CareWatch : One Stop Shop

1. CareWatch: One Stop Shop

2. Petersen Health Care- Who Are We? • 71 long term care facilities • Four Missouri homes • Largest long term care provider in Illinois • 67 homes

3. Petersen Health Care- Who Are We? • Four Regions • Licensed nursing home administrator as regional director • 1-2 regional nurses • Dietician • Regional marketing coordinator • Nurse liaison in hospitals

4. Petersen Health Care- Who Are We? • Three Reimbursement Specialists • Supervise 92 MDS coordinators • Average 3,000 Medicare MDSs per quarter for 31,000 Medicare days • Average 2,600 MDSs submitted for Illinois Medicaid RUGs per quarter

5. Two Most Important Reimbursement Functions of Reimbursement Specialists • Education • MDS coordinators • Administrators & DONs • CNA ADL documentation • Quality Improvement • Review of Medicare MDS/RUG • Medicaid MDS timeliness • Documentation reviews

6. MDS Coordinator Education • Includes Answers on Demand and CareWatch • MDS, CAA & Care Plan & Medicare • Side by side training with reimbursement nurse • Side by side training with a mentor MDSC • Three day classroom training

7. CareWatch Administrator Use:One Stop Shop • Administrator Education • Timeliness Checks • MDS 3.0 Assessments Due • Transmission Checks • MDS Transmission Enterprise Report • MDS Transmission Watch • Default Rates • Reimbursement Analysis- RUG Potential • 5 Star Ratings & QI/QMs • Transmission Watch- CMS Reports

8. CareWatch DON Use: One Stop Shop • DON Education • Late Loss ADL Checks • ADL Watch- review • Restorative Checks • Restorative Watch- preview & review • Survey Prep • 672/802 • Survey Watch- CMS Survey Report –enter state/zip • 3.0 Details • Hospital Readmissions- Readmission Watch

9. CareWatch Reimbursement Specialist: One Stop Shop • Medicare QA Mid-Month & End of Month • Census compared to MDS insure a RUG • All therapy RUGs are checked against therapy program • Billing is done out of the home office • RUGs are reviewed by the billing specialists in UBWatchprior to billing • Transmission is verified by billing specialists in Transmission Watch prior to billing

10. CareWatch Reimbursement Specialist: One Stop Shop • RUG Reimbursement Analysis • MDS 3 Assessments Due- review for past due & set dates for next month--assess these now to place on restorative programs so tracking is in place before look back starts • ADL Watch- review as a team to be sure residents are coded accurately & to identify those who are declining • Restorative Watch- to be sure restoratives are being captured & to identify those who should be in programs • MDS 3.0 Details- to choose any MDS section to view accuracy & frequency of reimbursed item

11. CareWatch Reimbursement Specialist: One Stop Shop • RUG Reimbursement Analysis • Reimbursement Analysis-RUG Potential 66- Medicare RUG analyzed and improved by clicking on the “Rule Count” and making appropriate changes in the resident’s care • Reimbursement Analysis-RUG Potential 48- Medicaid RUG analyzed and improved by clicking on the “Rule Count” and making appropriate changes in the resident’s care within the Medicaid rules for reimbursement

12. CareWatch Reimbursement Specialist: One Stop Shop

13. CareWatch Reimbursement Specialist: One Stop Shop • Illinois Medicaid Review-average over 2,500 MDS per quarter • First quarter “live” there were 21 defaults = 0.84% • Almost $53,000 cost for the quarter • ½ MDSs not successfully transmitted & ½ resident not D/C from HFS system or not matched in the HFS system

14. CareWatch Reimbursement Specialist: One Stop Shop • RUG reimbursement analysis adjustments • BOM required to compare: • Prepayment report against census each month • MDSC required to review: • Suspended assessments • HFS provided roster report & insure validation report was present for an MDS in the quarter for each person on roster

15. CareWatch Reimbursement Specialist: One Stop Shop • Second Live Quarter-average 2,600 • 17 defaults = 0.65% • Still a $50,000 cost for the quarter • 12 MDSs not successfully transmitted • Several not transmitted successfully and several rejected and not re-transmitted

16. CareWatch Reimbursement Specialist: One Stop Shop • RUG reimbursement analysis adjustments • Reimbursement specialist list to admin & MDSC: • Any MDSs left in Suspended Assessments • Transmission Enterprise Report- review for late transmissions & rejected MDSs that have not been replaced • Both MDSC & reimbursement specialist review: • HFS provided roster report & go into- Resident Information- History- to insure “Transmission Complete” during quarter

17. Illinois Medicaid RUG Analysis • Reporting of analysis of RUGs is helpful in comparing among other facilities and comparing past performance to present performance

18. CareWatch Reimbursement Specialist: One Stop Shop • We are waiting to see the positive impact of the changes we have implemented using the Enterprise Report and the “double” check using the Resident History

19. eHealth Data Solutions:PHC’s One Stop Shop • What we like best about eHDS: Adaptability! • We have asked to see on the Transmission Watch page the actual type of MDS that has been transmitted- please give eHDS your positive feedback if this would be helpful to you too! • Included for you from this presentation: • Navigating the CW Website • Medicaid Facility Analysis Template • Medicaid RUG 48 Calculator

20. ANY QUESTIONS?THANK YOU FOR YOUR TIME & ATTENTION!