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Improving your CMS Universe
This document discusses improving a CMS (Centers for Medicare and Medicaid Services) universe by addressing common data problems like misclassification, duplicates, and formatting issues. It notes that healthcare payers feel overwhelmed by their universe due to a lack of time and difficultly finding, managing, and ensuring complete data from multiple locations. Failure to properly handle the universe can result in poor audit scores, penalties and sanctions from CMS. The document promotes an upcoming webinar on advanced reporting and analytics for generating accurate universe reports efficiently in the required CMS format from a single source of truth.
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Improving your CMS Universe
- 1. Jon Swisher, Solution& Product Development Manager Pat Goetz, Senior Account Executive Improving your CMS Universe
- 2. What the averageperson thinks of when they hear the term universe!
- 3. How a HealthcarePayer feels when they hear the term universe!
- 4. But why doyou feel that way? • You don’t have enough time? • Data is hard to find? • Data is in too many locations? • You rely on other departments? • Data is difficult to manage? • Data isn’t complete?
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- 6. Maybe time isn’tyour only issue…
- 7. Common Universe dataproblems: • Misclassification of cases • Duplicate cases • Insufficient or inaccurate date tracking • CMS required formatting • Locating supporting documentation • No single source of truth
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- 9. Consequences of failures: •Poor audit score • Civil Money Penalties (CMPs) • Intermediate sanctions • Termination of program • Adversely affect STAR ratings
- 11. Recap • Quickly andeasily generate universe reports • Ensure reporting data is accurate • Meet CMS required formatting • One solution
- 12. SAVE DATE “Advanced Reporting& Analytics” October 18, 2016 2 PM Eastern
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Editor's Notes
- #2 Introductions – Jon, Pat & Eric (?). Small intro about Kiriworks and then talk about why we are here…problems pulling universes, not enough time in the day to pull universe, poor or incorrect data – whatever the reason we will show you over the course of the next 30 minutes how to solve these problems.
- #3 So what does the average person think when they hear universe? Probably a picture of a galaxy, maybe Star Wars, space, Armageddon with Bruce Willis, but in the healthcare payer world this isn’t the case.
- #4 When a healthcare payer hears universe they think CMS, fines, audit, overtime, missed lunches and I’m sure a few other things go through your head that we will just keep to ourselves!
- #5 Time – you work through lunch breaks and overtime in order to generate the universe and still do your day to day talks Find – the data you have to find isn’t easily accessible? Locations – or maybe you can’t find it because it resides in multiple locations or different systems Mange – once you have the data you need to format it or manipulate it in order to meet CMS standards Complete – Data isn’t there, missing or completed
- #6 Maybe you don’t run into any issues when generating your reports, but maybe you have to put in a few extra hours to ensure the reports are complete and accurate, but maybe some of you wish you can hire additional staff or you do hire them. Use Gateway’s example of hiring additional staff this year to complete their audit. How long does it take you to generate your universe reports? Piece of cake, I haven’t missed a lunch break yet! I’m usually pulling an all-nighter. HELP! Can I hire additional staff members to get the job done?
- #7 *Based on results we can summarize where the majority of people have issues – and transition to next slide being that even if time is an issue or is not an issue there could be other problems.
- #8 Misclassification – appeals classified as grievance or inquiry Duplicate – cases come in via fax, but then member calls and phone case is opened and then maybe they also mail in a letter – we now have the potential for 3 duplicate cases Date tracking – wrong date entered or a guess was made or date not tracked at all Formatting – maybe you store your data differently than CMS requests to view. Now you have to make changes to clean and correct data Locating – Supporting documentation or outreach is not available or attached to cases – prolongs the search process in finding data Source – Is all of your data being recorded in a single repository
- #9 So of these problems, which do you struggle with the most or maybe you struggle will a little bit of all of them. What problem do you struggle with the most? Misclassification or duplicate cases Insufficient or inaccurate date tracking CMS required formatting Locating supporting documentation No single source of truth All of the above
- #11 And when we run into these problems, whether timeliness of universe reports or the data that makes up the reports, you can face some pretty steep consequences. I know you are all familiar with these items, but this is why we are here today to help you avoid these penalties and make your overall reporting process less stressful and you can become more confident with your results.
- #12 Jon will take you through a demonstration of our solution that will show you how easy it is to generate a universe report and then how we can ensure the data is a.) complete b.) correct and c.) meets CMS requirements. If you have questions please feel free to type them in the chat window and we will try and address as many as we can.
- #14 If you like what you saw today, we invite you to attend our next webinar on Oct. 18 at 2pm eastern. We will be discussing additional reporting requirements by CMS. These are your quarterly report submissions as well as other ways to internal report to staff and execs. So mark your calendar and follow up to todays webinar will include a registration link. We really hope you can join us.
- #15 And before you go, one last question. Maybe there are other items when it comes to appeals & grievances that you struggle with or want to know more about. So let us know which topic you are most interested in or if you have a topic in mind, please include it in the chat box. Thank you. What other topics would you like to learn about for upcoming webinars? IRE Packet creation Automatic Correspondence/Letter Generation Attaching supporting documentation Full product demonstration Workload reallocation