PECOS Database Audit to Highlight Medicare Patients

Based on feedback from our customers, we’ve enhanced our PECOS Database Audit Service to identify the physicians with Medicare patients and also to provide the unbilled and billed A/R amounts associated with the patients for each physician.  This will be extremely helpful as CPR+, HomecareNet and Ascend users prioritize the process of making sure the physicians they are receiving referrals from are registered with PECOS.  Although long term, it is best for every physician to be registered, technically only those who are referring Medicare patients are required to be registered.  The unbilled and billed A/R figures will assist in prioritizing the efforts to contact physicians and get them compliant with the Medicare law.

Rock-Pond Solutions will audit the physician file an unlimited number of times in a year for customers who are signed up for the PECOS Database Audit Service.   These added fields will improve efficiency and help our customers minimize risk. 

Featured Artist – Karrie Evenson

HomecareNet PECOS tracking

One of the great things about HomecareNet is that it is so robust. Sometimes viewed as complicated, it all pays off when you need to respond to business / industry changes. It’s great for the Mediware development staff too since they don’t have to constantly release “little fixes” with special instructions so the system will handle new, unforseen requirements.

The word of the moment is PECOS, the CMS physician registration process that everyone is scrambling to make sure their referring physicians have completed so they can get paid from Medicare. As a home infusion provider you need to do three things:

1. Identify the physicians you work with that are not registered.
2. Change your intake process to verify that the physician is registered with PECOS.
3. Contact physicians that are not registered to “encourage” them to register or make a decision not to take their patients. 

Do these three things and PECOS will not be a problem for you.  Best of all, these are not hard.  If you are using HomecareNet from Mediware, we recommend:

1. Use the Rock-Pond PECOS Database Audit to find out exactly where you stand right now.
2. Set up a PECOS organization in your HomecareNet system and add it as an affiliation to all of the physicians you work with who you’ve verified are registered in PECOS.  Modify your intake process to check this whenever a Medicare patient is admitted. 
3. Work with your physicians to see that they get registered. 

That’s it.

Featured Artist – Karrie Evenson

What are my billers doing?

All home infusion software systems have the ability to assign billers and collectors to payers, patients, invoices, at varying levels.  However, the day to day process of managing your billing department to measure and increase productivity requires the ability to report the revenue based on who actually created the claim versus who is assigned in the system to bill for the patient.  This will help you accurately measure who is creating revenue and measure the volume of claims and patients a billing clerk is working on.

The following are some areas that cause difficulty in accurately measuring productivity:

• Billing primary versus secondary claims
• Assigning specific billers to a therapy across all payers (such as IVIG) is usually not supported by software systems.
• The need to manually transfer the assigned payer when the invoice is transferred to the secondary payer or the patient is time consuming and often not done.
• The difficulty of billing based on therapy and payer is not always the same across therapies and payers, thereby making it difficult to compare productivity across billers.
• Employee changes and the need to temporarily or permanently adjust the billing workload makes the default assignments in the system ineffective.

The end result is that even though it appears that assigment and management of billing personnel is handled by existing software features, in other than the smallest home infusion providers, this is a very challenging area.  The first measurement to answer the question, “What are my billers are doing” requires the ability to produce a report like the one below, that is based on the biller who created the claim rather than who was assigned to the claim.

Unlimited audits included with PECOS Audit purchase

Rock-Pond announces unlimited PECOS Database Compliance Audits with single audit Solution purchase. 

The PECOS Database compliance audit tool released last week has been enhanced to provide repeated audits as new databases are released from CMS.  Each time a new database is released by CMS, all customers will be notified and if they want to re-audit their physicians, they simply have to reply to the email with their updated physican export attached and the Audit Excel Spreadsheet will be returned via email. 

“This is the kind of simplicity and service our customers expect from Rock-Pond” said Pete Tanguay.  “Especially in a time of uncertainty with the entire PECOS compliance situation.”

