# Presentation: 070759

## 103 HIM Plugged In

- Presented by:
- Paul Young, RHIA
- Beth Acker, RHIA

## Purpose for this Session

- Specific Requests for More Information from the Focus Group
- Search Tips
- Knowing which site to query
- Essential web references and resources

## Goals

- Effective Search Tools
- Favorites
- Key Web Sites
- Search Tools and Techniques
- Data Management
- Data Validation

**Notes:**
Favorites – how to add to them, how to save them to a folder and move them to another location
Key Web Sites – For information and reports

Search Tools and Techniques – what’s effective, what’s not

Data Management – where to get what you need, efficiently
Data Validation – How to be sure that you’re getting credit for what you do

## Effective Search Tools

- Search Engines
- What’s available?
- Why use one over another?
- Keywords
- How do search engines identify keywords?
- What’s the best way to pick a keyword?

## Search Engines...just to name a few

**Google**_**[http://www.google.com](http://www.google.com/)**_
-  **Yahoo**_**[http://](http://www.yahoo.com/)**__**[www.yahoo.com](http://www.yahoo.com/)**_
**Microsoft Live Search**_**[http://](http://www.live.com/)**__**[www.live.com](http://www.live.com/)**__**[/](http://www.live.com/)**_
**Ask.com**(formerly Ask Jeeves)_[http://www.ask.com](http://www.ask.com/)_
**Dogpile**
- 	_[http://www.dogpile.com/info.dogpl/search/index.htm](http://www.dogpile.com/info.dogpl/search/index.htm)_

**Notes:**
Most search engines require sites to pay a fee to be on special listings or directories, although most, if not all, also provide search results based on the relevancy of the topic.

Google:  known for the wide range of features it offers (being able to search more than just a web page), such as cached links that let you "resurrect" dead pages or see older versions of recently changed ones. 
Yahoo:  Launched in 1994, Yahoo is the Web's oldest "directory," a place where human editors organize web sites into categories. However, in October 2002, Yahoo made a giant shift to crawler-based listings for its main results. These came from Google until February 2004. Now, Yahoo uses its own search technology. 
Microsoft Live Search:  Microsoft Live (formerly MSN Search) was originally powered by LookSmart, which gained top marks for having its own team of editors that monitored the most popular searches being performed to hand-pick sites believed to be the most relevant. 
Subsequently, MSN Search used Yahoo listings to power its database for a while. Recently, Microsoft started using its own crawler-based technology and changed its name from MSN Search to Microsoft Live Search. 
Ask.com:  Ask (formerly Ask Jeeves) initially gained fame in 1998 and 1999 as the "natural language" search engine that lets you search by asking questions and responding with the right answer.
In reality, technology wasn't what made Ask perform so well. Behind the scenes, the company at one point had about 100 editors who monitored search logs. They then went out onto the web and located what seemed to be the best sites to match the most popular queries.
Dogpile:  Why not put six search engines to work on something in the same time it takes to use one? This is what we call metasearch. Dogpile puts the power all the leading search engines together in one search box to deliver the best combined results. The process is more efficient and yields more relevant results. 

## Keywords

- How do search engines use them?
- Coming up with the keyword that will give you what you want

**Notes:**
Search engines work on two types of technologies...directories and crawlers.  Use of directories was the most common technology available at first, and are pretty much as you’d think...a site submits a short description of their site to the search engine, or editors employed by search engines write a summary of what’s available.  It’s from this short description that matches are made and choices are displayed.  Crawler technology is now becoming most popular and is basically an automated search tool that gathers information from across the web without human intervention.  Some companies use a combination directories and crawlers.

Keywords:  First...think of the most unique word that describes what you’re looking for.  Search...did you find what you wanted?  No?  Check your spelling...or try mis-spelling...you’d be amazed...I’ve heard of this being especially effective in snagging bargains on eBay...

## Scenario

- You need to find out more information about standard line counts for transcription.  Name two keywords or phrases with key words and state why you think they would find the most appropriate resources for you to review.

## Sample Keywords and Results

- Line Count – 116,000,000
- Transcription Line Count – 1,750,000
- Define Transcription Line Count – 1,630,000
- Standard Line Count – 67,400,000
- AHIMA Line Count – 22,300

**Notes:**
Using Google...

## Use those Keywords

- VeHU
- VALO
- Forms and Directives
- VistA Documentation Library
- CPRS Project Notebooks
- Office of Quality and Performance
- VSSC

## VeHU

**Topic / Track Search**Search by Track or Subject using the Search function at the bottom of the Search by topic or keyword page. Select the Track from the drop down list or type the subject into the Keyword box and select Search.
- The "Keyword" and "Track" fields work together. If you don't select a track, content from all tracks will be displayed; if you don't type in a key word, all training for the designated track will be displayed

## Enter keyword here

**Enter keyword here**

## VA Learning Online VALO

- VA Learning Online (VALO) is a web-based campus offering over 1500 courses ranging from personal development to IT and management skills that can be accessed from work or home.

