Diana Williams Director, Recognition Programs. PCMH Manager, Recognition Programs Programs

Transcription

1 Getting On Board PCMH NCQA Recognition Programs Staff NCQA Recognition Programs Staff

2 Presenters s Peggy Reineking Christina Boye Karen Parrish Diana Williams Director, Recognition Programs Policy Manager, Recognition PCMH Manager, Recognition Programs PCMH Manager, Recognition Programs Programs 2

3 Today s learning objectives By the end of this session you should be able to: Know which practices should pursue medical home Recognition as single sites or Multi-Sites (Eligibility) Describe the PCMH submission process List the NCQA electronic platforms and software you will use Locate and navigate PCMH written resources Find additional PCMH training sessions If you are submitting under a federal government grant PCMH-GRIP@ncqa.org 3

4 This presentation will cover the whole Recognition journey Begin with a single site model Explain the PCMH 2011 process on a high level from submission to the Recognition decision Talk about add-ons, renewals and upgrades Describe how multi-sites submissions work This is the 1 st of 4 PCMH 2011 training sessions NCQA offers at no cost Each offers more detail Customers who receive training get better results 4

5 Your opportunity to ask questions We ll stop for questions at several places You may also type questions into the chat box at any time If there is background noise we ll mute the audience To mute or unmute your phone use *6 5

6 Resources Available -- Training Free training each month PCMH 2011 Standards (2 part program) Using the ISS System for PCMH 2011 The Online Application and How to Submit as a Single Site or Multi-Site 6

7 The Training Calendar (free training) Page on NCQA s public website ult.aspx 7

8 Resources Fee-based training Classroom seminars for PCMH Locations across the country see website Book early these fill up fast! Customized training Speakers Bureau for your strategic planning Comprehensive e e PCMH 2011 training at your location 8

9 Who can submit for PMCH 2011? Eligibility PCMH is for practices with primary care clinicians At least 75% of the PCPs patients come for: First contact Continuous Comprehensive PCP services Clinicians may be selected as personal PCPs 9

10 PCMH 2011 Eligibility Site-level Recognitions One survey for each geographic site One address per survey Note: This is true even if the clinicians are the same at multiple locations All the PCP clinicians who work together at a site must be included 10

11 If your practice includes non-pcp clinicians Specialists at your site should not be included in the Recognition All clinicians included in the Recognition, including OB/GYNS, must fill PCP role for 75% of patients Clarify your eligibility before you begin to work NCQA s programs for specialists Physician Practice Connection Specialist Recognition Program will launch in mid

12 NCQA s definition of a Multi-site Organization Multi-Site practices have: 3 or more clinical sites Share the same EMR Share the same policies and procedures for staff Ability to be bound under a single contract 12

13 Questions PCMH 2011 eligibility??? The definition of a Multi-Site organization??? 13

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15 Resources Available The PCMH Standards and Guidelines -- the rules Standards, elements, factors Policies and Procedures These are free of charge from NCQA These are also embedded in the software you will obtain 15

16 Resources Available - Software PCMH 2011 uses 2 NCQA platforms and 2 software products 1. Online Application Account Business and demographic information Software is the On-line Application Free 2. Interactive Survey System (ISS) Responses to the Standard and Guidelines Software is the ISS Survey Tool $80 per tool or (888)

17 PCMH 2011 written resources In the Recognition Programs section of NCQA s website In your ISS survey tool under Resources tab In your Online Application account software under Resources tab 17

18 Get the software licenses Online Application Account Free Your Administrative/Business Account Organization needs only 1 account* All sites on the same account PCMH 2011 on same account as old version (PPC-PCMH) Reusable over time for add-ons, upgrades, renewals CAHPS-PCMH on same account Agreements are attached here Safeguard the user ID and password * Each multi-site application needs a separate account 18

19 Get the software licenses Interactive Survey System Tool aspx#pcmh $80 per site for PCMH 2011 One tool for each site Multi-site practices need special approval and naming conventions Keep your URL, username, and passwords safe 19

