Welcome UDS Review for Intergy CHC Jeff Urkevich Director of Health Solutions Health Choice Network

Transcription

1 Welcome UDS Review for Intergy CHC Jeff Urkevich Director of Health Solutions Health Choice Network 1

2 Agenda Welcome Where is the UDS data Intergy POMIS Intergy EHR Practice Analytics cross walk Basic logic Table specific logic Common Errors What s New for Intergy UDS? Planned UDS changes for 2013 Getting Help 2

3 Target audience UDS expert About This Session Intergy CHC set up specialist Purpose Intergy PM System Intergy EHR This session provides an overview of the Intergy UDS report logic and where the information is found. 3

4 Changes for 2012 Table 6A, Column A Diagnoses are counted regardless of primacy. In prior years only the primary diagnosis was counted In 2012 data all diagnoses are counted If a patient has hypertension as primary and diabetes as secondary, the patient is counted once on line 11 (HTN) and once on line 9 (DM). A single visit may generate more than one countable diagnosis Table 6B New Measures Coronary Artery Disease (CAD), Ischemic Vascular Disease (IVD), Colorectal Cancer Screening have been added Data for these measures will come from your Clinical Dashboards 4

5 Where Does My UDS Data Come From? 5

6 Where is the UDS Data? Patient Information Patient Patient Sliding Fee page Special Population Information Charge Posting Payment Posting Account Insurance System files setup UDS Report Maintenance Labs Dashboards Intergy EHR 6

7 Patient Information Screen 7

8 Patient Information Crosswalk 8

9 UDS Data Slide & Special Population 9

10 Slide & Special Population Crosswalk 10

11 Charge Posting Screen 10 Key Fields in Charge posting 1. Insurance must be accurate for the visit 2. Charges must be posted to the correct provider 3. The Service Ctr. Must be accurate 4. The Finance center must be valid 5. The Department must be correct for the service provided 6. The Start Date (DOS) must be accurate 7. The Procedure Code must be correct for the service provided 8. The Diagnosis codes must be accurate for the service 9. The Charges must be correct 10. The Adjustments must be correct for the plan or sliding fee scale. 11

12 Charge Posting Crosswalk 12

13 Charge Posting Crosswalk 13

14 UDS Data Payments & Adjustments Multiple areas of input Payment at charge posting Insurance Payment Posting Account Payment Posting Electronic Remittance Advice (ERA) 14

15 Payment & Adjustment Crosswalk 15

16 UDS Table 6B & Table 7 Three reporting options provided Intergy Electronic Health Record Clinical Dashboards UDS Report Clinical Audit Worksheet Childhood immunization Pap tests Hypertension Diabetes Weight Assessments (children and adults) Tobacco Asthma IVD CAD 16

17 Intergy EHR Problem List Created by using Diagnosis Medcin findings Problem list must be maintained to meet UDS reporting needs 17

18 Intergy EHR LOINC All labs must have LOINC component cross-references 18

19 Intergy EHR Problem List 19

20 Intergy EHR OB chart 20

21 Intergy EHR Immunizations 21

22 UDS Data Crosswalk 22

23 UDS Setup 23

24 UDS Setup Important! The Procedure Priority setup table is no longer available in Intergy v8. Services are selected in order of posting. Be sure to post your E/M codes first! 24

25 UDS Data Report Setup Multiple table setup Crosswalks center usage to UDS Exclude for: Providers Payers Procedure Full directions: F1 (Help) CHC Implementation or Training Plan 25

26 UDS Report 26

27 UDS Report Options Universal all counts that meet criteria Grant all patient counts only for that grant Migrant Health Health Care for Homeless Public Housing Primary Care Patient and visit count by date range Can run for all or select criteria Full directions: F1 (Help) CHC Implementation or Training Plan 27

28 Basic Logic 28

29 Report Basics Face to face visit within report date range Minus visits: By excluded provider With excluded procedure code only With an excluded insurance or payer Administration codes only Voided charges Patients with no date of birth (age) Patient with no gender 29

30 Report Basics & Conversion UDS conversion If demographic conversion from Vitera Medical Manager CHC Final report count Add totals from both systems in conversion year Table 9D totals add until old system closed out Benefit Patient count not duplicated Visit counts increased as appropriate Full directions: F1 (Help) 30

31 Table 6B & 7 Audit Worksheet UDS Report Clinical Audit Worksheet Creates a list of universe Provides basic patient demographic information Provides a line number for each patient in universe Use the HRSA Randomizer to select charts to pull: Provides total count for universe 31

32 Clinical Audit Worksheet 32

33 Clinical Audit Worksheet 33

34 Table 6B - PA Dashboards 34

35 Table 6B PA Dashboards 35

36 Table 6B PA Dashboards 36

37 Table 7 Using Intergy EHR Section A Deliveries & Birth Weight by Race & Hispanic/Latino Identity Delivery date as defined in Intergy EHR OB Chart Birth weight defined in OB Chart Patients by Race and Hispanic or Latino Identity Report as defined in UDS setup Patient ethnicity found in Patient Information Patient race found in Patient Information Line 2 Procedure codes used to identify deliveries: 59414,59409,59410,59612,59614,59515,59620,59622, 58605,59400,59510,59514,

