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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

Alaska updates

I recently did a webinar which i thought went pretty good. I don’t know about everyone else but even with planning it out and having an outline I always feel like I forgot to talk about something or went through it too fast.

Our agency is moving forward with everyone doing ISP’s or at least almost everyone, we still have the logistics to figure out for those that don’t work at one of the houses or office buildings. there is the issue of hardware, viruses on personal devices etc. Our IT guys are working on policies and procedures surrounding the use of personal devices. Meanwhile everyone is anxious to get started.

Now that we have gotten past Thanksgiving and are full swing in the holiday season things are getting busy around here and I am preparing to take some time off work to be home with a new litter of puppies that are due in less than 2 weeks. I’m sure that I will be doing some work from home during that time but oh well that is life and at least I get to be at home with the Emma and her babies.

I hope that everyone enjoys the holiday season and doesn’t let it get them too stressed out. Take some time for yourself and relax.

By |2016-11-03T10:15:19+00:00December 5th, 2013|Categories: Uncategorized|Tags: |Comments Off on Alaska updates

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

Settling in For a Long Winter

It is a busy time of year here in Alaska as we all scurry around finishing all those outside projects before everything is buried in ice or snow. Yards cleaned, tools put away, toys winterized and covered, it is a lot to do and the temperatures are already dipping below freezing at night and some days.

I recently had knee surgery and was able to work from home while I recovered, we are trying to get all departments up and running doing ISPs so that we can move to electronic billing. I was able to get a lot accomplished working from home without all the regular interruptions of my attention being pulled 20 different directions. We are still not ready but partly because of IT issues with hardware.
We were looking into Chrome books but then there was some IT conference so that may all be changing again. We have bypassed our original date to have all departments go live and pushed it out due to hardware for the remote staff. I do feel like we are making great progress in training all staff and input of data.

Now I am looking forward to the National Conference, hope ot see you all there!!

By |2016-11-03T10:15:20+00:00October 10th, 2013|Categories: Kristine Davis's Posts|Tags: , , , , , |Comments Off on Settling in For a Long Winter

The Big Push!

After spending a week with Allison training staff we are we are working feverishly at getting as much information about all our individuals and their ISPs into the system. We have high hopes of having ALL departments go live (currently only Residential and some vocational on line) by Oct 7th. We have staff working extra hours doing data entry to get everything in for all departments.

Having Allison here was great to get staff excited about what the program can do for us and what we can do with it. We did lots of sessions with the supervision and talked about reports and pivot tables and that got a lot of interest.

I am finally feeling like there is a light at the end of the tunnel, I know we are in for some hick-ups but it is moving forward at a steady pace now. I am really exited to get things up and running. The next step will be billing and we hope that will be by the end of the year.

Thank you Allison for coming up and getting everyone headed the right direction!

By |2016-11-03T10:15:21+00:00August 30th, 2013|Categories: Uncategorized|Tags: |1 Comment

Almost August!

It is hard to believe that it is Almost August. It will be a very busy month here in Alaska, for us it is the start of the changing seasons. Our seasons are so short, at least all of them except Winter which lasts a LONG time. August is Fair time, time to finish the outside projects and best of all Allison will be visiting!

Allison’s visit means we will hopefully be that much closer to full implementation. I am working feverishly to get the system gone over to make sure everything is in place. We hope to put all the departments on and be ready to do billing by the end of September. I have to stay positive about it because it is a lot to accomplish with little assistance from others in house.

I am really looking forward to the new release this weekend, just hope that staff don’t panic since I will be out of town at a dog show.

August also means the end of our Dog show season, This coming weekend is our final summer show. I have accomplished so much in the show ring this year despite my injury to my knee. My Girl Emma has earned her Championship and her Rally Advanced title, her daughter Cassi has earned a 4 point major toward her championship, and I have had fun and learned so much more about showing and grooming. It is a never ending learning process, as is everything in life.

Kristi Davis

By |2016-11-03T10:15:22+00:00July 24th, 2013|Categories: Kristine Davis's Posts|Tags: |1 Comment

Still Floating in the clouds

This has been an exciting weekend for me, it is one that I have been waiting for. I can now introduce my Bernese Mountain dog as my First Champion, CH Emma V. Riverhaus, BN, RA. We drove to Anchorage to go to our Regional specialty (a Dog show for dog of all one breed), knowing that our girl only needed 4 points to get her championship and with the number of dogs entered she only needed to take Winners Bitch (best of all the girls) one day to get that. She did it on the first day of the show so the pressure was then off and we could enjoy the rest of the weekend.

At this point I’m not really sure how to tie this all into Therap other than I was able to monitor what was going on back at the agency while away and I wanted to share this with all the friends I have met through Therap.

