Additional Documentation Requests (ADRs) are on the rise and can be very costly to your homecare business.  On January 12, 2012 our friends at Ohio Council for Home Care and Hospice clarified that a number of their members received ADRs, and Palmetto recently stated “there will be more in the near future as new edits have been recently placed on some of the reviews”.

The purpose of this post is not to be a guide to fix ADRs but a source of information and resources shared from the many conversations going on across the nation regarding ADRs.

Consistent throughout the information being shared by home health consultants and professional associations, is to implement a proactive ADR management strategy. While it is certainly important to have a plan in place to respond to ADRs, avoiding them altogether by putting a proactive strategy in place will have more significant long-term benefit to your agency.  As they say, proactive is always better than reactive.

The 3 T’s of Proactive ADR Management

Talent

Success in home health is very dependent on human resources.  We are in a people business which requires excellent talent in both the field and the office.  Your staff needs the aptitude to learn and understand the importance of complete documentation and process as it relates to the health of your business and the continued ability to care for patients in their home.

Training

Focused training on activities that can minimize ADRs include the Intake/Referral process, OASIS Assessment and clinical documentation, QA, Order Management, Coding, and Pre-Billing Audits.

Technology

Several technologies can help agencies implement and manage to a more proactive environment.

Agency Management Software - A comprehensive home health agency management software system helps agencies adhere to regulatory requirements by putting checks and processes in place up front in key processes.  Key features to look for that can help minimize ADR impact includes:

Electronic Intake/Referral capabilities that requires certain data (such as Point of Origin) to be collected in the admission process.

Scheduling functionality that matches orders to schedules

Correct G-Code documentation at the Point of Care.

Order Management features that enable an agency to verify that an order is complete, signed, and dated prior to releasing an electronic trigger for that pre-billing check.

OASIS Inconsistency Checking that alerts agencies to changes between assessments prior to OASIS and claims submission.

Comprehensive Pre-billing Checks that hold claims from being created until necessary upstream processes are clean such as ensuring orders, schedules, and visit records are properly QA’d, validated, and complete.

OASIS Scrubbing - To compliment the process-driven agency management features, an additional layer of OASIS scrubbing can also be a significant element in your strategy.  There are several available tools such as Home Health Gold, PPS Plus, and Strategic Healthcare Programs (SHP) that integrate with agency management software to provide additional OASIS analysis.

Point of Care - Adopt Point of Care documentation technologies that facilitate timely, accurate, and complete documentation.  If your staff is not documenting at the point-of-care, then its not point-of-care.  All too often in home health, clinical documentation is not completed at the point of care due to the complexities in many technology-heavy approaches.  Thus, nurses end up documenting after the fact, which impacts downstream processes and also reduces accuracy, as the human brain continually loses information over time.

HomeSolutions.NET has been built to help agencies manage their business in a more proactive manner with several in-line processes and Flex Point of Care options.  When combined with OASIS scrubbing tools, exceptional talent, and focused training, the impact of ADRs can be minimized significantly.

ADR Resources – MAC’s

Palmetto

• Palmetto GBA Responding to Home Health Additional Development Request (ADR) Checklist
• Recent Palmetto update regarding notice now being sent in white instead of yellow envelopes
• Palmetto GBAs detailed list of what needs to be provided
• Palmetto GBA DDE manual with steps on accessing DDE (page 41 regarding ADRS)

Cahaba

• Quick Reference Tool

CGS

• Point of Origin: Avoid billing errors caused by overlapping episodes
• Quick Resource Tool

NHIC

• NHIC PDF with Information on ADRs and sound process for submission/reviewing

ADR Resources – Industry

We encourage providers to monitor the many ADR topics on their state and national homecare association listserves.  Here is a list of other known resources.  If you have more you’d like to share please contact us and we’ll continue to update this resource.

• Michael McGowan – Medicare Appeals Development -  http://www.madappeals.com/

• Carol Anderson – Article regarding having a pre-billing audit plan

• Haydel Consulting - Blog: http://haydelconsultingservices.com/2012/01/

• NAHC –  2011 Presentation  - Two Sides of the Coin – Why Was My Agency Denied

Computer Science Education Week (CSEdWeek), designated by the U.S. House of Representatives as the week of computing pioneer Grace Hopper’s birthday, recognizes the transformative role of computing and the need to bolster computer science at all educational levels.  During the week, Sansio staff members participated in a panel at the College of St. Scholastica.

