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Therap and the Release of Information

As the QA Director, Therap Administrator, and one of the few that can spell HIPAA (no it isn’t spelled HIPPA), I was assigned the additional duties of HIPAA Privacy Officer, HIPAA Security Officer, HIPAA Compliance Officer, and HIPAA Training Officer.  So I went to HIPAA School and got educated.  With my suitable for framing HIPAA certificate in hand, I started building procedures for various HIPAA issues.  One of the first I tackled was release of information (ROI).

This blog isn’t going to be about HIPAA, but rather some thoughts on how to release Protected Health Information stored in Therap.  In my agency we serve primarily minor children so most of the discussion is going to be based on the parent requesting information or filling out an ROI.  Whether it is a parent, guardian, or individual served (client) submitting the ROI the idea is the same.  So here goes:

In my mind I separate the information we store on the individuals we serve into two categories.  The first category is what I think of as relatively static, it doesn’t get updated frequently, and doesn’t change day to day.  In Alaska we have a Plan of Care as the primary document determining the kind and amount of services an individual will receive at our agency.  And there are other documents containing diagnosis, family contact information, application for Medicaid waiver, Care Coordination/Case Management assignment, and acknowledgement statements for HIPAA, agency policies, and a host of other paperwork required to get services at our agency.  Despite my continuing efforts most of this information continues to be stored on paper files vice in Therap.  However, whether it is stored in Therap or on paper it is a finite amount of data, usually not requiring too space.  Since it is information parents usually provide us or sign for us, rarely is it the object for a ROI.  If it is requested this information is easily copied, printed and provided.

However, once an individual has been receiving services with us for six months or so, the amount of information stored in Therap is HUGE!  For example, we have individuals who get four detailed ISP Data inputs daily, including weekends.  To provide all of this information for an ROI can be a major undertaking.  That is going to be my focus.

My first step is try to figure out the who, what, and why of the ROI.  In my short term as the agency HIPAA guru these are the broad categories of ROIs I’ve addressed:

