Electronic Medical Record Delivery

Transcription

1 Electronic Medical Record Delivery

2 Document History Publication Date: March 20, 2013 Document Edition: 1.1 Contact Information HealthPort 120 Bluegrass Valley Parkway Alpharetta, GA AudaPro Customer Support Phone Number: Copyright and Trademarks Copyright 2013 HealthPort. All rights reserved. Document History and Copyright

3 Electronic Medical Record Delivery AudaPro v1.8, released in October 2012, added several new features intended to support the delivery of medical records to auditors through electronic channels. See the following topics for more information on these features: Enabling Electronic Delivery Electronic Delivery Settings for Customizable Audit Types Tracking Electronic Delivery in AudaPro Electronic Request History Entering an Audit Request for Electronic Delivery Tracking Electronic Delivery in AudaPro Backup Delivery Method Electronic Medical Record Delivery 3

4 ENABLING ELECTRONIC DELIVERY HealthPort must configure your facility and Audit Group for electronic delivery before the features described on the following pages will be available to you in AudaPro. Contact the appropriate HealthPort Regional Director to initiate the setup process: Region Director Phone Western Scott Phillips Eastern Will Kappauf Enabling Electronic Delivery

5 AUDIT TYPES AND ELECTRONIC DELIVERY Customers who sign up for AudaPro s electronic delivery option (page 4) will notice substantial changes to Federal and State Audit Types. See these sections for more information: RAC and CERT Audit Types Electronic Delivery Settings for Customizable Audit Types Example Electronic Delivery Audit Type Configuration RAC and CERT Audit Types If your Audit Group is configured for electronic delivery, the RAC and CERT Audit Types will be automatically updated to deliver records electronically. These Audit Types are managed at a global level by HealthPort AudaPro System Administrators. You do not need to change any settings; in fact, users cannot modify the RAC and CERT Audit Types through AudaPro s Audit Setup Wizard. Electronic Medical Record Delivery 5

6 Electronic Delivery Settings for Customizable Audit Types As described on page 5, the RAC and CERT Audit Types do not require editing if your Audit Group chooses to use electronic delivery. However, you must configure ZPIC, MAC, and PERM Audit Types to take advantage of the electronic delivery option. Key Field Description A Audit Category Electronic delivery is only available for certain Federal and State auditors. B Audit Type Electronic delivery is currently available for ZPIC, MAC, and PERM Audit Types. C Electronic Delivery Indicates that the first delivery option will be the electronic connection. D Review Contractor Lists all audit contractors, for the selected Audit Type and your geographic location, who will accept electronic submissions. E Contact # You must still search for the auditor s physical address using a phone number. F Address HealthPort has created a backup delivery process for electronic Audit Types. In the event that an electronic transmission fails, records will be sent to this address by FedEx (street addresses) or the USPS (P.O. Boxes). 6 Audit Types and Electronic Delivery

7 Example Electronic Delivery Audit Type Configuration This tutorial shows how to setup a MAC Audit Type that will deliver requested medical records through an electronic pathway. Group System Administrators and Facility System Administrators can access the Audit Type Management function. Audit Administrators can configure the Audit Types to which they are assigned. Regular AudaPro users cannot configure Audit Types. 1. From AudaPro s Administration menu, click Configuration Audit Type Management. 2. On the Audit Types page, click Create New Audit Type. 3. The Audit Types step of the Audit Setup Wizard appears. 4. All of these fields are optional and are not discussed in these instructions: Include this audit in Dispute matching? Contact Name Contact Fax # Attention To Send Medical Records to View & Approve Electronic Medical Record Delivery 7

8 5. In the Audit Category field, select Federal. 6. In the Audit Type field, select MAC. 7. Use the Audit Description field to create a title that clearly identifies the auditor. This title will be especially useful if your Audit Group includes facilities that respond to different MAC auditors. 7.1 For this example, we ll use MAC J F Noridian as the Audit Description. 8. Select the Electronic Delivery? checkbox. 9. In the Review Contractor list, choose the appropriate auditor. Because your Audit Group may need to respond to multiple MAC auditors, this list can include several choices. 8 Audit Types and Electronic Delivery