The panel presentation was part of the college’s Pathways to Computing, a full day program allowing high school and college students an opportunity to explore careers in computer science and information technology.

Participating on the panel from Sansio were St. Scholastica graduates Kim Berrisford, Tom Berrisford, and Russ Kurhajetz, along with other Duluth-area CSS graduates working in technology including Reed Fulghum from 3Five Designs, Alyssa Engleson from aimClear, and Ben Friesen from Saturn Systems.  The panelists provided students with an overview of their technology businesses and personal insight into their positions and how they arrived at their career choices.

The engaging audience of students asked several questions that spurred conversation such as:

“How much of our day is spent working in teams?”

“How much difference in salary do you see if you have a degree?”

and “What skills did you learn that are vital to your role?”

Sansio representatives also provided these words of encouragement to students, “gain a base set of technical skills and show off your enthusiasm.  Technical skill may get you an interview at a Software as a Service (SaaS) company like Sansio, but attitude, aptitude, and passion will all be very influential in landing you a career.”

More information about CSEdWeek can be found online at: http://www.csedweek.org/

CMS has made available the 2012 Final Rule for Home Health Agencies, which takes effect January 1, 2012.  The Final Rule was displayed at the Federal Register (and revised 11/9/2011) to update Medicare’s Home Health Prospective Payment (HH PPS) rates for Calendar Year (CY) 2012.

A summary of the changes introduced include:

• Payments to home health agencies (HHAs) are estimated to decrease by approximately 2.31 percent, or $430 million in CY 2012, the net effect of a 1.4 percent payment update ($280 million increase), the wage index update ($10 million increase), and a 3.79 percent case-mix coding adjustment ($720 million decrease).

• The final rule imposes a negative 1.32 percent case-mix coding adjustment to the national standardized 60-day episode payment rates for CY 2013.

• The final rule finalizes structural changes to the HH PPS by removing two hypertension codes from the case-mix system, lowering payments for high therapy episodes and recalibrating the HH PPS case-mix weights to ensure that these changes result in the same aggregate payments.

• Finally this rule adds flexibility to allow physicians who attend to a home health patient in an acute or post-acute facility to inform the certifying physician of their encounters with the patient in order to satisfy the face-to-face encounter requirement.

Related:  The online version of the 2012 Home Health PPS Final Rule is available on the Federal Register webiste.  See this link for the online version. 

Sansio hosted a HealthEMS User Conference on Thursday, September 29, 2011 for Minnesota area Fire/EMS customers.  The event was held at the new state of the art Woodbury Public Safety Building training center in Woodbury, MN.  Attendees received valuable information to help maximize their investment in HealthEMS and related partner services. 

The attentive crowd heard presentations from Sansio staff that ranged from strategic items including corporate updates and product roadmaps, to practical tips on optimizing the HealthEMS experience in the areas of dashboards, reporting, and operational management.   The conference was specifically geared for administrators, operations and clinical QA/QI staff, and Medical Directors.

In addition to reviewing new HealthEMS feature enhancements, Sansio staff presented the vision for development of the browser- based ePCR, previewing the new HealthEMS Mobile v5 running on tablets and iPads.

Attendees were also provided a preview of HealthEMS RevNET™, an optional HealthEMS Extension designed to provide secure, integrated, web-based revenue cycle management for processing claims, ERA, eligibility, and statements.  Sansio staff shared how HealthEMS RevNET will provide Fire/EMS customers benefits of having a single, completely integrated “CAD to Cash” solution.

Sansio thanks the City of Woodbury EMS Division for providing the venue for this conference.

Sansio is pleased to announce that Kaitlyn Steffen, a graduate of Park Rapids High School, was awarded the 2011 Sansio Scholarship for the UMD Labovitz School of Business and Economics (LSBE).  Ms. Steffen is a senior at UMD studying Human Resources Management and Finance. 

Sansio representatives Kevin Noreen, CFO and Dave Purdy, HR Manager presented the award during the LSBE Scholarship Reception at the UMD Kirby Ballroom on Thursday October 6, 2011.  “We were impressed with the spirit and passion for excellence that this young lady exhibits and she was very appreciative of the financial award,” stated Kevin Noreen. “The Sansio Scholarship for UMD is an investment in the development of future business leaders and we couldn’t be happier with this year’s winner.  We wish her the best of success.”

