# Presentation: 045461

## Automated Service Connected Designation (ASCD)

- VeHU Session 151H

**Notes:**
Linda:

Welcome

Get seated

Introduction to some new software to assist with the review of SC encounters prior to doing the Code Me report from QMED.

## Faculty 

- Linda Nugent, Director, HIM
- Margie Woehrle, VHIT Representative
- Mary Garding, Chief, HIM, St. Cloud VAMC

**Notes:**
Linda: HIM has led the initiation of this software with the endorsement of the CBO office.
Margie:  Analyst—understands the working of the software better than any of us at this time
Mary:  Used the OLD SCAM software and can compare the two and give you some hints on ways to make this software work for you and your staff.

## Project Status

- Purpose
- Release plans
- Future development

**Notes:**
Linda:   Purpose: 
Introduction to some new software to assist with the review of SC encounters prior to doing the Code Me report from QMED.  Class III SCAM has been upgraded to Class I with added functionality.  This is phase one of the project and only affects PCE and Scheduling.  The point is to assure that encounters marked SC are reviewed to assure the right designation has been made.  Benefits may include: Software focuses on those cases needing up front evaluation; It removes encounter where there is a positive match with the VBA code—therefore decreasing the # of cases requiring an initial (eyeball) review.  For those facilities who contract out outpatient coding, it would provide a vendor worklist of insured cases needing coding

Training Scheduled:  1st viewing is here at VeHU.  Additionally scheduled Conference calls, one more VeHU presentation, Live Meetings by VISN (using VeHU presentation), UR Table Talks, FAQ and user manual.

Release date:  8/31/07

Future:
QMED Interface
Ancillary Packages – FY08
Review map/continue to refine

## The MAP

- Rules were established prior to mapping ICD codes to VBA codes
- Rules concluded with the following:
- 	True match
- 	Partial Match
- 	No Match
- Matching is to the primary Dx code only
- All Partials and No Match go for review

**Notes:**

Linda: Examples:
	ICD is broader than VBA – not mappable

Laterality

Large VBA code buckets that encompass many ICD concepts that a veteran might have one or more conditions that would be SC or not SC  

## How It Works...

- The Service Connected status is automatically determined within Scheduling and PCE during the checkout process
- Certain encounters sent to ASCD application for review

**Notes:**
Margie:
The SC Status is automatically determined when the dx code is entered during the checkout process based on the mapping that Linda was talking about earlier.
This automation only happens within PCE & Scheduling 
Certain encounters will be sent to the ASCD application for review based on the mapping criteria as well.  
These encounters are automatically set into the review file as soon as the checkout process is complete.
Even though the encounter is set for review existing billing processes will still take place after the checkout is complete.

## ASCD Users

- General Users – New Status Only
- No Key Assigned
- Clinical Reviewers – Review Status Only
- SDSC CLINICAL Key
- Supervisors – All Statuses
- SDSC SUPER key

**Notes:**
Margie
You will have the ability to see encounters at various statuses within the ListMan view (NEW, REVIEW & COMPLETE).

There are 3 types of users....

## Automation/Review Criteria

| Criteria | Status | Review |
| --- | --- | --- |
| Primary DX Code is a true match. | SC | No |
| Secondary DX Code is a true match. | SC | Yes |
| Primary/Secondary DX Code is a partial match. | SC | Yes |
| Patient is service connected but has NO rated disabilities. | SC | Yes |
| Patient has rated disabilities but they are not mapped to any DX codes. | SC | Yes |
| Patient has rated disabilities but the encounter DX Code DOES NOT match any mapped DX Codes. | NSC | Yes |

**Notes:**
Margie:
Below is the criteria that is used to set the SC/NSC status as well as determine if the encounter is to be set for additional review within the ASCD application.

## Encounters from Ancillary Packages

- Same review criteria will be used when encounter is sent to PCE
- If the ancillary package originating SC/NSC value differs from the ASCD SC/NSC value, the encounter will be set for review
- The ancillary package originating SC/NSC value will not be changed when the encounter is sent to PCE
- Only CPRS will be updated if SC value is changed via the ASCD application
- Other ancillary packages will NOT be updated if SC value is changed via the ASCD application

**Notes:**
The same review criteria listed in the previous slide will be used for encounters sent to PCE from ancillary packages.
Originating ancillary packages will NOT be updated... This is how PCE currently works.