## Enter keyword here

**Enter keyword here**

## VHA Forms, Publications, and etc. 

**Enter keyword**
** ****	****here**

## VISTA Documentation Library

- _[http://www.va.gov/vdl/](http://www.va.gov/vdl/)_
- All software Manuals
- Using a keyword, Search to find functionality
- Example...You have a question about how to ‘099’ a PTF record...

## Slide 20

## Slide 21

## CPRS Project Notebooks

## Slide 23

**Notes:**
Typically, I’m interested in an active project.  Click the down arrow and the list of active projects will display.  In this case, say we’re interested in knowing what’s going on with the Ambulatory Care Phase II Inpatient Encounter Project.  I’ll select that from this list.

**Notes:**
If you scroll down the page, you can see the notes for the project.  This shows that the national release for this patch was delayed so that that HIMS could announce the patch to the field.

## Office of Quality and Performance

**Notes:**
Accreditation Main History and Overview: You can find Contacts Presentations, Policies and and various Accreditation Links and Calendars
Clinical Practice Guideline Home Page TopicCardiovascular Chronic Heart Failure (CHF)   Dyslipidemia (LIPIDS   Hypertension (HTN)   Ischemic Heart Disease (IHD)   Endocrine Diabetes Mellitus 
Eye Glaucoma 
Genitourinary Tract Erectile Dysfunction (ED) 
Pre-End-Stage Renal Disease (ESRD 
Pre-End-Stage Renal Disease (ESRD) 
Mental Health Major Depressive Disorder (MDD) 
Post Traumatic Stress Disorder   Psychoses 
Substance Use Disorder (SUD) 
Musculoskeletal Low Back Pain (LBP) 
OB/GYN Uncomplicated Pregnancy (UCP) 
Other Biological, Chemical and Radiation Induced Illnesses 
Biological, Chemical, Radiation Induced Illnesses 
Biological, Chemical, Radiation Induced Illnesses: INTRANET ONLY 
Management of Tobacco Use (formerly TUC) 
Medically Unexplained Symptoms: Pain/Fatigue 
Pocket Guide References: Terrorism 
Post Operative Pain 
Post-Deployment Health Evaluation & Management (PDH) 
Overview The CPG Process 
Pulmonary Chronic Obstructive Pulmonary Disease (COPD) 
Rehabilitation Stroke Rehabilitation (STR)

## Allocation Resource Center (ARC)

- Reports
- Education
- Groups
- References
- Mailing List
- Links to other pertinent sites

## Slide 27

## Educode

- The following modules are available in the WebInservice online coding training that may be helpful to you in developing training for provider documentation.  In addition, this online training is available to all VA employees, contractors, and volunteers.
- http://www.educode.com/vaees/
**Module: Documentation Improvement**
- The following lessons are part of this module:
**Lesson Name**
- _[Documentation Improvement: Cardiology Documentation in the Medical Record](http://app15.webinservice.com/KDS50a/content/admin/ShowLessonInfo.asp?Intro=CME99-A-05&IsEducode=True)_
- _[Documentation Improvement: Coding Impact on Reimbursement](http://app15.webinservice.com/KDS50a/content/admin/ShowLessonInfo.asp?Intro=CME99-A-06&IsEducode=True)_
- _[Documentation Improvement: Documentation Prior to Coding ](http://app15.webinservice.com/KDS50a/content/admin/ShowLessonInfo.asp?Intro=CME99-A-08&IsEducode=True)_
- _[Documentation Improvement: Ensuring Optimum Reimbursement](http://app15.webinservice.com/KDS50a/content/admin/ShowLessonInfo.asp?Intro=CME99-A-07&IsEducode=True)_
- _[Documentation Improvement: Official Coding Entities](http://app15.webinservice.com/KDS50a/content/admin/ShowLessonInfo.asp?Intro=CME99-A-02&IsEducode=True)_
- _[Documentation Improvement: Principal Diagnosis Defined](http://app15.webinservice.com/KDS50a/content/admin/ShowLessonInfo.asp?Intro=CME99-A-03&IsEducode=True)_
- Documentation Improvement: Secondary Diagnosis Defined
- Documentation Improvement: The Role of Documentation in Reimbursement
-   **Module: Documentation Improvement for Reimbursement**

## Putting New Skills to the Test

- Where would you find the answer to a question about PTF functionality?
- Local P&P’s
- VistA Documentation Library
- Directives Web Page

## PTF – AUSTIN DATA BASE

- $$
- Approximately what percentage of a facility’s budget comes from VERA?