The Sansio Scholarship for UMD was established in 2007 to reward a deserving LSBE student for their excellence in and out of the classroom.  Sansio is a leading provider of SaaS (Software as a Service) information management solutions that help healthcare providers improve clinical, operational, financial, and regulatory performance.  Always “Thinking Customer First”, Sansio employees and partners follow its SIETE principles at the core of its business model; Be Responsive, Kind, Courteous, Respectful, Professional, always Listen, and provide Answers. This award is targeted for students that demonstrate those principles.

The UMD Labovitz School of Business and Economics (LSBE) was established in 1974 and serves approximately 1,850 students annually. The UMD LSBE is one of only four schools in Minnesota to be accredited by the Association to Advance Collegiate Schools of Business International (AACSB).  Nationally, only one-third of the 1,200 schools of business and management have earned and maintained AACSB accreditation. LSBE offers high-quality undergraduate and MBA programs and its students experience a rigorous curriculum inside the classroom and through hands-on internships and projects with area businesses outside the classroom.

Sansio hosted its annual HomeSolutions User Conference on Saturday, October 1 in Las Vegas as part of the events surrounding the National Association of HomeCare and Hospice Annual Meeting.  The theme of this year’s User Conference was “Taking Care to the Cloud™” and the content focused on cloud-based computing in home healthcare.  Home care customer attendees received valuable information to help maximize their investment in HomeSolutions and related partner services. 

The attentive crowd heard presentations from Sansio staff that ranged from strategic items including corporate updates, national technology priorities, and product roadmaps, to practical tips on optimizing the HomeSolutions experience in the areas of dashboards, scheduling, reporting, and operational management. 

Customer success sharing was again a key component of the conference.  Pictured below, customers shared how their agencies were able to improve performance by incorporating HomeSolutions Virtual Office integrated document management and RediPay payroll pre-processing Extensions.

After a long day of absorbing vast amounts of information, attendees were able to share ideas and network at an evening reception hosted by PPS Plus, Dial N Document, HC Billing and HC Healthcare Consulting, a few of Sansio’s valued business partners whose services compliment HomeSolutions. 

It was helpful for customers to maximize their travel and time away from the office so they could attend both the NAHC Annual Meeting and the HomeSolutions User Conference in one trip.  In support of NAHC, Sansio was a sponsor of their 30th Annual Meeting and exhibited at the Homecare Expo on the days following the User Conference.  The NAHC Annual Meeting also provided a great face to face opportunity for customers to followup with Sansio staff. 

The 2011 NAHC Annual Meeting was well attended and many homecare customers spent time at the booth with their Sansio account managers and business analysts, formulating plans to apply what they learned at both the User Conference and NAHC educational sessions. 

Plan now to join us in Orlando, FL October 20 – 24, 2012!

Visit us on Facebook for more photos.

In a sign of support for its New York City Fire/EMS customers, Sansio is proud to become a Charter Member and Cobblestone Sponsor of the National 911 Memorial and Museum. The 911 Memorial will be dedicated during a ceremony with victim’s families on September 11, 2011, the 10th Anniversary of the attack, and will open to the public the following day.

“The fact that this memorial outlines the very footprints where these towers stood sends a message to the world of what we lost that day and how we’ve come together,” said 911 Memorial President Joe Daniels.

On the twin footprints of the towers are gentle waterfalls that empty into massive reflecting pools edged by bronze parapets with the names of the 2,983 people killed on 9/11 in New York, in a field near Shanksville, Pennsylvania, and at the Pentagon, along with victims of the 1993 bombing at the World Trade Center.

The cobblestone that Sansio sponsored is in the Memorial Glade area, which is on the west side of the south pool. The exact location is shown below:

The 911 Memorial Glade area is designed for special gatherings and is outlined with several trees and benches for reflection with clear views of the museum and memorial pools.

At the time of the 9/11 attacks, Sansio was working with FDNY to pilot its HealthEMS ePCR solution. Today, Sansio is proud that its ePCR solution is assisting FDNY provide exceptional care to the citizens and visitors of New York City. Sansio looks forward to continuing its service to the Fire Department of New York and is thankful for this opportunity to remember those who cannot be with us today.