The PECOS audit tool has been well received by our customers and has also introduced a number of new home infusion providers to Rock-Pond Solutions. The tool works with the CPR+ system as well as the Ascend, Ascend-HI and HomecareNet systems from Mediware.

NHIA members have access to a PECOS compliance page in the Reimbursement Resource Center on their website.  It has comments from NHIA as well as valuable links for more information and free web-based tools to help you be informed and ready.  Click on the image on the left to go to this page.

Rock-Pond Signs Agreement with NHIA to support DATA Initiative

Change in health care is happening rapidly.  Now, more than ever, the home infusion industry must come together to communicate the value of home infusion and lobby for it’s place in the future of health care in America.  The story simply can not be told or the case made with out data.  One of the top priorities of the National Home Infusion Association in 2010 is to establish a base data initiative that will provide the data needed to take the case for home infusion to Washington.  And this is just the beginning.  Data will be needed to support pay-for-performance initiatives when they are implemented in non-acute care settings and to support best clinical practices on an industy-wide basis.

Rock-Pond Solutions has signed a mutual agreement of understanding where Rock-Pond will provide FREE tools to any home infusion provider to mine their data source to extract and deliver the data requested to NHIA.  NHIA will promote this as the tool of choice to gather the data in a standardized and consistent manner.

Click here for more information.

CPR+ Revenue Analysis with Averages

When you need to report your revenue, a standard revenue report will do.  If all you are trying to do is get the revenue numbers to close the month, a standard revenue report will do.  The standard revenue reports available within the CPR+ system are to the left. 

However, if you need to analyze your revenue to determine why revenue is up or down (or how to make it go up or keep from going down), you need more than a standard revenue report.  Rock-Pond has developed two powerful revenue analyzers to help you see exactly what is happening.   The power is in the ability to group by up to 9 different key data items (Payor Type, Payor, HCPCS Code, State, Type of Claim, Billed Month, Revenue Code, Therapy and Patient) in up to 3 different grouping levels.  Although not every grouping option would make sense, this is over 700 different ways to print a report. 

The revenue analyzer with averages takes the ability to analyze, trend and compare groups to another level by providing an average revenue per day, calculated by using the number of days on the invoice.  For the first time you can compare the average revenue per day for different payers for each HCPCS code you bill. 

This example will help you see how different payers are paying the same product.  If you want to see how the reimbursement for specific payers has changed over time you could refresh the report and group by billed month within payer within HCPCS code.  The ability to spot trends and see variances will alert you to issues that need to be attended to.  They might be issues in your system setup, the accuracy of your billing staff or the viability of the payer contracts you have.  Regardless, if you are using standard revenue reports you may never know why your revenue is not what you expect it to be.

Complete Report Sheet for Rock-Pond Revenue Analyzer Reports.

Collector Reporting Quandary

As I’m scrambling to get myself back into full work mode on Jan 4th, I answer my phone to a billing manager who is in a state of panic because all of her HomecareNet collector reports have suddenly stopped working. This was a major show stopper as these reports define what each of the collectors are responsible for during their work day.

Needless to say, I thought it was strange that these reports would just quit on her. They had recently performed an upgrade of their HomecareNet system and they were convinced this was the problem. I contacted Healthcare-Automation to find out if any work had been done in the collector areas of the system to find out that nothing had been changed in the version they upgraded to.

I put the issue aside for the moment so I could let my brain come up with some answers. Just as suddenly as her collector reports stopped working, the probable cause of the problem rushed to me. Effective Dates. I called her up and asked her if the ending effective date on her responsibility rules was 12/31/2009, and it was. A quick change to that date and her reports were back up and running.

So the next time something suddenly stops working, blame the system after you look at all the logical reasons it may have happened in the first place, however small the oversight may be.