## PTF – AUSTIN DATA BASE

- Each facility’s budget is based on the workload that is get credited in Austin
- 			= VERA Dollars

## austin.aac.va.gov/

**Austin Automation Center z/OS Enterprise Server**

- Host On-Demand For help if required, call the Austin Help Desk at (512) 326-6780.
- Host On-Demand version 1 (when so instructed by Austin Tech Support) This old, limited-function, unsupported version is only for special-purpose, one-time use. Its continued availability is not guaranteed! ***IMPORTANT: Do NOT use on a daily basis; upgrade to current version above! ***
- Web Server Configuration and Administration Page
- EOS API The EOS API is a way to look at RSD reports stored on the AAC S/390 server. Click here to access your RSD reports using your Web Browser, and/or to access the RSD EOS API Help document.
- Perform test for Java enablement (when so instructed by Austin Tech Support)
- Alternate version of this page This version can be used whe n so instructed by Austin, or when DNS problems are suspected. The set of links this page leads to do not require domain name resolution.
- z/OS Documentation page
- For help with these applications, call the Austin Help Desk at (512) 326-6780.

## Austin Automation Center z/OS Enterprise Server

**Austin Automation Center z/OS Enterprise Server**

- !!! IMPORTANT INFORMATION FOR EOS USERS PLEASE READ CLICK HERE!!!
- go to EOS API The EOS API is a way to access RSD reports stored on the AAC S/390 server. If you already have access to RSD, just click here and use your userid and password to get into the RSD Web Interface. If your first attempt to logon to RSD should fail, please hit the cancel key and see what reason was given for the failure. If your password has expired, please call the Austin Help Desk at (512) 326 - 6780.
- go to RSD EOS API Help Click here for detailed instructions on how to access RSD reports using your Web Browser. Some of the items contained in this help document include step-by-step instructions on how to save your report as a PC file, and how to print your report in an acceptable format.
- go to RSD Manual info Click here for information on obtaining a complete RSD Manual.
- For help with this application, call the Austin Help Desk at (512) 326-6780.

## Log on with user name, password

 Welcome to the EOS WEB application

-  **Welcome to the** **EOS WEB application**

|   |   |
| --- | --- |

**Click on the "Logon To EOS" button to get the global user directory.**
**Optionally specify how many lines per page must be shown in the report list.**

|  Number of lines per page :  |   |  (Optional) |
| --- | --- | --- |

## Slide 35

## A number of other reports listed as well:

**PM.XRD.PTF419         PM04         PTF DISPOSITION IN MASTER FILE  74  FRI JUN 8 20:17:00 2007**

- PTF AVG LENGTH OF STAY:
- 				VA HOSPITAL
- 				NURSING HOME
- 				NON-VA HOSPITAL
- PTF TRANSACTION REPORTS
- PTF MTHLY TRANS. ANALYSIS & SUM

## Where it states Number of pages "1", change that to "99999" 

- Where it states Number of pages "1", change that to "99999"
- The report will then be displayed as one long report and allow export to Excel.
- Otherwise the report will only have 30 lines and you will have to enter NEXT
-  for every page.

##  DISPOSITIONS IN MASTER FILE   

**                                      **
**    ****OCTOBER 01, 2000 THRU JUNE 08, 2007****                                                                    **
** ****589A4    COLUMBIA  MO   **
**                                                                                   **
**  ****DISP-DATE/TIME    SOCIAL-SECURITY NO       PATIENT'S NAME  INIT     ADM-DATE/TIME         LOS         DRG**
** ****061001     1221     000-00-0001              CPRSPATIENT       O     06/09/24   1608        7          398**
** ****061001****	****1115     000-00-0002              CPRSPATIENT****	****    T     06/09/30   2222        1          183**
** ****070607     1246     000-00-0003              CPRSPATIENT****	****    T     07/06/06   1102        1          143**
** ****070907     1013     000-00-0004              CPRSPATIENT****	****    T     07/05/28   1954        10         296**
**	****	****	****	****	****	****	****	****	****	****                 ****TOTAL PREVIOUS FY                    0**
**                                                                                                     ****	****	****TOTAL COMPLETE CURRENT FY        2,842**
**	****	****	****	****	****	****	****	****	****	****TOTAL INCOMPLETE CURRENT FY          0**
**	****	****	****	****	****	****	****	****	****	****TOTAL CURRENT FY                    42**

