It’s no secret that every state Medicaid system has a unique set of requirements for documentation and billing of waiver services. It is a cumbersome process to follow the requirements and stay abreast of any changes to remain in compliance at all times. For this very reason, MediSked has a dedicated Compliance Department. Their job is to monitor and be experts in the requirements for documentation in every state that our customers operate in.

Through our platform, a Compliance Pack is installed for every customer that is specific to their state’s requirements. This ensures that all of the documentation matches requirements and is accepted by your state. Updates are made to the Compliance Pack as state requirements change.This is a managed process on our end that essentially doesn’t require any work on our customers’ end to stay compliant.  Our Compliance Department is a huge asset to our customers and a key to an Agency Management Platform.

In the search for the best software solution, provider agencies regularly come across EMR (Electronic Medical Record) and EHR (Electronic Health Record) systems. For most agencies, EMRs are not the best fit based on the types of services that make up the bulk of agency offerings. An Agency Management Platform (AMP) is a better choice in most cases. Below is a quick guide to understand the difference between EMRs and AMPs.

 

-Clinical in Nature. EMRs are not intended for the unique requirements of a waiver provider agency. Instead it is for more clinical agencies. Most EMRs are off the shelf, which means that it is intended to be used as-is, without a lot of modifications. A typical provider agency would have to make many modifications based on their unique workflows and demands.

 

-Episodes of Care. EMRs are a system that’s based on a workflow that clearly has a beginning, middle and end. It is clinical by nature, so the focus is on records management and the creation and documentation of patient assessments and treatment plans on the front end. The work flow clearly follows a path that an agency would treat the “patient” and eventually discharge them. In fact most have a module called Discharge and Transfer Management. We all know that with an Agency Management Platform, the workflow is about providing a lifetime of service and support to the individuals they serve. Goal plans and service notes replace assessments and treatments and managing employees to help individuals reach fulfilled lives are what is important in our system. The bottom line: a provider agency would have a bunch of modules and workflows that have no relevance to them or they would have to change some of their processes to fit the system- which is risky and costly.

 

-Disconnected schedules and shifts. Because EMRs are not targeted to provider agencies, they don’t treat their schedules or appointments, clients, employees and service programs in the same capacity as an AMP. Most have schedules that seem more like an Outlook calendar where you can schedule “events” with a client similar to scheduling a meeting in Outlook but those “events” don’t bring billable hours, service notes, and pay rates together. With most EMRs, it seems like everything is floating on its own, whereas AMPs tightly integrate everything through its platform to ensure tight audit controls, premium service delivery, and trackable payroll and billing information. Most don’t mention anything about error free scheduling- the ability to eliminate double bookings or unqualified staff which an AMP schedule engine does. This goes back to the fact that the average clinical agency that an EMR is serving does not have the home and community based schedules that a provider agency has.

 

-Not focused on waiver specific compliance. Another big piece of an Agency Management Platform is the compliance packs that come standard. So an agency using an AMP is always in compliance with all federal, state and local requirements automatically. Both from a billing and documentation standpoint. This is huge for Medicaid supported services, which is our focus. That is not a focus with EMRs.

 

-Paying for irrelevant functionality. There are some similar functionalities when it comes to certain things like their billing – both EMRs and AMPs integrate with general ledger and payroll software, reporting, HIPAA security measures, we’re also SureScripts certified for e-prescribing. EMRs are more medically slanted, which doesn’t really benefit most provider agencies and it definitely takes the cost of a much higher. Both offer medications management but it’s not a focus for us or most of our customers.

 

Ultimately, most EMRs are geared for agencies that deal with episodes of care that have a beginning and an end. Agency Management Platforms are completely built around supporting agencies that provide a continuum, or lifetime, of care. That affects the functionality and purpose of the software as explained above.

Here’s a typical scenario we encounter when we engage with a prospective customer. We sit down and meet with key members of the agency and begin talk about how things are currently done at the agency. “How do you manage service notes?” “How do you manage billing?” “What happens when there is an audit?” “How much time does your staff spend doing paperwork?”

Most agencies we talk to have a system or approach in place that is typically a patchwork of different types of data gathering and management. Maybe it’s an Access database with notebooks. Or perhaps it’s the filing cabinets in the back room plus some Microsoft spreadsheets. Whatever the case there is always a common thread – it’s cumbersome and disconnected. The thing is, if it’s always the way you have done it and you have grown and been successful as an agency, than what’s the point in changing? If it ain’t broke, why fix it?