ABOUT THE NATIONAL SEPTEMBER 11 MEMORIAL & MUSEUM

The National September 11 Memorial & Museum is the not-for-profit corporation created to oversee the design, raise the funds, and program and operate the Memorial and Museum at the World Trade Center site. The Memorial and Museum will be located on eight of the 16 acres of the site.

The Memorial will remember and honor the nearly 3,000 people who died in the horrific attacks of February 26, 1993, and September 11, 2001. The design, created by Michael Arad and Peter Walker, consists of two pools formed in the footprints of the original Twin Towers and a plaza of trees.

The Museum will display monumental artifacts linked to the events of September 11, while presenting intimate stories of loss, compassion, reckoning and recovery that are central to telling the story of the 2001 attacks and the aftermath. It will communicate key messages that embrace both the specificity and the universal implications of the events of 9/11; document the impact of those events on individual lives, as well as on local, national, and international communities; and explore the continuing significance of these events for our global community.

Donations can be made through and more information can be found at the 911 Memorial’s Web site, www.911memorial.org.

Job Title: System Administrator
Location: Duluth, MN
FLSA: Salary, Exempt

Qualified System Administrators who have what it takes to fit into our team oriented environment are invited to submit a resume.

Primary Duties:

• Design, install and configure computers systems
• Operate and maintain system hardware and software
• Make sure that that system hardware, software, operating systems and procedures conform to organization norms, values and standards
• Create user accounts and passwords
• Troubleshoot reported system errors
• Monitor operating system efficiency
• Oversee LAN, WAN, INTRANET and Internet connectivity issues
• Provide system and network security
• Effectively communicate system failures and potential solutions
• Testing of potential and implemented solutions

Qualifications:

• 4 year degree preferred
• Associates Degree plus relevant work history at a minimum
• Excellent communication skills at both a technical and professional level
• Strong problem solving abilities required
• SIETE – ability to be responsive, kind, courteous, respectful, professional, listen, and provide answers

 Sansio is an equal opportunity employer

Cloud-based Computing Changes the Home Health Point-of-Care Paradigm

How do clouds, the Google Effect, the FDA, and technology impact the homecare nurse?

They are all elements that lead to a paradigm shift in point-of-care electronic visit documentation (EVD). EVD is at the intersection of technology and healthcare. This article will help identify the benefits of “taking care to the cloud”.

Device-heavy EVD - It used to be that home care nurses had to “make do” with difficult approaches to point-of-care EVD that involved synchronizing loads of data from agency databases to applications running on mobile devices such as laptops or tablets. Often times, this process was so cumbersome that nurses would simply avoid using the technology in the home, during the visit, and would instead “document their day” on their own time at night. This certainly wasn’t the intent of device-based EVD technology but unfortunately an all too common occurrence.

In the rare cases when the point-of-care device was used during the patient encounter, the information which the nurse may have been basing decisions on was only as current as the last time they synchronized or updated their local EVD application. In the dynamic home health environment, information may have changed since the last “sync”, creating decision support concerns. As evidenced later in this piece, the Google Effect indicates that people are placing more reliance on computer information, so the accuracy of this information is critical to homecare professionals.

Because of “after the fact” documentation and data integrity issues, the “device-heavy” approach did not maximize the potential benefits of EVD to any stakeholder involved, including the patient, the nurse, or the home care agency.

Two driving factors have now created a paradigm shift and enable agencies to minimize the technical hurdles which prohibited the effective use of EVD in the past:

1. Internet Ubiquity, and

2. Cloud-based EMR Systems

Internet Ubiquity – The growth and maturation of Internet connectivity has reached a tipping point and today you can get Internet access nearly anywhere, even on a plane. Broadband accessibility and reasonable price points make mobile health effectiveness more attainable than ever before. Because cloud-based EMR systems are securely accessible from the field, the vast amounts of EMR data that used to be sent down to the device can now simply stay in the cloud and be accessed as needed. This “device-light” EVD approach significantly reduces the technical barriers to adoption and has proven to be used in the home, during the visit, more often than “device-heavy” applications which required lots of synchronization and updating.

Cloud-based EMR Systems – When combined with a cloud-based EMR system, the nurse is able to “go to the cloud” when extensive decision support is needed at the point-of-care, knowing that the information in the patient’s live EMR is accurate. With a cloud-based EMR, everyone in the agency, including all field staff, schedulers, billers and clinical management, is making decisions based on the exact same version of the data.