  • Involved Parent.  The involved parent is just trying to keep abreast of the services their child or dependent is receiving.  At my agency we are very much in favor of enabling the parent to have access to daily records to read the daily events.  Pre-Therap our agency had the parents sign the individual paper note prior to turning them in.  During the transition from paper notes to Therap one of the key points raised by the parents was visibility to the daily notes.  To give the same visibility to the daily notes the parents had with paper notes, we gave Therap access to each parent/guardian.  There was some significant work giving every parent/guardian (mother, father, step parent and guardian in some cases) access as we transitioned to Therap but it was what the parents asked for.  Each involved parent was given a Therap User account, read only, to view their child’s Therap entries.  In practice, most parents (97%) lost interest after a brief period and quit checking notes.  Now we only give that level of access to parents/guardians if they requested it.  Giving a parent a Therap account, Therap training, and access to their child’s information is our preferred solution to answer a ROI by a parent/guardian.  There is no cost to the agency or parent/guardian for this ROI.
  • Parent Requesting Bulk Data.  For a variety of reasons occasionally we have parents submitting a ROI for data covering a long period.  This is where a little detective work is needed to figure out what the parent/guardian is really looking for.  Sometimes the parent/guardian just want to know that the agency is responsive to their needs.  With a little hand holding and training, giving the parent Therap access will work.  Sometimes it isn’t the daily notes that are the concern but rather a trend of improvement is more what the parent is looking for.  In that case the answer is an easy report to generate from Therap and it usually will meet their needs.  In addition we are happy to teach parents how to print individual notes from Therap or export bulk data to Excel.  We are also happy to export the data at the office and burn it to a CD/DVD or copy it to a thumb drive they provide.  However, the real challenge is the parent with little or no computer skills.  For parents without confident computer skills giving them Therap access (or reports) is not going to work.  They want paper!  Now what format should we provide the data?  The parent’s typical expectation is something that looks like the paper notes they received prior to our move to Therap and electronic notes.  Therap will let you print out individual notes that the parent is looking for.  But when the parent wants all the notes from the start of the fiscal year, printing out individual notes is going to be very time consuming.  Again I ask what is the information going to be used for, the answer helps me better provide what they want.  If all they want is the basics of what type service and when, we provide them ISP data exported to Excel.  But if they want the information to justify additional or different services they will need detailed data exported to Excel.  A typical example is a family wanting to justify broadening their home and community based services to include nursing.  In this case the family asked for paper copies of all the Therap notes for the current fiscal year, about 5 months worth of data.  Their child receives a variety of services with us and usually has three to four Therap notes per day.  We determined the most efficient means of providing the information they wanted was ISP Data with a detailed export to Excel, then that spreadsheet was organized, sized, and printed for the parent.  A five minute discussion with the parent of how the data was displayed usually ensured they were happy with what they received.  HIPAA regulations state that parents have an absolute right to the information, and that we cannot charge for the man-hours required gather or print the information, but we can charge for the cost of the copies.  So, while the agency could bill the parent for the cost of copies, we don’t.  Our copier/printer company charges us 1.4¢ a page for black and white copies and we buy many cases of paper reams. So, in this case, a 300 page report would cost us approximately $6 and is not worth the time and effort to try to collect.  And for our computer challenged parents, who have been with us for a long time and remembered paper notes, billing them any amount for computer generated information would be an insult and a potential reason to move to another agency.
  • Parent Requesting Release to Third Party.  Again for a variety of reasons we have parents who want their child’s information to be released to a third party.  If a parent wants to provide information to another agency, or their physician, or another type of medical agency, they rarely really want each and every day habilitation note for the last three years, for example.  I usually start with a phone call to the third party to try and find out what type of information they want and in what format.  Most other agencies and physicians are happy with basic data or a report that shows a trend of data, rather than each and every note.  And, thankfully, they usually want it in some type of electronic format.  After the phone call it is a no brainer to provide the data.  However, since we provide services to children, occasionally we get a ROI during a custody battle.  Again, I call the third party to try to figure out what type information they are looking for and in what format.  But some of those phone calls have taken an ugly turn.  One particular law office seemed to think I was trying to hide something and forcibly insisted they had a right to have a copy of “each and every sheet of paper.”  …So I oblige them…  You want all the ISP data for the last two and half years, with a detail export to Excel?  You got it.  For the parents in the above paragraph I spend time working on making sure it is readable, the unused columns are deleted, and I show them how to read it.  For the law office I just put all the columns on one page and hit print.  As for billing, for other agencies and physicians we provide it for free as a professional courtesy.  For that difficult law office… HIPAA allows me to charge them for our actual cost.  Now how much is my time and effort worth?  Not only cost of each piece of paper, but wear and tear on the printer, cost of electricity for the machine and the lights, heat in the building, part of our rent, small piece of our annual Therap bill…  Oh my, I had an enormous bill for them…  But cooler heads prevailed, and pointed out that the law office would just pass the cost off to the parent, with a hefty percentage added.  We charged them for our employee’s wages and the cost of paper and printing.

My bottom line is that with a phone call ahead of time, most ROIs are more accurately and easily handled.

Happy Holidays!

Rob

 

By |2016-11-03T10:15:19+00:00December 14th, 2013|Categories: Rob Sterling's Posts|Tags: , , , , , , , |Comments Off on Therap and the Release of Information

Private Insurance Billing

—–While we have been working on using Therap to bill the State of Alaska for Medicaid services, a new challenge popped up.  How can I use Therap to bill private insurance companies for non Medicaid services?

—–Anybody else out there billing private insurance for providing services, like ABA, to families with private insurance?

——What we discovered is:

  • Each insurance company has different requirements.
  • Each company has different data fields requirement, and even the common ones are needed in different orders.
  • Often the insurance company will reject your with little explanation.
  • But once you get one service through the private insurance billing, it is very repeatable.

—–The nuts and bolts of making it happen can be challenging.  But once you have broken the code it can be lucrative.

Anybody else out there trying it?

Rob Sterling

By |2016-11-03T10:15:19+00:00November 19th, 2013|Categories: Rob Sterling's Posts|Tags: , , |Comments Off on Private Insurance Billing

Predictive Text

Just read Pat Watt’s Blog on GERs – Grrrrrr and I have to agree with her.  Here is my similar story.

The Problem

Focus is small but growing.  As we grow we find things we did manually in a short period of time, now are laboriously long.  To speed up the process I am creating Excel programs designed to make life easier and more accurate.  Our payroll coding was long seen as a log jam in the getting our Care Providers paid every two weeks.  Using ISP Data, exporting it to Excel, and then using macros and lookup tables I was able to complete most of the payroll coding.  One piece of the required coding was to capture if the Day Hab took place in our After School Program.  In the location block our Care Providers would enter: After School Program.  Or they would enter ASP, or asp, or AFTER SCHOOL PROGRAM; one Care Provider with a sticky shift key always entered AFter SChool PRogram.  I tried to capture every possible variation using nested IF functions in Excel but gave up when I found one Care Provider who was very “creative” in her spelling.  As she told me,

“It is the mark of a handcuffed creativity, and a constipated mind to only spell words one way.”