## Automation/Review Practice

- Logon to VistA
- Find Your Student # By Your Computer
- Click the KEA icon on your desktop
- Access:  ##VEHU
-   Verify:  VEHU##

**Notes:**
Margie:
We are going to run through a few of the scenarios mentioned in the previous slides.  Let go ahead and log-on to our training account.

## Exercises

- Exercise #1:  Secondary Diagnosis is a True Match
- Scenario: Checkout encounter via Appointment Management then review via the ASCD application
- Exercise #2: The Encounter DX Code Does NOT Match Any DX Codes That Are Mapped to the Rated Disabilities
- Scenario: Checkout encounter via PCE, then review via the ASCD application

**Notes:**
EX 1:  309.29 is primary DX code and it is mapped as a partial match for RD Code: 9440-CHRONIC ADJUSTMENT DISORDER (SC=Y)
003.24 is secondary DX code and it is mapped as a true match for RD Code: 5000-OSTEOMYELITIS (SC=Y)
780.6 is not mapped to either of the RD codes for this patient (SC=N)

EX 2: Patient has RD 7530 - CHRONIC RENAL DISEASE and 309.29 is not mapped to that RD therefore SC is set to NO. 
003.24 is not mapped to 7530 either, therefore SC is set to NO
780.6 is not mapped to 7530 either, therefore SC is set to NO

## Exercises Cont.:

- Exercise #3: Patient has Rated Disabilities But They Are Not Mapped to Any DX Codes
- - Scenario: Checkout Encounter via Appointment Management then Review ASCD application

**Notes:**
Margie:
EX 3: Patient has RD 5099 – BONE CONDITION and it is not mapped to any DX codes.  Therefore, 309.29 SC status is set to YES. 
003.24 SC status is set to YES. 
780.6 SC status is set to YES. 

## Exercises Cont.:

- Exercise #4: Encounter is Set to NSC via CPRS but primary DX is a True Match
- Scenario:  Change Service Connected Status via the ASCD application, then verify status changed in CPRS GUI
- Exercise #5:  Encounter is Set to NSC via Event Capture GUI but primary DX is a Partial Match
- Scenario: Verify message will display before you change service connected status via the ASCD application

## Daily VistA Email

- Subj: ASCD Compile Numbers  [#5026] 07/17/07@12:34  16 lines
- From: ASCD COMPILE  In 'IN' basket.   Page 1
- -------------------------------------------------------------------------------
- Date Range (Compile)   - From: Jun 17, 2007 Thru: Jul 17, 2007
- Date Range (Late Ins.) - From: Sep 27, 2004 Thru: Jul 16, 2007
- Number of encounters Service Connected (Compile)  :	0
- Number of encounters Service Connected (Late Ins.) :	0
-    (Number SvcConn with a True Map)       :       0
-    (Number SvcConn with a Partial Map)    :       0
-    (Number SvcConn that don't Map to VBA) :    0
- Number of encounters Not Service Connected	:	6
- Number of encounters that are Non-billable	:	3
- Number of encounters with Non-count Clinics	:	0
- Number of encounters with no diagnoses	:	0
- Number of encounters with other errors	:	0
- Number of encounters already evaluated	:	1
- -------------------------------------------------------------------------------------
- Total Encounters Checked:                                	10

## ASCD Reports

** ****Clinic Service Total Summary Report**
** ****Compile Results Report**
** ****Estimated Recovered Costs Report**
** ****First Party Billable Service Connected Report**
** ****Manager Summary Report**
** ****Provider Service Connected Encounters ****	****       ****	**
**      ****Report**
** ****Provider Total Summary Report**
** ****Service Connected Encounters Report**
** ****Third Party Billable Service Connected Report**
** ****Unbilled/Billable Amount Report**
** ****User Service Connected Encounters Report**
** ****User Total Summary Report**

## Compile Results Report	(Summary or Detailed Report)

- Results of the software compile for any date range.  This is _not _the results of the encounter review.
- Detailed report includes list of encounters reviewed by ASCD or marked for manual review due to diagnosis code.
- Detailed list is useful for audit of encounters and the selection of the appropriate SC diagnosis in checkout compared to documentation.