20 Get the software licenses How? Where? /t By phone M-F 8:30-5:00 ET Payment by check or credit card 1 st payment (of 2 payments) to NCQA Product licenses, URL, usernames, and passwords sent by from publications@ncqa.orgorg 20

21 Get software licenses SAFEGUARD the User IDs and Passwords Add several users to each platform Get them from your departing staff before they leave your company 21

22 Two platforms? Why? How does that work? Two types of information Online Application -- business info and agreements ISS -- responses to Standard d & Guidelines scored By entering your ISS software license number into the Online Application, NCQA will match your business information to your responses to the Standards and Guidelines Online Application with signed business agreements is submitted first before ISS tool can be submitted 22

23 Prep your ISS Survey Tool Initial set up of the ISS tool Launch your ISS Survey Tool Find & write down your ISS license number Complete 3 tabs in Organizational Background tab Practice Information Recognized Clinicians Multi-site Where to find the ISS license number 23

24 ISS License # ed at purchase 24

25 License # also visible in ISS 25

26 ISS Tool with License # (another view) 26

27 ISS Survey Tool Organizational Background Tab Inside the ISS Survey Tool 27

28 ISS Organizational Background Tab Complete Practice Site Information Attach more information about your practice. Give your practice a face to our reviewers. 28

29 Complete Recognized Clinicians List your clinicians with these current Recognitions for autocredit: Diabetes Recognition o Program Heart/Stroke Recognition Program Back Pain Recognition Program 29

30 We ll come back to the ISS tool You can close ISS for now Or.you may work on the ISS tool responses to the Standards & Guidelines at any time before you submit it 30

31 Completing your Online Application making the link Launch the Online Application Account Sign the Agreements electronically Create a separate application for each site Enter the ISS license # for each site creates a link Enter your clinician data for each site Bind your clinicians to each application who s current? Submit each site application to NCQA NCQA needs 5 business days to verify site prior to accepting ISS tool NCQA will send you an 31

32 No time limit from application submission to ISS Tool You can submit your ISS Survey tools at any time after you receive the from NCQA 3 months is a good target Attend Getting on Board again if you delay many months NCQA may make system changes 32

33 Take care with Online Application data! Spelling, punctuation matter! Data will be added to NCQA s database Some data elements will populate certificates and public websites. 33

34 Prepare your ISS Survey Tool Relaunch your ISS Survey Tool You can work on your ISS tool at any time after purchase Respond to each Element, each Factor Attach documents* Fewer is better -- 3/Element Highlight g and label the text that meets the standards Check work carefully Self score; check Must Pass Elements and Critical Elements Revise as needed *The document loading process in ISS changed in March 34

35 Submit the ISS Survey Tool Pay your program fee by check or credit card This is the 2 nd payment to NCQA Find fees and credit card forms in Online Application resource tab Checks to : NCQA Attn: PCMH th Street NW, Suite 1000 Washington, DC Fax credit card form to or to pcmh@ncqa.org Sponsors offer discounts Look at the Online Application. 35

36 Payment Instructions tab in the Online Application 36

37 Submit the ISS Survey Tool Submit NCQA Review process begins 37

38 Keep in mind Submit means sending data to NCQA You will submit matched pairs: one application for each site first one ISS Tool for each site 38

39 Questions Software??? Submission??? 39

40 The Review Process Tools are assigned to PCMH Teams weekly The Government Recognition Initiatives Team (GRIP) Blue Team Yellow Team A manager age will notify you within several e days Contact your manager for status updates Your manager may contact you with questions External and internal reviewers 60-day decision goal Recognitions are announced by Certificates 21 days later 40

41 PCMH Yellow and Blue Teams WA OR NV CA ID AZ UT MT WY CO NM ND SD NE KS OK MN IA MO AR WI IL MI OH IN KY TN WV WV NY PA SC VA NC ME VT MA RI CT NJ DE MD MS AL GA TX LA AK HI FL Contact: PR *Does not apply to federal government sponsored practices * 41

42 What can happen after you submit? 42

43 Audits NCQA may audit up to 5% of submissions At your practice site Virtual Keep your back-up data until you receive your decision Your manager may ask for missing information curing the Review process NCQA may audit your practice during your Recognition period 43

