Candace J. Chitty
RN, MBA, CPHQ, PCMH-CCE
your Key to
Online
Compliance
Management
To gain understanding of:
• Types of supporting documentation expected
by NCQA in...
your Key to
Online
Compliance
Management
 Email
 Internet Access
 Microsoft Word
 Microsoft Excel
 Adobe Acrobat Read...
your Key to
Online
Compliance
Management
Statement of the Standard
Elements
Factors
Scoring
Explanation
Documentatio...
your Key to
Online
Compliance
Management
5
your Key to
Online
Compliance
Management
6
your Key to
Online
Compliance
Management
7
your Key to
Online
Compliance
Management
Practices are expected to use five basic types of documentation
to demonstrate pe...
your Key to
Online
Compliance
Management
Review of Supporting Documentation Matrix . Please refer to reference materials
p...
your Key to
Online
Compliance
Management
 Adobe Acrobat Free trial available
 Microsoft Word – Text Boxes, Shapes
 Scre...
your Key to
Online
Compliance
Management
 Create a documentation project plan to track the progress of your
supporting do...
your Key to
Online
Compliance
Management
Must be implemented at least 3
months prior to survey submission
Highlight or u...
your Key to
Online
Compliance
Management
Documented Process/Policy Applies to
Appointment Availability PCMH 1 A: 1-4
After...
your Key to
Online
Compliance
Management
14
your Key to
Online
Compliance
Management
Good Example
15
your Key to
Online
Compliance
Management
16
your Key to
Online
Compliance
Management
 Reports requirements may be 5 days, 1 week,
1 month, 3 months, etc. Pay attenti...
your Key to
Online
Compliance
Management
PCMH 1A: Factor 2
Good Example
18
your Key to
Online
Compliance
Management
19
your Key to
Online
Compliance
Management
Annotate to point out key points
Check to see if they require
enlargement to re...
your Key to
Online
Compliance
Management
PCMH 5 A: Factors 3 and 4Good Example
21
your Key to
Online
Compliance
Management
22
your Key to
Online
Compliance
Management
PCMH 5 A: Factors 3 and 4
Good Example
23
your Key to
Online
Compliance
Management
PCMH Standard 5 Element B Factors 1
24
your Key to
Online
Compliance
Management
25
your Key to
Online
Compliance
Management
 Lack of understanding of documentation requirements
 Lack of process for track...
your Key to
Online
Compliance
Management
 Health Center Controlled Networks (HCCN)
 Primary Care Association in your are...
your Key to
Online
Compliance
Management
29
your Key to
Online
Compliance
Management
30
your Key to
Online
Compliance
Management
31
your Key to
Online
Compliance
Management
32
Mark your
Calendars.
Tuesday, August 20th.
The last session in the
PolicyPLUS PCMH
Webinar Series:
Taking Care
of Business...
PolicyPLUS PCMH Series, Webinar 3 - Telling your Story
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PolicyPLUS PCMH Series, Webinar 3 - Telling your Story

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To gain understanding of:
Types of supporting documentation expected by NCQA in support of the standards – key definitions
NCQA’s 2011 PCMH supporting documentation requirement by standard
Best strategies to present valid content
Common pitfalls to avoid
Useful tools and resources in creating supporting documentation
Other resources

Our speaker Candace J. Chitty, BSN, MBA, CPHQ, PCMH-CCE is a NCQA PCMH reviewer and an expert in the NCQA patient centered medical home model and recognition process

Published in: Healthcare, Technology, Business
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PolicyPLUS PCMH Series, Webinar 3 - Telling your Story