## Save to Excel File:

- FILE
- 	SAVE AS
- 		RSD EOS 060807
- 			TEXT
- OPEN EXCEL
- 	ALL FILES
- 		TEXT IMPORT WIZARD
- Parse the Data
- Hints:
- 	Disposition/DC date as YMD
- 	Admit date as MDY
- 	SSN and DRG as Text
- Sort it by DC Date and Patient Name

## Now have a file with Austin Data

- need to run what VistA PTF has.
- There is a VistA report:
- Transmitted Records List [DG PTF TRANSMITTED RECORDS]
- This report provides listing of all records transmitted within a date range.
- Trying to verify May 2007 discharges, run for May 1, 2007 through the date that you closed out May discharges.
- Put the report in an Excel spreadsheet, clean it up so that it only includes May discharges.

## You now have two spreadsheets with PTF data.  Copy the data from one to the other and lay them side by side.  If you set it up where the names are side by side, it is pretty quick to check and see if the two match.  Everything in VistA PTF should be in Austin.

| DC DATE | SSN | NAME |  | NAME | DC DATE | SUFFIX |
| --- | --- | --- | --- | --- | --- | --- |
| 5/1/2007 | 0001 | CPRSPATIENT,O |  | CPRSPATIENT,O | 5/1/2007 | 589A4 |
| 5/1/2007 | 0002 | CPRSPATIENT,T |  | CPRSPATIENT,T | 5/1/2007 | 589A4 |
| 5/30/2007 | 0003 | CPRSPATIENT,T |  | CPRSPATIENT,T | 5/30/2007 | 5899AB |
| 5/31/2007 | 0004 | CPRSPATIENT,F |  | CPRSPATIENT,F | 5/31/2007 | 589A4 |
| 5/31/2007 | 0005 | CPRSPATIENT,F |  | CPRSPATIENT,F | 5/31/2007 | 589A4 |

## Notice there is the one with a Suffix of 5899AB.  The "9AB" is what Columbia uses for its Nursing Home Care unit.  When you get data from Austin, there will be various files for different programs.  Make certain you do check all the data.  I copy and paste them into one Excel file so I can compare all at one time.  

| DC DATE | SSN | NAME |  | NAME | DC DATE | SUFFIX |
| --- | --- | --- | --- | --- | --- | --- |
| 5/1/2007 | 0001 | CPRSPATIENT,O |  | CPRSPATIENT,O | 5/1/2007 | 589A4 |
| 5/1/2007 | 0002 | CPRSPATIENT,T |  | CPRSPATIENT,T | 5/1/2007 | 589A4 |
| 5/30/2007 | 0003 | CPRSPATIENT,T |  | CPRSPATIENT,T | 5/30/2007 | 5899AB |
| 5/31/2007 | 0004 | CPRSPATIENT,F |  | CPRSPATIENT,F | 5/31/2007 | 589A4 |
| 5/31/2007 | 0005 | CPRSPATIENT,F |  | CPRSPATIENT,F | 5/31/2007 | 589A4 |

## GR Modifier

- Resident Supervision – VHA Directive 2005-054, Revised Billing Guidance for Services Provided by Supervising Practitioners and Residents
- Modifier Effective 1/1/06
- VHA Directive 2006-045, Monitoring Use of the “- GR” Billing Modifier

## Directive 2006-045: Monitors

- Have we stopped using “GC” and “GE”?
- Fileman lists all usages of “GC” and “GE.”
*Any *use is a concern, may indicate QuadraMed parameters not properly set or flags being ignored.
- Reduction in frequency of monitors:
- If two consecutive monthly reviews show no use, may reduce to quarterly.
- If four consecutive quarterly reviews show no use, may reduce to annually.
- Results to CBIO, who reports to VAMC, VISN, VACO.
- Success measured by *no *usages of “GC” or “GE.”

## Directive 2006-045: Monitors

- When “GR” is coded, is documentation sufficient to support the code?
- Fileman lists all usages of “GR” in billed encounters.
- HIMS reviews random statistical sample.
- Errors reported to Revenue, bills canceled, causes corrected.
- >10% coding error rate requires formal corrective action plan.
- Reduction in sample size.
- If accuracy is ≥95% for two consecutive months, may reduce to probe sample (n≥30) so long as accuracy remains ≥95%.
- Results to CBIO, who reports to VAMC, VISN, VACO.
- Success measured by ≥95% coding accuracy.

