMS to have the concerns of home care and hospice providers addressed. Article from NAHC Website: http://www.nahc.org/NAHCReport/nr141217_1/
SOFTWARE TIPS From Your Customer Service Reps 1. Report Center: HealthTrust Software has over 140 reports in our report center and quick consultant module. If you are looking for a particular report and do not currently see it, go to Administration>Groups>select the user group that you are in>scroll to the bottom of the page and click the boxes "Click here to select reports" and "Click here to select consultant modules". You can then select the reports you would like to access. Submit the changes. 2. Color Customization Option: If you would like to customize your user experience, you can select a color scheme by going to File>preferences>select a color scheme>submit. 3. Default Schedule Preferences: HTS allows you to customize your default schedule display by going to File>preferences>check the boxes that you would like to default when you view a schedule>submit.
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4. Care Validation - Failed Visits: If you need to view visits that are failed back to clinicians from Care Validation, check the box "show all visits". This will show visits that are in Care Validation needing to be validated as well as visits failed back to
clinicians. 5. Visit Status: If you have a visit that is in confirmed status and you need to put the visit back in Care Validation, go to the schedule or charges menu and select the date of service for the visit that you need to place in Care Validation. Clicking on the visit will open an edit charge screen. Change the status to "unconfirmed" and then click on the tracking tab and change the validation status to where nothing is selected. Submit the changes and the visit will then appear in Care Validation. 6. Online Point of Care: HealthTrust Software recommends that if you are working in the online Point of Care system to only have one internet browser tab or window open. Having multiple windows or tabs open might not allow your information to save correctly. 7. Home Screen Options: You can customize what screen appears first when you log in to the online system! You can choose to either view the home page or the dashboard when you first log in. You can select your preference by going to File>preferences>and checking
the box "show home page on login" or uncheck the box "show home page on login" to see the dashboard. 8. Medical Records: HealthTrust Software has a Medical Records module where you can view all of your patients' medical records or filter by patient or type of document. This module can be accessed by going to Patients>Medical Records. 9. Medical Records: In order for a visit to show in the Medical Records module, the visit must have been completed in Point of Care and passed through Care Validation. 10. Care Validation Group Setting: If your users cannot find a particular type of service in Care Validation, check the user group to verify if the group has access to the type of service. The user group can be verified by going to Administration>Groups>select the group that the user is in>scroll down to the "Compliance Menu" section. You can select to limit to service code or limit to service category. Submit the changes.
HEALTHTRUST SOFTWARE RELEASE January 2015
These updates took place on Saturday, December 20, 2014. SOFTWARE ENHANCEMENTS and RESOLUTIONS BILLING: Primary Physician Option on Claims There is a new option under the Claims section of the Edit Payer screen named "Requires Primary Physician". When a payer is added, this defaults to YES and is also defaulted to YES for all current payers. If the setting is set to YES, all claims require a primary physician in order to be confirmed through Pending Claims. If the setting is set to NO, claims can be confirmed through Pending Claims with or without a Primary Physician. In View Pending Claims, if a claim that does not require a physician has a primary physician attached, there is a warning that says THERE IS A PRIMARY PHYSICIAN ATTACHED TO THIS CLAIM. If there is no primary physician attached, the warning says THERE IS NO PRIMARY PHYSICIAN ATTACHED TO THIS CLAIM. This does not prevent the claim from being confirmed, as it is just a warning. For claims with no primary physician attached, box 17 of the CMS-1500 claim is blank and box 76 of the UB-04 claim also blank. PATIENTS/AGENTS: Linking Notes Between Patients and Agents A new tab labeled "Linking" has been added to the Add Note screen when adding notes for Agents or Patients. When this tab is clicked, there are 2 dropdown menus for agents and patients. The list of agents includes all agents with who are not limited to a provider and agents with the same provider selected as the patient. The list of patients only includes patients with the same provider selected as the current patient. When an agent is selected, it appears in the Selected Agent List below and when a patient is selected, it appears in the Selected Patient List below. Agents/patients can be deleted from the list by clicking the red X to the right. Any agent or patient that is selected to be linked receives a copy of the note that was added. REFERENCE FILES: Updated POC/Test Categories Menu The POC Test/Categories page in the Reference menu has been updated to match other similar pages under the Reference menu (e.g. Attributes). This includes consistent functionality when adding, editing, and deleting test categories. MAIN PAGE: Logout Button A new button has been added above the menu buttons to allow for one-click quick access to log out of the system without having to access the File drop down menu. The new logout button appears in the top right-hand corner of the screen next to the Messsages alert area. When it is clicked, the user is logged out of the system and brought to the healthtrustglobal.com homepage where they can log back in. DASHBOARD: Task Appearance on Dashboard Calendar If a new task is added that has a description that is longer than 25 characters, only the first 25 characters will show on the Dashboard calendar and then the rest can be seen once the task has been opened.
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The following bugs have been resolved in the system: TIMESHEETS: Timesheet Calculations Total time now calculates correctly on timesheets, whether the time is entered manually, edited, or by using the clock in/out function. Future dates are no longer allowed. Also, end times can no longer be entered that are before the start times and start times cannot be entered that are after end times. SERVICES/BILLING: Service Pricing Limitations If a service pricing is limited to a specific patient, that pricing will no longer show for any other patients. ATTRIBUTES: Inactive Attributes Now, only active attributes appear in the list of attributes under Patient > Patient Menu > Misc > Attributes > LINK ATTRIBUTES as well as under HR > Agents > Attributes > LINK ATTRIBUTES
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