  1. 1. Candace J. Chitty RN, MBA, CPHQ, PCMH-CCE
  2. 2. your Key to Online Compliance Management To gain understanding of: • Types of supporting documentation expected by NCQA in support of the standards – key definitions • NCQA’s 2011 PCMH supporting documentation requirement by standard • Best strategies to present valid content • Common pitfalls to avoid • Useful tools and resources in creating supporting documentation • Other resources LEARNING OBJECTIVES 2
  3. 3. your Key to Online Compliance Management  Email  Internet Access  Microsoft Word  Microsoft Excel  Adobe Acrobat Reader  Access to the electronic systems used by the health center (practice management, patient registry, electronic prescribing, electronic health record, web portals, etc)  Staff skilled in use of the above 3
  4. 4. your Key to Online Compliance Management Statement of the Standard Elements Factors Scoring Explanation Documentation 4
  5. 5. your Key to Online Compliance Management 5
  6. 6. your Key to Online Compliance Management 6
  7. 7. your Key to Online Compliance Management 7
  8. 8. your Key to Online Compliance Management Practices are expected to use five basic types of documentation to demonstrate performance. 1. Documented process—Written statements describing the practice’s policies, and procedures. 2. Reports—Aggregated data showing evidence of action, including manual and computerized reports the practice produces to manage its operations, such as a list of patients who are due for a visit or test. 3. Records or files—Actual patient files or registry entries that document an action taken. 4. Materials—Prepared materials the practice provides to patients or clinicians 5. Screen Shots – Electronic “copy” to demonstrate capability, materials, or records. 8
  9. 9. your Key to Online Compliance Management Review of Supporting Documentation Matrix . Please refer to reference materials provided. NCQA also provides a similar crosswalk. Which can be located at http://www.ncqa.org/portals/0/Programs/Recognition/PCMH_2011_Data_Sources_6.6.1 2.pdf 9
  10. 10. your Key to Online Compliance Management  Adobe Acrobat Free trial available  Microsoft Word – Text Boxes, Shapes  Screen shot software --Snag-It techsmith.com/snagit.com Free trial available --FastStone Capture fastonecapture.org Free or Buy Lifetime License for full set of features --Snipping Tool (Microsoft Product) 10
  11. 11. your Key to Online Compliance Management  Create a documentation project plan to track the progress of your supporting documentation from start to finish (ISS upload)  Use documentation tools provided by NCQA (Record review workbook and Quality Measurement and Improvement Worksheet)  Consider using CAHPS Patient-Centered Medical Home Survey (Distinction Award)  Consolidate supporting documentation across multiple factors when at all possible (create scenarios)  Clearly navigate (guide) a reviewer through your documentation. Narrate and guide the reviewer to what you wish them to find in your documentation.  Make sure EHR screenshots are clear and large enough to read without distortion  Consider an external resource to review your supporting documentation prior to the final application submission (Mock review) 11
  12. 12. your Key to Online Compliance Management Must be implemented at least 3 months prior to survey submission Highlight or use other means of directing a reviewer to the area in which the process meets a particular factor 12
  13. 13. your Key to Online Compliance Management Documented Process/Policy Applies to Appointment Availability PCMH 1 A: 1-4 After Hours Access PCMH 1B: 1-5 Selecting a Personal Clinician PCMH 1D: 1 Informing Patients about Their Medical Home (a written explanation is acceptable) PCMH 1E Interpretive Services PMCH 1F: 3 Care Team Communication Process (Chronic Condition Management)+ PCMH 1G: 2 Training and Orientation-Care Teams PCMH 1G: 4-7 Patient Assessments (Option: submit examples of completed assessments) PCMH 2C: 1-9 Identifying High Risk/Complex Patients PCMH 3B: 1 Electronic Prescribing Processes (Alternative Method, when selected) PCMH 3E Mental Health and Substance Abuse Referral Process (part of referral tracking) PCMH 4B: 3 Health Education Resources and Referral Process (part of referral tracking) PCMH 4B:4 Test Tracking and Follow-Up : Lab PCMH 5A: 1,3,5 Test Tracking and Follow-Up: Imaging PCMH 5A: 2,4,5 Newborn Hearing and Blood Spot Screening-Follow Up PCMH 5A: 6 Lab Ordering and Receipt - Electronic PCMH 5A: 7 Imaging Ordering and Receipt - Electronic PCMH 5A: 8,10 Referral Tracking and Follow-Up PCMH 5B: 4,5 Emergency Room and Hospitalization Tracking and Follow-Up PCMH 5C: 1-5 Patient/Family Involvement in the Quality Improvement Process PCMH 6C: 4 13
  14. 14. your Key to Online Compliance Management 14
  15. 15. your Key to Online Compliance Management Good Example 15
  16. 16. your Key to Online Compliance Management 16
  17. 17. your Key to Online Compliance Management  Reports requirements may be 5 days, 1 week, 1 month, 3 months, etc. Pay attention to the required time frame specified in the PCMH standards.  Data should not be more than 12 months old  Most reports require a numerator and denominator; description of the reporting criteria; the measurement period; and the result reported as a percentage.  De-identify 17
  18. 18. your Key to Online Compliance Management PCMH 1A: Factor 2 Good Example 18
  19. 19. your Key to Online Compliance Management 19
  20. 20. your Key to Online Compliance Management Annotate to point out key points Check to see if they require enlargement to read easily the quality does not distort. De-identify 20
  21. 21. your Key to Online Compliance Management PCMH 5 A: Factors 3 and 4Good Example 21
  22. 22. your Key to Online Compliance Management 22
  23. 23. your Key to Online Compliance Management PCMH 5 A: Factors 3 and 4 Good Example 23
  24. 24. your Key to Online Compliance Management PCMH Standard 5 Element B Factors 1 24
  25. 25. your Key to Online Compliance Management 25
  26. 26. your Key to Online Compliance Management  Lack of understanding of documentation requirements  Lack of process for tracking documentation  Incomplete documentation  Irrelevant and/or confusing documentation. If something may be confusing provide narrative in the support text or in the document itself  Not providing a narrative explanation for use of “NA”  Waiting too long to begin compiling your documentation  Throwing the kitchen sink into documentation  Inconsistent or contradictory documentation across standards 26
  27. 27. your Key to Online Compliance Management  Health Center Controlled Networks (HCCN)  Primary Care Association in your area (PCA)  NCQA Documentation Guidelines/Data Source http://www.ncqa.org/portals/0/Programs/Recognition/PCMH_2011_ Data_Sources_6.6.12.pdf  NCQA, ncqa.org (Policy support and FAQs)  HealthTeamWorks www.healthteamworks.org  NCQA Interactive Survey System PowerPoint ncqa.org/tabid/631/Default.aspx  Patient-Centered Primary Care Collaborative pcpcc.net  Healthcare Communities healthcarecommunities.org  Primary Care Development Corporation pcdcny.org  Medical Home Builder acponline.org  Transformed transformed.com  American College of Physicians acponline.org/running_practice/pcmh/resources_tools/ 27
  28. 28. your Key to Online Compliance Management 29
  29. 29. your Key to Online Compliance Management 30
  30. 30. your Key to Online Compliance Management 31
  31. 31. your Key to Online Compliance Management 32
  32. 32. Mark your Calendars. Tuesday, August 20th. The last session in the PolicyPLUS PCMH Webinar Series: Taking Care of Business Understanding the Survey Application Process 33 Thank you for participating in the PolicyPLUS PCMH Webinar series. If you have any comments or additional questions please do not hesitate to contact us at: CJChitty@Qfhc.com RChitty@Qfhc.com www.Qfhc.com www.Qfms.org Questions & Answers

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