## Compile Result Report Example

- Compile Results Report - Summary                                   PAGE: 1
-      For Encounters Dated 6/1/07 THRU 6/8/07
-   # Enc   Reason
- -------------------------------------------------------------------------------
- 	2  	A diagnosis fully matched a rated disability condition
- 	1  	A diagnosis partially matched a rated disability condition
-    21  	Eligibility is not service connected
- 	1  	No Diagnoses identified as service connected
- 	4	Non-billable because patient is not insured
- -------------------------------------------------------------------------------
-    29  	TOTAL Encounters
- * Third Party=TP; Means Test=MT
- <End of Report>

## Manager Summary Report

- Report can be run by division for date range
- Indicates the overall review status for any date range, including:
- Number of encounters to be processed
- Number of encounters sent to clinical review
- Number of encounters changed or not changed during review process

## Managers Summary Report Example

- Managers Summary Data Report                                       PAGE: 1
-      For Encounters Dated 6/1/07 THRU 6/8/07 For Division: ALL
- -------------------------------------------------------------------------------
- All Checked Out Encounters:			           36
- ASCD Encounters that are potentially billable:		7
-                                                        -------
- Encounters verified with Rated Disability Codes:		4
- Encounters where SC NOT changed:			3
- Encounters where SC was changed to NSC:		0
- Encounters where NSC was changed to SC:		0
- Encounters sent to Clinical Review:			0
- Encounters not editable:					0
- Encounters not yet processed:				0
- <End of Report>

## User Total Summary Report

- Report can be run by division for date range
- Useful productivity tool for review staff
- Indicates the overall review status by reviewer including:
- Number of encounters changed
- Number of encounters sent to clinical reviewer
- Number of encounters not changed

## User Total Summary Report Example

- User Summary Data Report                                           PAGE: 1
-      For Encounters Dated 6/1/07 THRU 6/8/07  By Division: ALL
-                                          REVIEW   SC to NSC  NSC to SC  SC KEPT
- ----------------------------------------------------------------------------------------------
- GARDING,MARY L.		0                    1                   0              8
- NUGENT, LINDA		0                    2                   2            10
- WOEHRLE, MARGIE		1                    1                   1              9
-                              	     -------              -------            -------          -------
- TOTAL                       		1                   4                    3            27
- <End of Report>

## User Service Connected Encounters Report

- Report can be run by division for a date range
- Report is sorted by user who last edited the SC connection information, includes:
- Encounter date and number
- Compile determination and user determination
- Status of review and date edited
- Total of encounters by user
- Detailed list useful in a validation audit of reviewed encounters, includes encounter diagnosis codes and rated disability codes

## User Service Connected Encounters Report Summary Example

- PAGE: 1
-      FOR ENCOUNTERS DATED 6/1/07 THRU 6/8/07  By Division: ALL   ENCOUNTER DATE    ENC #     VBA SC USER SC   STATUS    DATE LAST EDITED
- GARDING,MARY L.
-      06/01/2007@09:30  7632586   YES    YES     COMPLETED   JUN 28, 2007
-      06/01/2007@11:30  7632589   YES    YES     COMPLETED   JUN 26, 2007
-      06/04/2007@10:30  7632595   NO     NO      COMPLETED   JUN 26, 2007
-      06/05/2007@08:00  7632601   NO     NO      COMPLETED   JUN 28, 2007
-      06/05/2007@08:20  7632602   NO     NO      COMPLETED   JUN 28, 2007
-      06/05/2007@09:30  7632605   YES    YES     COMPLETED   JUN 28, 2007
-      06/06/2007@13:30  7632618   YES    YES     COMPLETED   JUN 28, 2007
-    Total: 7