9 10.Type the auditor s phone number in the Contact # field, then click Search. 11.If AudaPro finds an existing requester with the same phone number, you will see a list of matches Whenever possible, choose a street address rather than a P.O. Box. FedEx, which combines shipping speed and delivery verification, does not deliver to P.O. Boxes. Skip to Step If AudaPro finds an address but you want to enter a different one, click Cancel. Go to Step If AudaPro does not find a match, go to Step 12. Electronic Medical Record Delivery 9

10 12.If you could not select an existing auditor based on the phone number: 12.1 Manually enter the Audit Entity Name In the Requester Type field, select Medicare/Medicaid Manually enter the Address information. 13.Choose the Medical Record Shipping Preference. This field shows the backup delivery method (page 17) that will be used if the electronic process fails. AudaPro automatically selects the shipping method based on the address for the requester: 13.1 Street Address FedEx P.O. Box USPS. 10 Audit Types and Electronic Delivery

11 14.Click Save & Continue. 15.Continue through the remaining steps of the Audit Setup Wizard. 16.On Audit Wizard Step 3, copy the settings from the root MAC Audit Type.This copying function ensures that all of your MAC Audit Types root and custom use the required data entry fields specified by government regulations. Electronic Medical Record Delivery 11

12 17.On Audit Wizard Step 4, copy the settings from the root MAC Audit Type.This copying function ensures that all of your MAC Audit Types root and custom use the appeal levels specified by government regulations. 12 Audit Types and Electronic Delivery

13 18.If you copy the settings from MAC for Audit Wizard Step 4, the Turnaround Times for the root MAC Audit Type will automatically populate Step 5 of the wizard. 19.Confirm the Audit Type settings on Step 6. The Audit Type will then be ready for use. Electronic Medical Record Delivery 13

14 ENTERING AN AUDIT REQUEST FOR ELECTRONIC DELIVERY 1. Start a new audit request, selecting an Audit Type that is configured for electronic delivery (page 5). 2. See the following table for guidance in entering data for the request. Field Audit Address Claim # Audit ID 2 Records Requested More Information Supports a backup delivery method if the electronic process fails. See page 17 for more information. Required for all requests delivered electronically. This field is typically not required for electronic audits, but if you are entering a CERT request, we recommend that you enter the Case ID # (CID) here. You can use an electronic delivery Audit Type to respond to automated audit requests, which do not require copies of medical records. Obviously, no records will be collected or shipped if Records Requested = No. Facility NPI # Must be 10 digits, although it may look longer, as explained on page 20. Preferred Delivery Method RAC / Audit Records Due Date You cannot edit this value; it shows Electronic by default. If the records must be shipped as hard-copy documents (page 17), the Delivery Method field on the RAC / Audit Information tab will show the actual shipping method. As described on page 17, HealthPort may still send hard-copy records if the request is entered in AudaPro 5 days or less before the Records Due Date. AudaPro generates a warning prompt if this situation occurs. 3. Save the request. 14 Entering an Audit Request for Electronic Delivery

15 Tracking Electronic Delivery in AudaPro The Medical Records Delivery section of the Audit / RAC Information tab shows key information about the electronic delivery process. FIeld Records Mailed Date Delivery Method Records Received Date Description Shows when HealthPort initially transmitted the records through the electronic system. If you transmit additional records to the auditor, either because more records were located by HealthPort ROI specialists, the Records Mailed Date field shows only the date on which the first PDF file was acknowledged. The request s History tab shows all of the PDF files that were added to the Medical Records subfolder on the Documents tab, and subsequently sent to the auditor through the electronic channel. If the records are delivered successfully through the electronic process, this field shows Electronic. You cannot edit this field. The Delivery Method field may show something other than Electronic if the backup delivery process, described on page 17, was used. This date shows when HealthPort received an electronic acknowledgement from the auditor, indicating that the records were received. Electronic Medical Record Delivery 15

