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Quality Assurance for Billing

Hi All,
We have a wonderful webinar published on Therap’s Youtube page which covers “How to use Therap to Support Billing” . The presenter, Jide Amosu, is a Certified Trainer as well as the Financial Analyst for Capital Hill Day Services. Jide walked attendees through a successful system check and balance for billing by running ISP data reports and attendance reports to support billable services. While there are many approaches to preventing under and/or over billing, Jide did a great job highlighting his agency’s approach to preventing recoupment, over-billing, and under-billing.

I hope everyone enjoys this video as much as I. If you are interesting in using the excel template within the recording, please feel free to email me directly (chelsea.newby@therapservices.net).

 

https://www.youtube.com/watch?v=QJVnvI_YMBg&feature=youtu.be

 

 

Enjoy!

By |2016-11-03T10:15:09+00:00June 10th, 2015|Categories: Uncategorized|Tags: , , , |Comments Off on Quality Assurance for Billing

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

Questions for Therap Vets…

Okay so this blogging commitment is no joke! It sure doesn’t take much time to fall behind does it? This morning I blog to you with questions. I’ve learned this blog is filled with very experienced Therap users out there that I’d like to pick the brains of. IO has been using Therap for a year now and has implemented a huge chunk of the modules but are not at the Pro level yet. With our rookie year behind us and as our use has increased,  I’ve found come more questions and a growing “my issues” list. So here are a couple of my burning ones…

1. How do large agencies handle temporary on call managers? Our agency has a rotating schedule of on call administrators and RN’s. We have found the best way to give them weekend Therap access to an additional 10-15 (or more) residential facilities is to add a Profile on Friday afternoon and then delete it Monday morning. We’ve had to do it this way so that they don’t get blasted with notifications when they are not on call from facilities that they are not typically responsible for. We thought about creating a On Call user account but then you don’t have the e signature of the actual person handling client business on the weekend. Thoughts??? What are other large agencies out there doing to solve this issue?

2. With regards to giving auditors access (licensing and Regional Center-CA users), how do agencies get around not being able to give them access to VIEW ISP Data Reports? In order to see progress on an individual they would have to sift through raw data which can quickly turn a very pleasant auditor into a rather unkind and difficult to work with person (with understanding!). It seems the only way to navigate this is to print the monthly progress reports created by the Administrator and leave them in the facility for those unannounced auditor visits? In efforts to go paperless, I cringe at the though of telling our team to routinely print these reports each month. This would also include the RN’s monthly Health Care Reports. Do other agencies have a standard book/chart of items that remain printed and left in the facilities?

I hope a few of you will have the time to give some feedback and advise on these issues. Hope all in Therapland are doing well!

With Gratitude,
Summer

I love the smell of Therap in the morning…It’s the smell of victory

A month or two ago we began laying the ground work for a overhaul to our system. We were trying to decide how to make or system look more “Individual based”, without giving everyone access to everything. What we decided on was the following. Our programs (in Therap) were no longer going to be formed around a house, but around the individual instead. Each program would be a single person ie, the person Bill Kilgore would be enrolled in the Program Bill Kilgore. Our Caseloads would be changed from program based to individual based (just residential). But, we did keep the caseloads named after houses  that way we could put multiple people/programs into it.

The work involved was far less than we expected: Really, REALLY, time consuming, but easier than thought. First programs where created for each person. Each person was then enrolled in their new program. The supervisors then created reports for all the ISPs up to the date switch over, copied the ISPs over to the new program and then D/C’d the old ones. We then un-enrolled the person from their old program. Once this was done we proceeded to  change over the caseloads,  removing the house program and replacing it with the individuals in the house.

Pros: We no longer have to copy/ DC  ISPs every time a person supported moves houses; when they move we simply change the address of the program, meaning that we no longer needed to enroll or un-enroll . This goes for personal finance, and other modules that require you to chose a program to create data, as well.  From here forward if a person moves during the year we will no longer have to worry whether to search by program or individual, because either one will produce the same results. Chances of recording data under the wrong person has been greatly reduced because you have to click on the name twice now, this is becaseu when you click on their name (program) the next screen will only have their name, not anyone else’s.

The Cons: We lost the ability to comment on t-logs from the old program (minor). If a report was not created for an ISP, from the old program, we lost the ability to create one (again minor). Our list of programs has become ENORMOUS, but that only affects the Res. Admins. (so minor).

So all in all the war for making things easier and more efficient is going in our favor. Minus the few little hiccups already mentioned, our soldiers move forward better equipped.