44 Denials (Non-Recognition) or Recognition at a lower level than expected -- options If your practice does not earn 35 points and 50% for all Must Pass Elements, your Recognition will be denied 2 options to change results for any practice (Recognized or denied) Reconsideration within 30 days Rationales accepted, but not additional documentation Evaluated by new Reviewers and physicians $500 Add-on 44

45 Add-on Surveys For practices that want to achieve a higher level Level I or II may submit anytime during their current Recognition period Add-on application through the Online Application NCQA prepares your tool to receive new data; issues a new ISS license # You may add to any Element with < 100% score No need to resubmit for all Elements if you re satisfied with the score Upload new documents Submit and receive new decision Add-on fee is 50% of initial fee for Recognized practices 45

46 Renewals/Upgrades PPC-PCMH to PCMH 2011 A streamlined process for upgrade or renewals for PPC- PCMH Level II or III practice sites to PCMH 2011 Upgrade PPC PCMH to PCMH 2011 Similarities/Differences il iti Renewal PPC PCMH to PCMH 2011 X Purchase and complete a new survey X X X X X Submit new documentation for 12 Elements only; attest to the others Add on pricing Full survey pricing No extension of Recognition period New 3 year Recognition period Multi site site level only Begin a new, full multi site process with corporate tool X X X X 46

47 Renewals/Upgrades PPC-PCMH to PCMH 2011 Level II and III PPC-PCMH PCMH sites should submit documentation with the following Elements for Renewals and Upgrades 1C 1G 2C 2D 3A 3B 1G 2C 2D 3A 3C 3D 4A 5C 6A 6C For all the remaining elements for factors that you answered Yes, you must attest that you are eligible and implement those factors. ABC Family Practice previously achieved Level 2 or 3 Recognition as a Patient-Centered Medical Home and attests that the responses to the factors for this element reflect the current operations of the practice site and the documentation to support these responses can be provided d on request. The practice must be able to provide documentation for the elements that do not require documentation if it is selected for audit. 47

48 Questions Review Process??? Upgrades??? Renewals??? 48

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50 What Are Multi-Site Surveys & Who is Eligible? The multi-site application process is an option for organizations or medical practices that have 3 or more sites that share policies and procedures and electronic systems across all of their physician sites. NCQA does not give organization-wide Recognition Corporate elements are completed once for multiple practice sites. You may response to of these corporate elements. 1B 1C 1D 1E 1F 1G 2A 2B 2C 2D* 3E 4B 5A 5B* 5C 6F * Must Pass All other elements require site-specific responses 50

51 Resources Available - Software Multi-Sites use the same software 1. Online Application Account Request eligibility consultation Business and demographic information Software is the On-line Application 2. Interactive Survey System (ISS) Responses to the Standard and Guidelines Software is the ISS Survey Tool 51

52 Resources Available -- Training Free training each month PCMH 2011 Standards (2 part program) Using the ISS System for PCMH 2011 THE ONLINE APPLICATION AND HOW TO SUBMIT AS A SINGLE SITE OR MULTI-SITE Recorded training on website 52

53 Resources for Multi-site-- Written sent when Multi-Site eligibility teleconference has been scheduled Online Application account software under Resources tab ISS survey tool under Resources tab Recognition Programs section of NCQA s website

54 Get the Online Application Online Application Free Organization needs only 1 account All sites on the same account Apply for Single Site and Multi-sites in one account Reusable over time for add-ons, upgrades, renewals Safeguard the user ID and password Multi-Sites should not purchase any ISS Survey Tools until approved 54

55 The Multi-Site request PCMH 2011 Launch Online Application Select New Multi-Site Application Answer the Multi-site Eligibility Request NCQA calls to set up a teleconference with a Recognition Manager within several days 55

56 Multi-Site approval request You initiate a Multi-Site teleconference via the Online Application 56

57 Multi-Site approval request You ll answer 3 eligibility questions 57

58 Multi-site approval request The system will ask you to wait for a call from NCQA to schedule your teleconference 58

59 What happens during the Multi-Site approval teleconference? Be prepared for your teleconference Read through h ed materials Set up your list of sites using naming conventions You must be at your PC with Online application open during teleconference Recognition Manager will determine eligibility and approve practice sites Recognition Manager will go over the Multi-site process and answer questions 59

