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CareWatch : One Stop Shop. Petersen Health Care- Who Are We?. 71 long term care facilities Four Missouri homes Largest long term care provider in Illinois 67 homes. Petersen Health Care- Who Are We?. Four Regions Licensed nursing home administrator as regional director 1-2 regional nurses

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Presentation Transcript
Carewatch one stop shop
CareWatch: One Stop Shop


Petersen health care who are we
Petersen Health Care- Who Are We?

  • 71 long term care facilities

    • Four Missouri homes

    • Largest long term care provider in Illinois

      • 67 homes


Petersen health care who are we1
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


Petersen health care who are we2
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


Two most important reimbursement functions of reimbursement specialists
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


Mds coordinator education
MDS Coordinator Education Specialists

  • 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


Carewatch administrator use one stop shop
CareWatch Specialists 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


Carewatch don use one stop shop
CareWatch Specialists 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


Carewatch reimbursement specialist one stop shop
CareWatch Specialists 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


Carewatch reimbursement specialist one stop shop1
CareWatch Specialists 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


Carewatch reimbursement specialist one stop shop2
CareWatch Specialists 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


Carewatch reimbursement specialist one stop shop3
CareWatch Specialists Reimbursement Specialist: One Stop Shop


Carewatch reimbursement specialist one stop shop4
CareWatch Specialists 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


Carewatch reimbursement specialist one stop shop5
CareWatch Specialists 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


Carewatch reimbursement specialist one stop shop6
CareWatch Specialists 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


Carewatch reimbursement specialist one stop shop7
CareWatch Specialists 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


Illinois medicaid rug analysis
Illinois Medicaid RUG Analysis Specialists

  • Reporting of analysis of RUGs is helpful in comparing among other facilities and comparing past performance to present performance


Carewatch reimbursement specialist one stop shop8
CareWatch Specialists 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


Ehealth data solutions phc s one stop shop
eHealth Specialists 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


Any questions thank you for your time attention
ANY QUESTIONS? SpecialistsTHANK YOU FOR YOUR TIME & ATTENTION!


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