38 Table 7 Using Intergy EHR Section B Hypertension by Race and Hispanic/Latino Identity Defined as Hypertensive in Patient Problem list Added prior to June 30th Identified by MedcinID/diagnosis codes 401.xx Hypertension controlled Compares last blood pressure in Vitals to UDS standard Less than 140/90 38

39 Table 7 Using Intergy EHR Section C Diabetes by Race & Ethnicity Patients by Race and Hispanic or Latino Identity Report as defined in UDS Setup Patient ethnicity found in Patient Information Patient race found in Patient Information Two medical encounters in reporting period Proportion of adult patients born between January 1, 1938 and December 31, 1994 with a diagnosis of Type I or Type II diabetes, whose hemoglobin A1c (HbA1c) was less than or equal to 9% at the time of the last reading in the measurement year. Using the excludes for Polycystic ovaries diagnosis 256.4x Gestational diabetes Steroid-induced diabetes 39

40 Table 7 Using Intergy EHR Section C Diabetes by Race and Hispanic/Latino Identity Type I or Type II Diabetes in the Patient Problem List Identified by diagnosis codes 250.xx, 357.2, 362, , 648.0, 775.1, Define HBA1C ranges Compare patients most recent lab results as recorded in the Intergy Labs Subsystems LOINC code is , , ,4548-4, Cross reference required to associate a component ID for each Lab with the LOINC Code Defined in Lab Setup 40

41 Table 9D Patient Related Revenue By the nature of the UDS rules for this table It will not reconcile to other Intergy financial reports. Procedure and provider exclusions do not apply Defined by center in UDS setup for Table 9D: Insurance plan excludes Payor type Managed versus non-managed care Plans mapped to State or Local Indigent Care Program report as self pay Plans not defined default to Private and Non-Managed Care 41

42 Table 9D Patient Related Revenue Full Charges Full standard fee New charges for services in reporting period Excluded Voided charges Excluded Admin charges Balance will progress through payer transfers. Example: A patient has Medicare and no secondary insurance $100 Medicare charge is initially in the Medicare charge bucket Medicare pays with total of $80.00 in payment and adjustment $80.00 stays in the Medicare charge bucket $20.00 remaining balance transfers to patient due IE: Medicare reduces by $20.00 and Patient due increases This does not affect overall total dollars New charges and transfers from prior services 42

43 Table 9D Patient Related Revenue Amount Collected Payment allocations & unapplied credit Net receipts collected during reporting period May be for services prior to reporting dates Payment voids and refunds Voided payment made during reporting dates are excluded Voided payment made prior to reporting date are negatives Capitation payments not included 43

44 Table 9D Patient Related Revenue Retroactive settlements Currently not reported from PM System Allowances adjustments Insurance adjustments posted within reporting dates May be for services prior to reporting dates When charges are voided that include an adjustment If charges is in reporting period the adjustment is excluded If charges prior to the reporting period a negative adjustment occurs 44

45 Table 9D Patient Related Revenue Self-pay sliding discounts Sliding fee schedule discounts Adjustments posted in reporting dates May be for services prior to reporting dates Self-pay bad debt write-off A subset of configurable guarantor adjustments As defined in UDS Other setup Adjustments posted within reporting dates May be for services prior to reporting dates 45

46 Common Errors 46

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48 Common Errors 48

49 Intergy Patient Visit Report New report in version 8 Useful for validating UDS reports Up to 3 concurrent sorts Encounter and/or patient characteristics Must be configured before use Go to Setup -> CHC Reports -> Patient Visits Report 49

50 Income Option Reminder Pay close attention to the unverified reporting option at the bottom of the Universal report 50

51 Planned Changes for 2013 Table 6B MEASURE: Children who have received age appropriate vaccines prior to reaching their 3 rd birthday during measurement year (on or prior to 31 December) Previously read: Children who have received age appropriate vaccines who had their 2nd birthday during measurement year (on or prior to 31 December) Aligns with Health People 2020 requirements 51

52 Planned Changes for 2013 Zip code table to be broken down by insurance type 52

53 Planned Changes for 2013 Table 6B Measure: Cervical cancer screening - Count as compliant women age 24 to 64 years with a Pap test every 3 years and women age 30 to 64 years who choose a 5 year interval for Pap tests when accompanied by an HPV test. Previously read: Count as compliant women age 24 to 64 years with 3 year intervals between screenings. The revision allows 5 year intervals for women age 30 to 64 years with a Pap test accompanied by an HPV test. Aligns with the 2012 recommendation of the U.S Preventive Services Task Force. 53

54 Planned Changes for 2013 TABLE 4 SELECTED PATIENT CHARACTERISTICS Current measure: Principal Third Party Medical Insurance Source 0-19 years old ( a ) 20 and older ( b ) New measure: Principal Third Party Medical Insurance Source 0-17 YEARS OLD ( a ) 18 AND OLDER ( b ) 54

55 Additional Resources CSA is your first point of contact Software Support UDS Workgroup BPHC 2012 Reporting Manual tics/reporting/2012udsmanual.pdf UDS 2012 Quick Fact Sheet

56 Intergy UDS Review Question and Answer 56

57 Intergy UDS 2012 Thank you!