## QuadraMed Reports

- Audit Compliance Module (ACM)
- PCE Compliance Module
- Daily Assignment to Coders
- Suspended Encounters
- Specialized Reports
- E&M Reason for Change
- Compliant Coding Module (CCM)
- Workload/Productivity Monitoring

## QuadraMed Reports

- PCE Compliance Module
-   Daily Assignment to Coders
-      Pull List by
- 	Date of Service
- 	Status - Data Entered/ Not Coded by CCM
-      Review for Action Required – Suspend
-      Assign to Coders

## QuadraMed Reports

- PCE Compliance Module
-   Suspended Encounters
- 	Pull List by
- 	Date (DOS or Assigned)
- 	Status - Suspended
-      Review – Change Status as appropriate and 		   assign to Coders

## QuadraMed Reports

- E&M Reason for Change
- 	Sort by:
- Date Range
- Providers – All or Specific Provider(s)
- Location – All or Specific Clinic(s)
- Division
- Reason/Type of Change

## QuadraMed Reports

- E&M Reason for Change
- 	Reasons For Change Selections:
- Insufficienct HPI, FSH, Exam, etc
- Sufficient HPI, Exam, etc
- Incorrect Category or Provider
- Types of Change Selections:
- No Change
- Category Change
- Increase/Decrease
- New Code
- Deleted

## QuadraMed Reports

- In a January review we found in one contract CBOC that 83% of E&M code levels were decreased by our coding staff.
- Provided Training, worked with COTR.  In June, when we looked at it again, the percentage that coding staff decreased was 23%.

## QuadraMed Reports

- Do your OPT Coders deserve an award for their productivity?

## QuadraMed Reports

- Compliance Coding Module (CCM)
- 	Workload and Productivity Monitoring
- All CCM Cases by Date Range – by Last Date Coded
- CCM Status
- Referred to Billing
- Reviewed/Accepted
- Reviewed/Not Billable
- CCM Coded
- Select CCM Coders
- Under Edit,
- User Preferences, Visible Report Columns, can Edit

## QuadraMed Reports

- Compliance Coding Module (CCM)
- 	Workload and Productivity Monitoring
- Under Edit
- 	User Preferences
- 		Visible Report Columns
- Edit which columns you want in Report:
- 	Flag, **Visit Date/Time**, Check Out Status, **Patient Name**
- Primary Eligibility, Current Means Test, **Location**, Division,
**Provider**, Insurance, Reason Not Billable, Visit Notes, **CCM Coder**, **CCM Status**, CCM Priority, **Last Date Coded**,
**Coder Assignment Date/Time**, CPT Code, Total CPT Charges,
**CCM Comments**

## QuadraMed Reports

- Compliance Coding Module (CCM)
- 	Workload and Productivity Monitoring
**Visit Date Pt Name      Location    Coder                  Date Coded       Assign. Date**
- 06/22/07  CPRSPT,O  OPHTH      CPRSCODER,O  07/02/07 08:10   06/29/07
- 06/22/07  CPRSPT,T   BH MHT    CPRSCODER,O   07/02/07 08:18  06/29/07
- 06/22/07  CPRSPT,T   ENT F/U    CPRSCODER,T   07/02/07 08:27  06/29/07
- 06/22/07  CPRSPT,F   PHYS TX   CPRSCODER,T   07/02/07 08:38  06/29/07

## Compliance Coding Module (CCM)
   Workload and Productivity Monitoring - Spreadsheet

-    Workload and Productivity Monitoring - Spreadsheet

|  | CPRSCODE,A |  |  CPRSCODE,B |  | CPRSCODE,C |  | STAFF TOTAL |  |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| JULY | PROD HRS | # ENC | PROD HRS | # ENC | PROD HRS | # ENC | PROD HRS | # ENC |
| 2 | 7.5 | 100 | 7.5 | 80 | 7.5 | 79 | 22.5 | 259 |
| 3 | 6.5 | 68 | 7.5 | 74 | 7.5 | 73 | 21.5 | 215 |
| 5 | 7.5 | 75 | 7.5 | 76 | 5.75 | 60 | 20.75 | 211 |
| 6 | 7.5 | 78 |  |  | 7.5 | 70 | 15 | 148 |
| TOTAL | 29.0 | 321 | 22.5 | 230 | 28.25 | 282 | 79.75 | 833 |
| AVG # ENC |  | 83 |  | 77 |  | 75 |  | 78 |
| % STAN |  | 118% |  | 110% |  | 107% |  | 111% |

## QuadraMed Reports

- Be Aware that ANY reports run in QM take a while to run, especially if it is for any lengthy date range.