Managing Billers and Collectors

One of the features of the CPR+ system is you can assign a default biller and collector to each insurance company.  The flexibility allows you to override this at the patient, delivery ticket and invoice level.  This can be a very powerful feature if you need to override the collector responsible for a specific patient or invoice.  However, if you are not careful, you can end up with an unmanageable mess if your biller / collector assignments don’t easily fit into the CPR+ rules, you have significant turnover in your reimbursement department or your payer mix requires that you adjust collectors for workload balancing.

Rock-Pond recognizes this and provides powerful reports you can use to manage collectors based on the default insurance collector or the collector currently assigned to the invoice.  In addition, audit reports are available to alert you when the default collector is not the same as the collector assigned to the invoice.  This is critical because you have to manually reassign the collector when you transfer the balance to another payer or to the patient if the collectore who will rework the remainging balance is different than the one for the payer the invoice was transferred from.

Bottom line, in order to effectively use the biller and collector fields in CPR+, you’ll likely need some additional reporting to manage your data quality based on your current collector assignments and you may need additional reporting to produce reports for your collection manager and collector to effectively do their job.  If you have cases where you have payers that are divided based on the first letter of the last name of the patient, you’ll need some custom reporting unless you are going to have a process to manually assign these at intake.

If there is one thing an infusion company must do it is manage their A/R and determine how to get the most productivity out of the billing and collection staff.  It’s not always easy, but the effort is worth it.

CPR+ gets a LIFE

Each year CPR+ delivers one major upgrade that is announced and demonstrated at their Fall user conference.  2009 is no exception and this year the buzz is that CPR+ is releasing LIFE (Line Item Financials).  Simply put, this breaks out each invoice into multiple claims.  Gone is the limitation that you can only have money due from one payer at a time.  If you want to collect a co-pay up front from the patient prior to billing the insurance company, with LIFE you can do this without putting the money in unapplied cash.  There are many other reasons that this is a very good and needed upgrade.

However, it will not come without some serious consequences.  Consider this:

1. Line item financials will require a data conversion from your current data formats to the new data formats and there is no turning back.
2. The process changes required in your business are so significant that customers who wish to “get a LIFE” are required to go through training.
3. The 3 tables in the database that hold all of the invoice data will be expanded to 9 tables.  All custom reports you have written against these three tables will have to be reviewed, rewritten and retested as part of the implementation process.
4. The changes are so major that CPR+ is allowing customers to upgrade to 8.3 without “getting a life”.

There are more consequenses, but these are enough to indicate that this is a serious upgrade.   When you ask for major change from your software vendor, what do you get?  Major change.  This is not like the interim updates and program fixes that are received throughout the year.  Read the release notes, listen to CPR+, pay attention, invest the time in testing and training and most of all, make sure you “need a LIFE” before you “get a life”.

Rock-Pond Solutions is working hard to stay on top of the changes at the data level.  We are identifying all of our reports that need to be changed and offering new version (no cost) to our customers who need reports that support the new structures.  Our advice?  Be sure and call us before you “get a LIFE”.  You’ll be glad that you did.

Inventory File Integrity in CPR+

The impact of accurate inventory files in CPR+ can not be underestimated.  Inventory drives pricing.  Inventory is the basis for compounding and dispensing.  Key billing codes (therapy types, NDC codes, HCPCS codes, pricing codes, etc.) are set in inventory and carry forward through the home infusion process.  Whether you use the old term GIGO (Garbage In Garbage Out) or more descriptive terms like data accuracy and data integrity, the issue is the same.  The effectiveness of your home infusion company is significantly impacted by the quality of the data in your inventory and pricing files.

Reporting in CPR+ and other home infusion software products often assumes the data is accurate.  Over 50% of the fields in the system do not appear on any report.  The result is you have to view the information on the screen they are entered in or a browse screen such as the grids available in the CPR+ Enterprise module.  This might be sufficient if your data is correct (key word here is “might”) but it will not be sufficient if you have data errors (key words here are “will not”).

Whether you use Rock-Pond Reports or learn to use a report writer to write your own reports, be sure you have reports available that will support your need to validate that the information in your inventory file is accurate as well as reports that alert you when inventory items are added or changed.

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