Because EVD can be completed at the point-of-care and uploaded to the cloud-based EMR in near real-time, QA and downstream operational processes can be centralized and more effectively managed. Nurses can get their private lives back and do away with the need to document their day after the fact, and documenting at the point-of-care improves the relevancy and timeliness of patient encounter data.

Device-light EVD – Effective EVD technology should facilitate electronically documenting a comprehensive, accurate account of the patient encounter and provide a balanced amount of guidance that enables the nurse to primarily rely on their professional training. It should be quick and simple enough to encourage use at the point-of-care, work both online and offline, and ultimately enable the nurse to keep the focus on the patient, not the technology. The technology itself should allow the healthcare professional to naturally perform their assessment, or intervention, and be able to pull any reference information that would help improve care delivery. A balanced combination of human and computer assisted decision making can be achieved with a “device-light” EVD approach and a “cloud-based” EMR.

The device-light EVD model also limits the need to distribute ePHI (electronic Protected Health Information) to multiple devices, which substantially mitigates HIPAA risk for homecare agencies.

The Google Effect – In four cleverly designed experiments, psychologists explored how the Internet may be changing the way people handle information. Recently termed “the Google Effect” in the July 15, 2011 edition of Science Magazine, people are beginning to rely more and more on the ability to “find” information by searching online, resulting in lower rates of recall. Knowing “where” to get the answer is becoming more important than knowing the answer itself. This may not be a bad thing, but is an alarming cognitive consequence and raises a number of questions when applied to the nursing professional and the use of information in decision-making at the point-of-care.

How does the Google Effect impact nurses and their point-of-care decision making? Is an experienced nurse better off relying on their judgment, education, and intuition when making care decisions, or relying on computer generated information to guide them? Are point-of-care decision support tools becoming a nurse’s “external brain”? What happens when the “external brain” is not available or is inaccurate?

US FDA Proposes Health APP Guidelines – In a related development, the United States Food and Drug Administration (FDA) announced that it is proposing guidelines for certain medical health apps, its first move into the mHealth space. In the July 19, 2011 press release, the FDA is proposing to oversee mobile medical apps that could present a risk to patients if the apps don’t work as intended.

It is rather interesting that the Science Journal’s report on the Google Effect and the FDA’s announcement on medical app guidelines both came out within 4 days of each other. The dynamics are clear, we are relying more on computer information and the stakes are getting higher as to how we are relying on computer information.

A Balanced Approach – It makes sense that the FDA would want to ensure these “external brains” are accurate and used in a balanced approach. It also makes sense that computer information does not get in the way, or lead the professional home health nurse too much in their patient assessments and interventions.

FDA policy advisor Bakul Patel provided a pragmatic statement, citing the need for balance, “There are advantages to using medical apps, but consumers and health care professionals should have a balanced awareness of the benefits and risks.”

How true!

In the context of the home care nurse in the field, a device-light EVD solution combined with a cloud-based EMR system provides this balance by enabling electronic documentation at the point-of-care and offering decision support as needed to complment their professional judgment.

Sansio supported the Home Care Association of Florida (HCAF) this week by exhibiting and providing sponsorship to help fund their important Annual Conference. Sansio’s HomeSolutions.NET was shared with many current and prospective customers during the course of the conference.

Also this week, HomeSolutions v 7.76 was released to all customers via Sansio’s Software as a Service approach, which includes regular product updates.  The v7.76 release overview webinar was played live from the exhibit hall booth in Orlando.  HomeSolutions v7.76 is highlighted by Flex Scheduling options that help customers more effectively manage their home care visits, and Comm Notes, which help improve secure collaboration and communication within the agency.

Sansio’s sponsorship of the HCAF helped bring several presenters to the Annual Conference, including Bill Dombi, Vice President for Law at the National Association for Home Care & Hospice (NAHC) and Lisa Remington, publisher of The Remington Report. Both delivered excellent content on healthcare reform, regulatory updates, and policy-related trends in the industry, helping home care agencies with their strategic planning.

Sansio is an Associate Member of the Home Care Association of Florida. The HCAF is a non-profit organization dedicated to providing representation, education, and advocacy for Florida home care providers and vendors to help deliver high quality services to patients and clients in their home.  www.homecarefla.org