## VistA PTF Monitoring

- Daily Process:
- Monitor Productivity
- Monitor Completion of PTF
- Monitor Time Frames

## PTF Reports

- List of Open PTF Transactions
- Productivity Report by Clerk – VistA Option – we use a Fileman Report
- PTF File Status Report – Fileman Report we got from EK.  List patients in Discharge order for a date range, shows PTF status, and number of days from DC to Transmission.  Also gives Average Number of Days from DC to Transmission.

## With list of Number Open, Number Closed, and Discharges, track in a daily spreadsheet.

| JUNE PTF |  |  |  |
| --- | --- | --- | --- |
| DATE | OPEN PTF | PTF CLOSED | NEW DC |
| JUNE1 | 0 | 4 | 30 |
| JUNE 4 | 26 | 9 | 7 |
| JUNE 5 | 24 | 19 | 15 |
| JUNE 6 | 20 | 19 | 9 |
|  |  |  |  |
|  | OPEN PTF | CLOSED PTF |  |
|  | 20 | 51 |  |
| TOTAL DC | 71 |  |  |
| AVG DAYS DC-TRANS | 1.92 |  |  |

- PTF Reports

## PRODUCTIVITY REPORT BY CLERK

| NAME | DC DATE | CLOSE DATE | DC SPEC | FAC | SUF | STATUS | PRIM DX | DRG |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| CPRSPT,O | 6/7/07 | 6/8/07 | M OBS | 589 | A4 | TRANS | 414.00 | 133 |
| CPRSPT,T | 6/6/07 | 6/8/07 | GEN M | 589 | A4 | TRANS | 386.11 | 065 |
| CPRSPT,T | 6/6/07 | 6/8/07 | NH | 589 | 9AB | TRANS | V57.89 | 462 |
| CPRSPT,F | 6/7/07 | 6/8/07 | PSY | 589 | A4 | CLOSED | 296.30 | 430 |

- A coding staff member reviews this daily.
- 	Checks Documentation for Primary Dx:
- 		486 – Pneumonia
- 		038 – Sepsis
- 		518.81 – Acute Resp Failure
- 		410.xx	- MI
- 	Also reviews DRG 470 - Ungroupable

## Surgical Coding

- Requirement that all Surgeries be completed in the Surgical Package
**PCE FILING STATUS REPORT**
**COMPLETED CASES MISSING CPT CODES**

## Surgical Coding

**PATIENT      DATE OF OP       PRIN DX        CODER                 DATE CODED**
- --------------------------------------------------------------------------------
- CPRSPT,O    JUN 18,2007
- CPRSPT,T    JUN 18,2007
- CPRSPT,T    JUN 18,2007  07:35     185.       CPRSCODER,O     JUN 21,2007  12:10
- CPRSPT,F    JUN 18,2007  07:58     530.0     CPRSCODER,O     JUN 21,2007  12:38
- CPRSPT,F    JUN 18,2007  08:30     728.87   CPRSCODER,O     JUN 21,2007  13:05
- CPRSPT,S    JUN 18,2007  10:05     354.0     CPRSCODER,O     JUN 21,2007  12:26
- CPRSPT,S    JUN 18,2007  10:10     550.90   CPRSCODER,O     JUN 21,2007  13:18
- CPRSPT,E    JUN 18,2007  11:23     728.6     CPRSCODER,O     JUN 21,2007  13:14
- CPRSPT,N   JUN 18,2007  12:51     934.8     CPRSCODER,O     JUL  2,2007  09:58
- CPRSPT,T    JUN 18,2007  13:00
- CPRSPT,E    JUN 18,2007  13:30     354.0     CPRSCODER,O     JUN 21,2007  13:16

## What is a good way to tell if your ROI program is running smoothly?

- 			What is a better way?

## ROI Manager

- Monitor:
- 	Productivity
- 	Work Assignment
- 	Backlog
- FOIA Report –Annual and Backlog

## ROI Manager

- Reports are located under Print Option
- 	Print ROI Reports
- Requests by Clerk by Date Range
- 	Date Range
- 	Status
- 	Select Clerk

## ROI Manager

- FOIA Reports
- 	Specific Report Tab for Annual FOIA Report
- 	Backlog Reports – excludes completion of forms and those awaiting payment

## Do you ever get a request for data, and your first response is, why me?

- CMS – Relative Value Unit (RVU) Data

## CMS – Relative Value Unit (RVU) Data

- Web site: http://www.cms.hhs.gov/home/medicare.asp
- 	Physician Fee Schedule (PFS)
- 	PFS Relative Value Files
- 	Available by Calendar Year
- 	Gives listing of CPT Codes and RVUs associated with them