I like a good turn of a phrase.  And in my effort to share these words of wisdom with my favorite elementary school teacher, I pulled out my phone to text her.

Brief Side Track

That surprises most folks that a dinosaur like me can text.  I am of the generation that took typing (not keyboarding) in Junior High School on a manual typewriter.  It took real effort to use a typewriter.  To type a single character, you pressed the key firmly, then an arm with your selected character snapped up and struck the printer ribbon and paper with a sharp thwack.  Thwack, thwack, thwack, ding!  When you heard the bell, you finished that word and then manually returned the carriage to return to the left side of the page and advanced a line.  I’m guessing 90% of you have no idea what a carriage is.

The difference between Typing and a Word Processor:

  • “White out” was not a term for a bad blizzard, it was how you fixed typing errors.  Just hitting the backspace key didn’t fix anything.
  • You used a dictionary to “spell check” and you had to do it before you typed the word.
  • Your font and font size were determined by the typewriter you used; to change fonts you spent $300 to buy a different typewriter.
  • If you wanted a copy of what you just typed, you grabbed a different sheet of paper and typed it again.
  • And a mouse next to your keyboard was grounds for your roommate to move out.

Back to the story

We have this old fossil texting.  But the problem with someone from the Jurassic era is that our thumbs are not as limber as they used to be and texting is a hit or miss proposition.  To help me most cell phones have predictive text.  The function of predictive text is to help you rapidly enter correctly spelled words or specific abbreviations.  And the predictive text could learn new words too, like “Groovy” and “Far-out.”  And other new words like “AARP” and “Metamucil.”

The Solution?

Now if someone from my generation can learn how to use predictive text while texting on a cell phone, why can’t those young, bright and energetic folks from Therap insert predictive text in certain data fields?  Wouldn’t it be groovy if the Location box on ISP Data could use predictive text to help Care Providers enter “After School Program” the same way every time?

And if Therap can’t do that, then I would wonder who had the handcuffed creativity and constipated mind…

If we could, I would be LMAO…

By |2016-11-03T10:15:43+00:00April 23rd, 2012|Categories: Rob Sterling's Posts|Tags: , , |2 Comments

Rob’s Overlap Checker

My Alaskan Friends asked to know how I check for overlaps. This method depends on ISP Data export to Excel and then nested Excel IF formulas.  I’m a big fan of Excel Macros to eliminate repetitious key strokes and to prevent incorrect typing, do it right once and then let the Macro repeat it.  This explanation assumes you understand how Excel IF functions work. Get in touch if you want more details.

Step 1. Search ISP Data for all possible programs that could overlap. Ctrl and click will let you select all the programs you want to check for overlaps. I do not check all the programs. For example, as I understand it a Care Coordination meeting could overlap with Day Hab but would not be a problem, therefore I do not select Care Coordination. For me I select Day Hab, Hourly Respite, Supported Employ, In Home Supp, Supported Living, and Daily Respite. I may have missed one there but you get the idea. Export the search to Excel.

Step 2. Create columns for the Excel function TIMEVALUE for both the Begin Time and End Time. You need the timevalue function because the times are exported as text and without timevalue 1:00 pm sorts as an earlier time than 8:00 am.

Step 3. Sort the data by name, date, timevalue(begin time), and timevalue(end time). I’m not sure you need the timevalue(end time) but I do it anyway.

Step 4. Create column for overlap. In this column you insert a nested IF function. You are going to compare the current row with the data in
the row above it. The nested IF function is:

If the Individual Name is the same as the row above

  • TRUE, next IF Function
  • FALSE, Not an overlap

If the Date is the same as the row above

  • TRUE, next IF Function
  • FALSE, Not an overlap

If the current row timevalue(Begin Time) < timevalue(End Time) of the row above

  • TRUE, OVERLAP
  • FALSE, Not an overlap

The actual function looks something like this:  =IF(A2=A3,IF(B2=B3,IF(C3<D2,”OVERLAP”,””),””),””) Where column A is the Individual’s name, column B is the Date, column C is the timevalue(Begin Time), and column D is the timevalue(End Time). If there is an Overlap the cell will read OVERLAP, if there is no overlap the cell will be blank.

Hope this helps.