16 Electronic Request History The History tab for an electronic request captures a range of information about the delivery process: Records Sent Although the Medical Record Delivery section of the Audit / RAC Information tab only shows the first date on which records were sent electronically, the History tab shows any subsequent electronic deliveries for the request. CMS Acknowledges Transmission of Records HealthPort will automatically send the records through the backup delivery method (page 17) if this acknowledgement is not received within 24 hours of the records being sent. Auditor Retrieves Records from CMS/esMD Gateway. Records Fail Virus Scan at Auditor (if applicable). 16 Entering an Audit Request for Electronic Delivery

17 BACKUP DELIVERY METHOD HealthPort may still send hard-copy pages even when the request was configured for electronic delivery. We will ship electronic requests as hard copies under ANY of these conditions: CMS does not acknowledge receipt of the records within 24 hours of HealthPort transmitting them. OR The request is entered in AudaPro WITHIN 5 days of the Records Due Date. OR The auditor does not confirm receipt of the electronic data at least 5 days BEFORE the Records Due Date. This rule protects facilities against a breakdown in the electronic communication channels between CMS and the individual auditors. FedEx or USPS The backup delivery method depends on the available shipping address for the auditor. Whenever possible, records will be shipped by FedEx. If the auditor has provided only a PO Box address, which FedEx does not service, the backup records will be shipped by USPS. Electronic Medical Record Delivery 17

18 CHANGES TO FACILITY NPI # VALUES In previous versions of AudaPro, you could combine a numeric NPI with a descriptive text value, such as General Hospital. AudaPro v1.8 allows you to enter a numeric New NPI and a separate New NPI Description. The NPI Description can be up to 50 characters long. These values can be configured through the Administration Configuration Facility Information page. 18 Changes to Facility NPI # Values

19 Format of Facility NPI Values HealthPort s primary reason for splitting the NPI and NPI Description values is to support the electronic transmission of medical records, as described on page 3. Auditors who accept electronic medical records require that each submission be accompanied by a tendigit NPI value to identify the healthcare provider. However, this 10 digit requirement does not apply to non-governmental auditors or when records are not being sent electronically. It is therefore impractical to strictly limit the Facility NPI field to ten numeric characters. For this reason, an AudaPro administrator can create Facility NPI values that include alphabetic and special characters, as well as numeric digits. These values can be as many as 50 characters long. The ten-digit Facility NPI format and length validation are only enforced for electronic-delivery audit requests. Electronic Medical Record Delivery 19

20 Viewing Facility NPI Values and Descriptions The separate New NPI and New NPI Description values will be combined when you view them in the application. When you are working with an audit request that will be delivered electronically, it may appear as if you are choosing a Facility NPI that fails the 10 digit standard (page 19), but in fact the NPI value itself is 10 characters long. AudaPro Component Example Facility Information page Reports 20 Changes to Facility NPI # Values

21 Deleting Facility NPI Values If your facility will be using the electronic delivery option for audit requests, you may want to delete existing NPI values that are longer than 10 digits and/or include alphabetic (rather than only numeric) characters. Deleting these values prevents them from cluttering up the Facility NPI field on new requests. Electronic Medical Record Delivery 21

22 Existing Requests with Deleted Facility NPI Values Deleted Facility NPI values are NOT stripped from existing requests in the AudaPro database. However, you will only be able to see the deleted values on the My Audits page and in reports. Here s an example of locating requests with a deleted Facility NPI value through a Custom Report: If you open a request that was created using a Facility NPI that was later deleted, the Facility NPI field will be blank, prompting you to choose one of the current options. 22 Changes to Facility NPI # Values