## CMS – Relative Value Unit (RVU) Data Have to find the Geographic Practice Cost Indices for your area for that year.There is a Work Indices, a Practice Expense (PE) Indices and a Mal Practice (MP) Indices.The Formula for Facility CPT Value is:((Work RVU x Work GPCI) + (PE RVU x PE GPCI) + (MP RVU x MP GPCI)) x Conversion Factor

## Missouri has a GPCI of .95, a PE of .803 and MP .878

| HCPCS | DESCRIPTION | WORK RVU | FACILITY PE RVU | MP RVU | CONVERS FACTOR | TOTAL |
| --- | --- | --- | --- | --- | --- | --- |
| 99211 | OFFICE OPT, EST | .17 X .95 = .1615 | .06 X .803 = .04818 | .01 X .878 = .00878 | 35.9848 | $7.86 |
| 99212 | OFFICE OPT, EST | .45 X .95 = .4275 | .15 X .803 = .12045 | .03 X .878 = .02634 | 35.9848
 | 20.67 |
| 99213 | OFFICE OPT, EST | .92 X .95 = .874 | .29 X .803 = .23287 | .03 X .878 = .02634 | 35.9848
 | 40.78 |
| 99214 | OFFICE OPT, EST | 1.42 X .95 = 1.349 | .45 X .803 = .36135 | .05 X .878 = .0439 | 35.9848
 | 63.13 |
| 99215 | OFFICE OPT, EST | 2.00 X .95 = 1.90 | .62 X .803 = .49786 | .08 X .878 = .07024 | 35.9848
 | 88.81 |

## JCAHO

- With emphasis on Tracers, totally different process from reviewing multiple charts to find the few that you were willing for them to review
- I was requested to provide:
- Top 10 Diagnosis List
- Hospital Medical Record Statistics

## ACRP – Outpatient Diagnosis/Procedure Frequency Report

- ACRP Reports Menu Option:  OutpatientDiagnosis/Procedure 				     Frequency Report
- For Medical Center Division:  ALL// 589A4  COLUMBIA VAMC DIVISION     589A4
- Select another division:
-           Outpatient Diagnosis/Procedure Frequency Report
-                          **** Date Range Selection ****
- Beginning date: 6-1-06  (JUN 01, 2006)
-    Ending date: 5-31-07  (MAY 31, 2007)

## ACRP – Outpatient Diagnosis/Procedure Frequency Report

-  **** Report Format Selection ****
-      Select one of the following:
-           D         DIAGNOSIS FREQUENCY
-           P         PROCEDURE FREQUENCY
-           B         BOTH DIAGNOSIS AND PROC
- Specify the type of report to print: D  DIAGNOSIS FREQUENCY
- Limit list to most frequent:  (1-99999): 50// 10

## ACRP – Outpatient Diagnosis/Procedure Frequency Report

-  <*>  OUTPATIENT DIAGNOSIS FREQUENCY REPORT  <*>
-                        For the 10 most frequent diagnoses
-                       For division: COLUMBIA VAMC DIVISION
- --------------------------------------------------------------------------------
- For date range: JUN 1,2006 to MAY 31,2007
- --------------------------------------------------------------------------------
- CODE                                                            PRIMARY   SECONDARY       TOTAL
- NUMBER   DIAGNOSIS                             DIAGNOSIS   DIAGNOSIS   FREQUENCY
- -------  -----------------------------------               ----------           ----------           ----------
- V68.89   ADMINISTRTVE ENCOUNT NEC       42396          774                   43170
- 401.9      HYPERTENSION NOS                          18234        20122                 38356
- V65.49   OTHER SPECIFIED COUNSELING       23061         2249                25310
- V68.1     ISSUE REPEAT PRESCRIPT                  20856         3901                 24757
- 250.00    DMII WO CMP NT ST UNCNTR             15384         8919                24303
- 272.4      HYPERLIPIDEMIA NEC/NOS                 6155       16794                 22949
- V65.40    OTH UNSP COUNSEL                             9840          2278                 12448
- 303.90    ALCOH DEP NEC/NOS-UNSPEC            7141          4107                   11248
- 496.        CHR AIRWAY OBSTRUCT NEC            9396         1173                   10569
- 309.81    POSTTRAUMATIC STRESS DIS             1807         8597                  10404
- TOTAL:                                                                    154270       68914                223184