60 Approval teleconfernce When your teleconference is schedule, you will receive a number of documents via see next few slides 60

61 Approval teleconference Multi-Site process overview Detailed instructions ti for getting the application ready using the NCQA naming convention 61

62 Approval teleconference eligible corporate elements Determine which elements you ll answer at the Corporate level 62

63 Approval Teleconference Multi-Site fee calculator Multi-site fee calculator 63

64 The outcome of a successful teleconference a Multi-Site ISS survey tool order form Print Order Form from Online Account for approved sites Designate which sites you want to order first Buy your ISS Survey Tools as you need them You can add future sites to the order form later 64

65 Print order form After your teleconference -- this is where you ll find your order form in your Online Application 65

66 Print order form 66

67 Buy ISS survey tools Interactive Survey System Tool Safeguard user IDs and passwords Pay by check or credit card Corporate and each site tool cost $80 Corporate + 3 sites = $320 , fax, or mail printed order form with payment of approved sites to NCQA customersupport@ncqa.org Fax: Mail: NCQA Attn: PCMH Depart 4038 Washington, DC

68 Link the platforms and apply online Launch the Online Application Sign the Agreements electronically for all sites Corporate and sites each have an application Each application has an ISS license # -- make the link Enter your clinician data for sites, not Corporate Bind current clinicians to application 68

69 Submit the Online Applications first PCMH 2011 Submit each Online Application to NCQA NCQA needs 5 business days to verify each Corporate or site application prior to accepting ISS tool You will receive an when NCQA is ready to accept your ISS tool 69

70 Prepare corporate tool first Launch your ISS Survey Tool Respond to Corporate ISS survey first; corporate elements/factors Attach documents Fewer is better Highlight and label the text that meets the standards Check work carefully Self score Revise as needed 70

71 Prepare corporate tool first Complete Organizational Background Complete the Organizational Background Tab Practice Information tab Multi-site organizations only fill out Corporate Survey tab 71

72 Select corporate elements in Organizational Background tab This is the Corporate Survey Tool section of the Organizational Background tab in the ISS Tool 72

73 Submit corporate tool first Pay your program fee by check or credit card Find fees and credit card forms in Online Application resource tab Checks to : NCQA Attn: PPC-PCMH 2008 or PCMH th Street NW, Suite 1000 Washington, DC Fax credit card form to or to pcmh@ncqa.org Multi-site it fees are discounted d 73

74 Submit Corporate Tool First Submit Submit Corporate Tool first, 30 days before first site tool NCQA reviews corporate tool within 30 days Corporate is merged to site tools before they are submitted 74

75 Prepare and submit site tools You will see the Corporate elements and full score Practice completes site-specific specific tools and submits Site-specific tools must be submitted within 12 months of Corporate tool score date Remainder of the review process is the same as single site Site tool turn around time target is 60 days 75

76 Unique situations Streamlined Upgrades and Renewals are available for PPC-PCMH Level II or III practice sites Very large organization may work with NCQA to submit a series of Multi-Site batches 1C 1G 2C 2D 3A 3B 3C 3D 4A 5C 6A 6C ABC Family Practice previously achieved Level 2 or 3 Recognition as a Patient-Centered Medical Home and attests that the responses to the factors for this element reflect the current operations of the practice site and the documentation to support these responses can be provided on request. 76

77 Multi-Site Upgrade and Renewal Rules Suppose you have a PPC-PCMH Multi-Site with 5 Level III sites, 2 Level I sites, and 1 new site Submission Requirements Upgrade Renewal No tool required Abbreviated up to 5 Corporate Tool corporate elements PPC PCMH Level II or III Site Abbreviated all 12 elements Abbreviated the rest of the 12 elements Renewal full single Renewal allsite Level I Site site survey level elements New Recognition full New Recognition all New Site single site survey site level elements 77

78 Questions on Multi-Sites? Thanks so much for attending! Best wishes for your upcoming Recognition! Feedback and questions to 78