By |2012-03-16T20:58:37+00:00March 16th, 2012|Categories: Rob Sterling's Posts|Tags: , , , |1 Comment

Tracking Timeliness of ISP Data Inputs

The first of March, another beautiful day in Eagle River.  Forecast high temperature 26 degrees, forecast low temperature 20 degrees… Current temperature zero degrees…  Our Alaskan weathermen never get it right.

FOCUS joined the Therap family to eliminate paper notes.  Our Direct Support Providers had a habit of hanging on to the paper notes and turning them in bunches.  As the stories go, they often had coffee stains, spilt cereal, creamed carrots, and other biological hazards spread across them.  It wasn’t unusual for staff handling the paper notes to be using universal precautions; you know, gloves, surgical mask, and HAZMAT bins.  With Therap we no longer have to keep our shot records up to date just to read the notes our Providers write. 

However, since our Providers need to access a computer to write their notes, they often are unable to complete the notes immediately.  While with paper notes our Providers had a habit of hanging on to them and turning them in bunches, with Therap some of our Providers have a habit of writing their notes in bunches.  Unfortunately, some are submitting the ISP Data for the services they provided very time late, three to four weeks in one extreme case.  Of course this adds to the difficulty in billing and payroll.  My concern is, since I can’t remember what I had for breakfast, how can the Providers write accurate notes for services they provided so long ago?

When I do a performance review with any of our Providers, I always check the timeliness of their ISP Data submission to ensure it is within our standard.  Took me a while to figure out how to do it in quickly and accurately.

In an ISP Data Search you can check an individual ISP Data Collection entry.  In the blue field at the top is a date / time stamp for when the data was submitted.  That can be compared against the date the services were provided to determine how time late the entry was made.  However, that is data for a single note and does not indicate a trend or average over a broader time frame.  To get that trend or average the data can be exported to Excel.  Unfortunately, that date / time stamp is not included during an export to Excel.

In an Activity Tracking Search you can search by Provider for a given time frame (no more than one month) to see when they submitted ISP Data.  Each line of data cannot be accessed in this search; but the data can be exported to Excel.  However, it will not give the date the services were provided; just the date the entry was made.

Now we have two separate Excel spreadsheets; one with the date services were provided and the other with the date the data was submitted.  How do we combine them to get at the length of time between the time the services were provided and when the Therap ISP Data was submitted?

The secret is that both spreadsheets contain the Form ID number.  With the Form ID number to connect the date the service was provided and the date the ISP Data was submitted it is a relatively simple process to use the “Lookup” function (I used “vlookup”) to put all the needed data on one spreadsheet.  With the data on one spreadsheet, the data can then be easily manipulated to determine how late the data was submitted and any average or trends you may be interested in.

This of course is just an overview of how I do it.  If you need help with the details, just let me know.

By |2012-03-01T20:55:56+00:00March 1st, 2012|Categories: Rob Sterling's Posts|Tags: , , , , , |Comments Off on Tracking Timeliness of ISP Data Inputs

FOCUS Therap Implementation

Greetings from FOCUS,

FOCUS launched ISP Data Collection in August 2011 as a means to eliminate paper notes.  I was hired after the implementation so I can not speak to how smoothly it went.  But since I have been here I have discovered that, between our Therap data, and the ability to export the data to Excel, we have been able to examine our data in new and novel ways.  For example, at FOCUS we use the ISP Data as our means to determine our Care Providers payroll.  Next we are using data exported to Excel to review our input to Finance for billing and claims.  Not exciting to most of you, but a good starting point for us.  Our next step was expanding into utilization.  Without the Billing module, and less than a full year of Therap data, it was quite a detailed exercise to create Excel graphs depicting service utilization using input from the legacy system and Therap data.  Now we are in the process of setting up Service Authorizations.  Once again discovering that with less than a full year of  Therap data, the ability to export Therap data to Excel, combine it with the our legacy system, is the key to capturing a good starting point for Therap Service Authorizations.

My plan is to share these magical spreadsheets with everyone in my required Webinars…  Stay tuned for more details…  Or give me a blast if you can’t wait and I will see if I can give you a hand.

Want to know more about FOCUS?  Check out our web site: http://focusoutreach.org/

This is my first blog since becoming a Certified Trainer… Honestly, it is my first blog ever.  Who says you can’t train old dogs.  Or Old Salts.

Rob

By |2016-11-03T10:15:45+00:00February 15th, 2012|Categories: Rob Sterling's Posts|Tags: , , , |2 Comments