## TOP 10 INPT DX

- OUTPUT FROM WHAT FILE: PTF//
- SORT BY: NUMBER// @3  FACILITY
- START WITH FACILITY: FIRST// 589
- GO TO FACILITY: LAST// 589
-   WITHIN FACILITY, SORT BY: @5  SUFFIX
-   START WITH SUFFIX: FIRST// A4
-   GO TO SUFFIX: LAST// A4
-     WITHIN SUFFIX, SORT BY: 79  PRINCIPAL DIAGNOSIS
-     START WITH PRINCIPAL DIAGNOSIS: FIRST// 000.00
-     GO TO PRINCIPAL DIAGNOSIS: LAST// 999.99
-       WITHIN PRINCIPAL DIAGNOSIS, SORT BY: @70  DISCHARGE DATE
-       START WITH DISCHARGE DATE: FIRST// 6-1-06  (JUN 01, 2006)
-       GO TO DISCHARGE DATE: LAST// 5-31-07  (MAY 31, 2007)
-         WITHIN DISCHARGE DATE, SORT BY:
- STORE IN 'SORT' TEMPLATE:
- FIRST PRINT FIELD: 2.2  WARD AT DISCHARGE
- THEN PRINT FIELD: 70  DISCHARGE DATE
- THEN PRINT FIELD: 79  PRINCIPAL DIAGNOSIS
- THEN PRINT FIELD: 9  DRG

## TOP 10 INPT DX

| DX | DESCRIPTION | COUNT |
| --- | --- | --- |
| 414.01 | Coronary Atherosclerosis, Native Vessel | 485 |
| 428.00 | Heart Failure | 146 |
| 491.21 | Obstructive Chronic Bronchitis, w (acute) Exacerb | 136 |
| 486.00 | Pneumonia, Organism Unspecified | 131 |
| 786.59 | Chest Pain, Other | 114 |
| 786.50 | Chest Pain, Unspecified | 63 |
| 410.71 | Acute Myocardial Infarction, Subendocardial, Ini | 60 |
| 599.0 | Urinary Tract Infection, site not specified | 59 |
| 414.00 | Coronary Atherosclerosis, unspecified | 58 |
| 682.60 | Other Cellulitis and Abscess, Leg, except Foot | 55 |

## Hospital Medical Record Statistics Form

***Overall Statistics/Organizational Timeframe:***
**1.****	****Average Monthly Discharge Rate (AMD)**_________________
- 	*Total number of inpatient discharges in the 12 months prior to survey ÷ 12*
*	*_*Note: This number represents all inpatient (*__***and can include other records such as***__* observation beds, ambulatory surgery, endoscopy, cardiac catheterization, or emergency department*). Does not include any other type of ambulatory/outpatient encounter.*_
- The records included for delinquency counts should be included in both the numerator and denominator of the calculations.
**________________________________________________________**
**2.****	****Medical Record Delinquency Timeframe: **________________
- 	*As specified in the Medical Staff rules and regs.*[1]

## Hospital Medical Record Statistics Form

***Quarterly Measure:***
**3.  ****Total Acute Care Medical Record Delinquency Rate**
- 	For each quarter prior to survey, note the **average acute care medical record delinquency rate**[1].  This includes records delinquent _for any reason_.
- 	*TOTAL AVERAGE = total of all quarterly averages ÷ 4.*
- 	Note: The total average is compared to the AMD listed in 1. above.

| Quarter 1 Average | Quarter 2 Average | Quarter 3 Average | Quarter 4 Average | TOTAL AVERAGE |
| --- | --- | --- | --- | --- |
|  |  |  |  |  |

## Hospital Medical Record Statistics Form

***Important Notes***
**•****	****	****If the average total number of medical records delinquent (calculated from the last four quarter measurements) is equal to or greater than twice the average monthly discharge rate (AMD), conditional accreditation will be recommended at the time of survey.**
-      Completed by
-            _______________________(Print)________________Date________
-      Name/Job Title
-            _______________________(Print)________________Date________
-      Name/Job Title

## HIMS BOOKMARKS

- VHA HIM HOMEPAGE
-  VHA CHIEF BUSINESS OFFICE
- VHA FORMS, PUBLICATIONS AND RECORDS MANAGEMENT
- VA PUBLICATIONS
- VHA PRIVACY OFFICE
- VISTA UNIVERSITY

## HIMS BOOKMARKS

- CMS  http://www.cms.hhs.gov/
- ARC RVU CALCULATOR
- FEDERAL REGISTER HOME PAGE  http://www.gpoaccess.gov/fr/
- CMS PHYSICIAN FEE SCHEDULE RVU TABLES  http://www.cms.hhs.gov/PhysicianFeeSched/PFSRVF/list.asp?listpage=2
- AUSTIN AUTOMATION CENTER ENTERPRISE SERVER
- VHA OFFICE OF COMPLIANCE AND BUSINESS INTEGRITY

## HIMS Plugged In

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