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Provider Statistical and Reimbursement System

Provider Statistical and Reimbursement System. The New and Improved. PS&R. Presented By: Don Fry, Director, KPMG LLP, Los Angeles With permission of Tony Matos, FCSO SME Members For The Redesign Team. THE EXPECTATIONS OF THIS PRESENTATION. Provide a basic understanding of

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Provider Statistical and Reimbursement System

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  1. Provider Statistical and Reimbursement System The New and Improved PS&R Presented By: Don Fry, Director, KPMG LLP, Los Angeles With permission of Tony Matos, FCSO SME Members For The Redesign Team

  2. THE EXPECTATIONS OF THIS PRESENTATION • Provide a basic understanding of • The infrastructure of the old system vs. new system • Benefits of the redesign • The new enhancements on reports,output formats and requesting capabilities • Navigational steps • New PSR Summary and Detail request procedures • Managing your Inbox • Once CMS completes the final revision of the training material, they will be notifying all users and provide a Web location where you will find documentation and Web Base Training (WBT) .

  3. Who is this Redesign Team? • This is a joint effort among... • CMS - Project Owner • CGI Federal - Development Firm • BCBS Association - SME • PS&R Admin./Users of the FI community - SME

  4. PS&R Redesign Project • The PS&R Redesign project started in October 2003. It has involved: • Re-designing a new technical architecture, report generation logic and report layout • Developing the necessary software and integrating with the appropriate systems • Implementing the system after development, testing, training and rollout activities are complete • The new system will support all the reports that are currently applicable in the legacy system

  5. Enhancements • Enhancements include: Improved Access • Providers can generate their own Summary reports and order Detail reports online • All users have increased access to data • Centralized PS&R system/data resides at CMS including all data processed by Regional Home Health Intermediaries (RHHIs) • Increased security over information with conformance to Office of Information Services (OIS) enterprise security standards • Web-based application • Online Help and user documentation

  6. Enhancements • Increased flexibility • Efficiency and consistency maintaining business rules • Requestor can select single or multiple providers, report types, and service periods • Single source when updating; code-focused approach to installing system updates • Improved delivery • Standardized approach to provider requests for detail reports • Summary reports are delivered to the user’s on-line Inbox • can be downloaded at the user’s convenience • Detail reports are downloadable by CMS and FI/MAC users • Detail reports will still be available for providers on password protected CD

  7. Enhancements • Just-in-time • All users will be able to run summary reports on demand • FI/MACs and CMS can run detail reports on demand • Providers can expect shorter turnaround time when requesting detail reports • Improved data processing • Report type assignment routes claims and claim lines to appropriate reports • State-of-the-industry electronic data transfer and data warehousing of paid claims data • Quicker updates to reports based on Medicare regulations and policies

  8. The Old Way PSR Flows Data is sent to the FI’s Data Center / RHHI Centers Provider This Is All Done by Mainframe Processing, Fax Request And/Or Regular or Express Mail Delivery Fiscal Intermediary

  9. Log in to use PS&R ID PWD The New Way PSR Flows Via the World Wide Web. • On the World Wide Web! Data is sent to the CMS Data Center/EDC Provider CMS Data Center/EDC PSR Users Will Access the Data Using Web Based Application Via Internet , and reports will be stored in users inboxes All PSR Users CMS

  10. Data by User Type • Providers: • Only view their data • Have direct system access to their summary reports • Can request detail reports from their FI/MAC PS&R administrator via the PS&R system • Due to PHI data displaying on the PSR detail reports , these reports will not be transmitted to the user’s inbox • Providers will receive the detail reports via password protected CD or other methods determined by the FI/MAC

  11. How Will Data Be Regulated? • The PS&R system will know, by your login profile, what type of user you are and the information and functions that can be displayed on your home page • Providers see only the reports that relate to their data • Parent providers see all their hospital and subunit information

  12. Time Frame to Access the System • NEW System – • Starting point for paid claims available will be determined by CMS: CMS is projecting for first quarter of 2008 • Legacy PS&R – • The implementation of PS&R V37D will allow the legacy PS&R system to produce reports. • We are working on another cut off, CMS will give us the new date very soon • Legacy System will continue to be available for older service dates : Access to the new PS&R system depends on the progress of the development of the new CMS IACS system “Individual Authorized Computer Services”

  13. New CMS I.A.C.S. Login Page“Individual Authorized Computer Services” I.A.C.S. This is an application that’s in the process of being implemented by CMS. The system will be a gateway for all CMS system users, including providers. All users will be required to complete a registration application. Once completed and approved, each user can log on to I.A.C.S. and, depending on one’s profile, will have access to CMS systems and data. Appropriate information will be provided by CMS once they are ready to activate the application.

  14. CMS IACS Login Page

  15. Let’s Take a Look atBefore and After Report Enhancements

  16. Before Legacy Reports – 110 Summary

  17. After What Does the New Summary Reports Look Like?

  18. Summary Section and Line Reorganization

  19. Summary Section and Line Reorganization

  20. Before Legacy Detail PSR

  21. After What Do the New Detail Reports Look Like? Reimbursement Section Claims Section Additional Information Section Example: Detail Report

  22. These are links of all the reports generated; clicking on the link will take you directly to that report type Report Cover Page

  23. Provider Statistical and Reimbursement System Navigating in PS&R

  24. Depending on your logon the Menu options on the navigational tool bar will change Home Page

  25. Header Navigation Pane Home Page – Three Navigation Panes Content Section

  26. Search Feature Paired with Transfer List Box

  27. Transfer List Box – Elements Available Items list Selected Items list Transfer buttons

  28. Check Box Check Boxes

  29. Radio Button Radio Buttons, Select only one

  30. Scroll forward or backward through months or years • Select a specific day Dynamic Calendar

  31. Output Format Selection The user can pick the output to be created in PDF, CSV or both.

  32. Please use the logoff option to exit the system Logging Off The System You will be directed back to the IACS login page

  33. Provider Statistical and Reimbursement System Request and Retrieve Summary Reports

  34. Report Request Process • Request a summary report by entering report parameters in a sequence of Web pages.

  35. Drill Down Menu Starting Out – Home Page Select Request Summary

  36. By Provider Type By Provider Number Select Provider(s)

  37. Select one of the report filtering options Select Report(s)

  38. Select Service Periods • By Interval • Select Interval • Type Period 1 Start Date • Click Apply

  39. Select Service Periods • By Period • At least one period but up to four periods can be selected • Type dates in From and To fields • Dates can be non-uniform and non-continuous • Click Apply

  40. Select Service Periods • By Provider • Change default dates • Change for each provider in report • Exclude entire period or period by provider

  41. Default Paid Dates based on earliest and latest paid date of a loaded paid claim file for FI/MAC Press The Reset Button to set back the default values Select Paid Dates

  42. Select Report Format

  43. Select Report Format CSVin Excel PDF

  44. Great way to check to see if requested data is available for a provider! Confirm Report Request

  45. Confirm Report Request • What You Can Change: • Your Request Name – up to 50 characters • Exclude entire period or period by provider

  46. Confirm Report Request THEN Click the Submit button to generate the report…and you’re done! If this is frequent request parameter , save it !

  47. Click a column heading to sort reports by that column Delete un- wanted reports Summary Report Inbox Page Displays a list of all reports that have been submitted for processing. If there are no reports, “There are no results to view at this time” message appears.

  48. Date request submitted From Your Request Name field on Request Confirmation page Request Name and Request Date

  49. Open a Report If Status = Complete, Report column shows link Click link to open report

  50. PDF Report Cover Page Displays all generated report types per provider and total number of pages per report type

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