To answer that question, you have to be able to step out of how you are currently operating and envision what your agency and daily work life would be like if you were using a different approach. Would life be easier, harder or no different? This is what we try to do when we sit down with a provider agency for the first time. Using paper methods to document service provision is by far the most common way for provider agencies to log this information. The workflow processes that are created to support this method have often evolved over time and most likely are at a point where it is being handled as efficiently as possible. The problem is, even with the most efficient paper documentation and collection processes in place it is still less efficient and accurate than using an agency management platform. Let’s compare the two processes at different points.

Point of care

• Paper System: Notebooks are used to document the daily activities that are worked on with the client by the field staff. Staff hand writes notes and signs off on them. Typically, the clients authorized plan of care or goals are not in front of them while these notes are created to remind staff of what, specifically, they should work on. Sometimes notes are written at the end of a shift, other times agencies allot non-revenue generating time at the end of the week or pay period for staff to catch up on or create their notes.

• Agency Management Platform: Notes and documentation are done directly through the web based platform on the client’s specific note page. Included on the notes page is their goal plan, a narrative section for writing descriptions of what they did along with check boxes staff can click that relate specifically to activities they should be working on with the client. Staff is constantly reminded of the goals and activities that are important and authorized for the client. Documentation can be done at the point care through any device that connects to the internet: computer, laptop, tablet or smartphone. All notes are completed and stamped with a digital signature.

Delivery back to the office

• Paper System: Paper notes have to physically make their way back to the main office. With staff members that are out in the community and some who are rarely at the office, this task can become cumbersome. Staff members have to hand deliver notes back to the office for which they can charge mileage, they can mail them which cost money or the agency will have office staff physically drive around to pick up notebooks from different locations, which costs mileage and non-productive time.

• Agency Management Platform: Notes are submitted in real time through the platform with the click of a button.

Billing

• Paper System: Once notes are delivered back to the office they are processed for billing. This is typically where the paperwork begins to pile up! Paper notes are used to generate claims for billing. What happens if the note is wrong or missing? Well, that’s where file folders, desk trays, post it notes, “organized” small piles of paper that only the person who’s desk it is knows the “system” that’s been developed to keep track of them come into play. And once billing has been submitted, where does the paper go then? Into other organized piles or folders and eventually they go into storage where they are archived and never see the light of day again!

• Agency Management Platform: All completed notes are connected to completed shifts in a platform. Once a note is complete, it gets sent through a workflow that has an internal auditing module that ensures authorized services were performed and are clean for billing. Once it makes it past that step, notes are staged in the system waiting to be processed for billing. The agency has the ability to sort and view notes any way they wish (by program, by employee, by client, all of them, etc). An agency management platform is connected to funding sources electronically on the backend. This means that once notes and shifts are audited and approved, billing simply pulls up all of the claims waiting to get billed and in one click they all get submitted. Completed notes are stored with the client file and can be pulled up at any time for reference.

Progress Tracking & Trending

• Paper System: To track client progress on goals and activities over a period of time using a paper system means an agency has to have all note files stored actively somewhere and someone has to go through them to try to quantify success or progress while pouring over each note. This is rarely accomplished and successful through a paper system.

• Agency Management Platform: Through the use of an AMP, progress tracking happens naturally throughout the course of a client’s time with an agency. Staff can see how many times specific activities were worked on and the success of them, as well as how well their allotted hours authorized have been efficiently used. This data is available at the user’s fingertips without having to do extra work to uncover progress trending.

Auditing

• Paper System: In a paper system, auditing is the process of going back to filed or archived documentation and matching it against the request. This can be a simple task in some agencies or it can turn into a “needle in a haystack” task that can waste significant hours of productivity from staff. There is also a risk that paper is missing or does not conform to regulations, which end up in fines and unfunded time coming out of your pocket.

• Agency Management Platform: In a paper system, auditing is many times a reactive process that involves going back to documentation once it’s been billed. In an Agency Management Platform, auditing is proactive. It is built into the system and very easily allows the agency to manage and keep track of all service notes to audit pre-billing. If a note does not comply, it can be sent back to the staff member to fix inside of the system. If an agency does get audited by a third party, it is extremely simple to pull documentation by simply clicking on the client name and date that is being requested and instantly pulling that documentation. And if it has made it through the system without a flag, then you know you have nothing to worry about once an auditor shows up.

Breaking down the different points in a workflow process with paper documentation really uncovers some inefficiencies and also highlights some great benefits of an agency management platform. At the end of the day, you have the ability to do much more with client data that’s collected and you can be more efficient with your staff’s time. And just think of all the new space that will be available on your desk – a picture of a loved one is certainly more desirable than a stack of paper!

 

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