The Office of Inspector General ( http://oig.hhs.gov) just released an audit report of Personal Care Services in the State of West Virginia.? Over a 2 year audit period, they looked at 100 beneficiary months and of those 18 were found to have a claim or claims that did not meet federal requirements.

 

In total, the audit report recommends that the State agency:

• Refund $360,539 to the Federal Government and

• Improve its monitoring of providers to ensure compliance with Federal and State requirements for personal care services.

To view the full report, click here.

 

The two main deficiencies laid out in this report are Services Not Supported by Documentation and Services Not In Accordance with Plan of Care.? If agencies are still utilizing paper based methods to document services and plans of care, they run a real risk of incurring these types of deficiencies.

 

Everyone knows that auditors are looking very carefully for misuse of Medicaid dollars.? Human error is a fact of life when agencies put their faith in paper, binders and non-electronic sources.

 

For a free report on the most common audit issues for home health and human service provider agencies, click here.? Agencies Management Platforms, such as MediSked Connect, remove human error and eliminate the common audit issues, including the deficiencies listed in this report.

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.