## Service Connected Encounters Report

- Report can be run by division for a date range
- Report is detailed listing of encounters reviewed by ASCD or marked for manual review due to diagnosis code including:
- Veteran name and last 4 SSN
- Encounter number
- SC value (YES or NO)
- Diagnosis and codes for encounter
- Rated disabilities and codes for rating.
- Report can for run to just include the Service Connected, Non-Service Connected or All encounters from ASCD compile
- List is useful in validation audit of NSC encounters compared to documentation to ensure clinical staff note all treated diagnoses in checkout process, especially the SC conditions

## Provider Service Connected Reports

- Provider Service Connected Encounters Report
- Very similar to Service Connected Encounters Report except listed by provider.
- Report is useful in on-going review and education with selected providers.
- Provider Total Summary Report
- Indicates the overall status of compile and review listed by provider
- Clinic Service Total Summary Report
- Indicates the overall status of compile and review listed by clinic with totals by Service

## Clinic Service Total Summary Report

- Service Summary Data Report                                        PAGE: 1
-      For Encounters Dated 6/1/07 THRU 6/4/07 For Service: ALL
-                                    VBA OK    REVIEW   SC to NSC    NSC to SC   SC KEPT   NEW
- -------------------------------------------------------------------------------------------------------------------
- MEDICINE
-  CLINIC A		4	0	    0	         0                 3	      0
-  CLINIC B		6	0	    0                   0                 2	      0
-                                         ---------     ---------         ---------          ---------         --------  -------
- Subtotal MEDICINE	              10	0	    0                   0                 5        0
-                                         ---------     ---------         ---------          ---------         --------- -------
- TOTAL		              10              0                  0                   0                 5        0
- <End of Report>

## Unbilled/Billable Amount Report

- Report can be run by division for a date range
-  Report includes reviewed encounters that were changed from SC to NSC or NSC to SC which already were billed
-  Useful to run periodically and communicate information to Revenue Unit

## Unbilled/Billable Amount Report Example

- ASCD Billable **(NSC to SC**) Amounts Report by Division ALL
-           Run Date: Jun 26, 2007@16:31:08
-                                             Page   1
- *** Report reflects ONLY reviewed encounters ***
- Name                  SSN          Enc Date/Time       Encounter No.
-      Clinic                Prim Prov          Date Edited     Instit $  Profess $
-      Bill Nos.
- --------------------------------------------------------------------------------
- --------------------------------------------------------------------------------
- TOTAL:                                                           0.00      0.00
- <End of Report>

## Billable Services Reports – Estimated Costs

- Estimated Recovered Costs Report
- First Party Billable Service Connected Report
- Third Party Billable Service Connected Report

## Estimated Recovered Costs Report Example

- Recovered Costs Report by Division: ALL
-           Run Date: Jun 28, 2007@17:40:36
-                                             Page   1
- Enc #     Patient                          Enc Date       Change Date    AuthDate       Pay Date         Prncpl Bill      Prncpl Pay
- ---------------------------------------------------------------------------------------------------------------------------------------------------------
- TOTAL FIRST PARTY:
-                                0.00
-                                0.00
-  ---------------------------------------------------------------------------------------------------------------------------------------------------------
- TOTAL THIRD PARTY:
-                                0.00
-                                0.00
-  ---------------------------------------------------------------------------------------------------------------------------------------------------------
-  TOTAL FOR BOTH:
-                                0.00
-                                0.00
- <End of Report>

## Working with QuadraMed

- Service connected encounters should be reviewed as may be potential billable
- ASCD has advantage to have one area or person reviewing the SC determinations and making changes. Also provides for an automated secondary review (Supervisor, UR or MD)
- If review is done in ASCD then SC encounters do not need to be reviewed in CCM.  Those encounters can just be purged from code me list.
- ASCD can streamline the Code Me process since those encounters are already reviewed and not need to review by coding staff or contract coding staff

## Reports Practice

- Automated Service Connected Designation Menu Option
- ASCD Reports
-  Compile Results Report
- Please enter START date:          Enter 7-9-07
- Please enter END date:              Enter 7-13-07
-      Select one of the following:
- 	       S         Summary Report
-           D         Detailed Report
- Enter response: S//                     Hit Enter Key
- DEVICE: HOME//		          Hit Enter Key

## Questions???

- Q&A