Picture of Deserve Victory

 

 

Still Breathing

Yesterday was a monumental day for me. I hosted, with the aid of the incomparable Allison, my first webinar and I am still alive. This was an eye opening experience for me. I am the main Therap trainer for my company and I have never “heard” myself before. Note, “um” fills space in a bad way. Other than that I am super excited and hope you watch, Allison has posted it, and enjoy.

By |2013-04-23T17:41:36+00:00April 23rd, 2013|Categories: Craig Buswell's Posts|Tags: , , , , , , |Comments Off on Still Breathing

I’m a presenter!!??

So I just agreed to be a presenter at the Montana Regional Conference in Helena June 12-13. I am excited and nervous all at the same time. I am going to be talking about GER’s and Montana’s Incident Management System and also how to take Montana’s PSP’s and put them into Therap’s ISP module. Are there comments/suggestions on these topics that people wish they would have known about or that I should make sure to mention?

By |2013-03-19T17:34:12+00:00March 19th, 2013|Categories: Lacy Hutchens's Posts|Tags: , , , , |1 Comment

ISP Data Status

Now that we are implementing ISP’s across our pilot agencies, a question has come up regarding the status of ISP Data. From what we can tell, there are only 2 statuses – In Prep & Deleted. Does the data ever change to a different status? Our agencies would like to see Approved or Reviewed, for data that has been reviewed by management. It would also be nice for those that are tied to a Billing Service Authorization, to change to a Billed status.

By |2013-02-13T16:36:30+00:00February 13th, 2013|Categories: Lorelei Glenn's Posts|Tags: , , |2 Comments

Getting ready for fall in CT

I have to admit that I am very “reserved” (a little shy) when it comes to blogging and hosting webinars.  This is definitely obvious from the date of my last blog (almost one year ago to date).  I am committing myself to get a lot better and overcome this.  As it is the same time of year as my last post, rereading that one really shows how routine things can be.  I am once again getting ready for my sons birthday as well as the CT Therap Conference in Meriden next week.  This is the absolute best time of year in CT in my opinion-summer humidity is ending and fall is right around the corner.  Apple and pumpkin picking, long sleeved shirts and chilly nights.  Some of the great things that I hope never change.

As for the company I work for (WILA), we have advanced in our use of Therap somewhat.  We have more users on board and they are a lot more advanced in their Therap skills than a year ago.  We are currently utilizing as much of Therap as pertains to us as a smaller company, including but not limited to T-Logs, Scomms, GER’s, ISP Data and Programs, TMS, Health Tracking and other Therap “staples”.  We are not using IPOP’s, MAR’s or time tracking yet but hopefully they will be included in our near future endeavors.  The benefits of Therap are more than obvious for all of our staff.  The nurses see a lot of the benefits with Health Tracking and the ease of communicating updates/changes with all of the staff.   Therap allows for new staff to get to know our clients from different view points as well as track their health/behaviors/activities a lot more efficiently than ever before.  Therap has been a great advancement for us and I personally look forward to all that it will bring us in the future.

Hopefully I will see some of you at the CT Therap next week, especially as I will be hosting 2 classes during the conference!

P.S. Allison…I blogged!!!!

By |2016-11-03T10:15:34+00:00September 18th, 2012|Categories: Michelle Hansen'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

Therap: A Great Communication System

One of my earliest Therap revelations came when I realized that Therap is not just a form of electronic documentation…it is a way of communicating and doing business better.  Information is organized in smart modules that promote rapid access and analysis. Simply put, Therap helps us communicate more efficiently and more thoroughly so we can make better decisions.

For example, Progress Industries uses ISP Data for programmatic progress notes because this module features such powerful analysis and reporting tools.  We use T logs for communication of NONprogrammatic data that the team needs to know. 

[A quick reference note is also placed in T Logs to alert team members to special events. (E.G. High blood sugar reading at 2:00pm, see Vitals.)] We generally use S Comms for communicating to a particular staff, rather than the whole team.  One of the cool features of Therap is the flexibility it offers to various providers to cutomize the modules in a way that makes best sense to that agency.

Whatever design you choose at your agency, communication is enhanced when staff understand and follow that plan. For example when a staff at our agency sends programmatic information via S Comm, we find that sometimes team members are inadvertently omitted from the recipient list. Similarly, data entered into T Logs is not automatically captured in official ISP Data logs and requires time consuming data analysis of information inputed across various modules.  Of course, plenty of opportunities for exceptions arise, and it’s not usually a big deal. Often, simple reminders about how to use the tools suffices to get everyone on the same page. But we’ve found that agreeing on how we communicate as an agency and using the Therap modules consistently with our design is essential to achieving great results.

By |2016-11-03T10:15:45+00:00February 17th, 2012|Categories: Bryan Thayer's Posts|Tags: , , |Comments Off on Therap: A Great Communication System