Emma Proudly displaying her Ribbon from this weekend

Emma Proudly displaying her Ribbon from this weekend.

By |2016-11-03T10:15:23+00:00June 17th, 2013|Categories: Kristine Davis's Posts, Uncategorized|Tags: |1 Comment

Dreaming of full implementation

We have been working on trying to get all departments fully on board with use of Therap. It has been a long drawn out process. I wish that I had a magic wand and could wave it and make it all happen…..Allison can you look into that PLEASE.

We are still trying to get buy in from everyone, I am getting all the same stories…we don’t have time to input the data…it takes too long…why do we have to change…what if the computers go down…on and on….
I’m sure you all have heard the same thing at some point. I have done demonstrations & trainings to large groups, small groups and individuals. I think I am finally starting to win the battle. It will get there eventually.

I spent a week in Loveland, Colorado at a Dog show recently and had a great week but the heat was horrible. going from 30 – 40 in Alaska to 80 in Colorado with the altitude change was quite different. I was not able to show my own dogs because I had my knee in a brace from a dislocation that had happened in April. But they did very well with handlers. My home bred puppies took placements in Futurity, Cassi took 2nd and Sprig took 4th, and Cassi took a 3rd in the regular puppy conformation class. Their mother Emma got two qualifying scores in Rally Advanced which completed her title. We have a local show this weekend and all three will be competing again, not sure if my knee is up to handling them but we will see.

Have a great Memorial Day weekend!!!!!!

Finally Spring?

Despite some freak snowfall last weekend, it looks like we might actually have a real live spring on our hands here in Alaska. There’s some budding green bits on the tree outside my office, the pussywillows are puffy, and the sun stays in the sky until late into the evening. It’s been a long winter, and I’m ready to leave it behind.

I’ve been pretty light on the blog-front this month due to some very important projects that have been occupying my time. Our Administrative Compliance Project Specialist left us after several years of service, and while we scrambled to find her replacement, I ended up heading the effort to celebrate National Compliance Week here at The Arc of Anchorage. Every day we ran random compliance inspections in unlocked offices, leaving pass or fail slips on keyboards to make employees mindful of their surroundings at all times.

We’re also working hard to tighten our security here, both electronic and physical. As one consultant said, “HIPAA compliance isn’t a goal, it’s a process. Every day you should be more compliant than the day before.”

I’ve been thinking about that a lot lately, trying to figure out what I can do on my end, as Therap administrator, to help us be more compliant than the day before. I’ll keep you posted. Emoticon showing smiley face

By |2016-11-03T10:15:24+00:00May 22nd, 2013|Categories: Colleen Bailey's Posts|Tags: , , , , , , , , |Comments Off on Finally Spring?

Washington My Home!

Picture of Kristen Thompson in Washington State

Wow, what a treat it was to spend some time with the great folks of Washington State (and a few exceptional Oregonians, as well). I met some really smart and dedicated folks, who inspired me to remember my roots.  For the most part, I have really enjoyed my transition to Florida, but a week like last week can really bring the homesickness bug on strong. Of course, there was no rain, which makes it a lot easier to remember only the good times…and not the time when the evening news reported that Seattle had beat the bible with more than forty days and nights of rain.

I was happy to see that Seattle has added some new attractions, so I could play tourist in my home state.  First of all, the grand and beautiful Holiday Inn Express in the outskirts of Sumner.  Wow.

Picture of Ferris Wheel in downtown Seattle on the waterfront

Second, the awesome Ferris Wheel in downtown Seattle on the waterfront.  What a beautiful view, not only of the water and the mountains, but also a unique look back at the city skyline.  If you get a chance to hop on this new attraction, take it…and take a camera!

Finally, I was able to ride the new (or at least ‘new-to-me’) gondola at Crystal Mountain which takes you to the summit where you can dine in style at the new restaurant there.  However, you can only dine in style because they have removed the snack bar and brown bag lunch options from the summit…so needless to say, I didn’t eat at the summit.  Never in my wildest dreams did I think I would be going skiing on my trip back home in May, and I’m happy that my ski bum brother was there to help outfit me with the necessary equipment!  It was 72 degrees, so I didn’t need more than the basics!  It wasn’t the best snow, but far better than the skiing that you find in Florida.  (PS – there is no skiing in Florida).

So, a huge thank you to Therap for inviting me and an even bigger thanks to my boss who let me go!  Stay classy, Washington!

Kristen

By |2013-05-22T01:34:56+00:00May 22nd, 2013|Categories: Kristen Thompson's Posts|Tags: , , , , , |Comments Off on Washington My Home!