V i su m s o lu t i o n s

MDS/Reimbursement Medicare Compliance Claims Defense and Audits Operational Workflow and Re-engineering Survey Readiness/Recovery

VISUM SOLUTIONS is a division of Optimus EMR, Inc.

Visum solutions

was founded by industry experts

with a passion to help long term care facilities navigate the ever changing healthcare environment. Our team provides complete counsel and proven solutions to operational, financial, reimbursement, and compliance questions along with other client requests. Each clients objectives become the basis of our work plan and the guaranteed deliverables. Our primary goal is the success of our clients.

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Our team is made up of subject matter experts with hands-on experience. This practical knowledge base has proven to be one of the most valuable assets we offer our clients.

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Reimbursement
Solve the MDS Puzzle:
Do you want to receive all of the reimbursement your patient care justifies? Make sure your internal processes are aligned to prosper and survive in this challenging environment. The MDS can be a powerful tool for standardizing assessments and patient care in your nursing facility. If done improperly, it can be a source of serious audit problems and potential repayments. Accuracy and planning is the key to unlocking the puzzle. The implementation of MDS 3.0 has been a significant undertaking for the industry. Never in the history of the MDS have we seen such a fluid environment. This makes it even more difficult for staff to keep up with the changes. These rapid changes require the entire facility team to learn, absorb and understand the significant changes and to alter the manner in which they approach the MDS process and the reimbursement system. This is the proactive approach to developing the best internal operational approach and controls. From understanding the basic MDS coding and definitional changes in the MDS 3.0 process to understanding the significant changes to the RUG-IV categories themselves, there is a lot to learn. VISUM SOLUTIONS focuses on the required changes and helps the team (nursing, therapy, financial staff and others) work together to succeed under the new system. We cover a variety of specific topics intended to help ensure that your workflow and documentation is correct and that you receive all of the reimbursement you are entitled to through the following steps: Providing care to residents discharged from the acute hospital with long term care needs is challenging. The VISUM SOLUTION consultants provide guidance about how to use the Resident Assessment Instrument (RAI) correctly and effectively to help provide appropriate care and maximize reimbursement. This includes establishing workflow processes and controls to ensure success. Evaluation of the CAA process to help clinicians focus on key issues identified during the assessment process. Accuracy audits done to validate that Federal Regulations are being followed related to timing of assessments and proper coding of assessments. Quality audits to confirm the existence of appropriate documentation of services provided and that the information coded on the MDS is consistent with the care being given. Educational seminars such as: Item by item coding, how the MDS 3.0 interacts with the reimbursement system, and how the facility team can work together more effectively under the new system. Customer Testimonials
I have used VISUM consultants in six of the skilled nursing facilities I am responsible for as a Regional Administrator. They are the most knowledgeable people I have come into contact with on Medicare guidelines, Medicare billing, CMS compliance and current MDS information. They understand Medicare audits, the current audits as well as the soon to be activated audits. With their knowledge of these audits they have saved the companies I have worked for hundreds of thousands of dollars by helping us submit the correct information to Palmetto. Also, they have been there to do our ALJ hearings and they have won! J.Z., NHA, San Diego, CA

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Medicare Compliance and Record Audits

These internal audits are intended for periodic verification or to address a weakness that has been identified. Now there is an alphabet soup list of potential reviews and audits. Included in the list of potential auditing entities are the following: Zone Program Integrity Contractors (ZPIC), the Medicare Administrative Contractor itself (MAC), Recovery Audit Contractors (RAC), Office of Inspector General (OIG), Department of Justice (DOJ) and Comprehensive Error Rate Testing reviewers (CERT). The error rates being calculated by the various compliance audits are significant and if left unchallenged could result in large repayments and undue financial hardship for the individual facility or company. The most common audit type, Medicare Medical Record Audits are intended to determine whether the medical records support the level of care billed and meet Medicares definition of reasonable and necessary. This standard is used by all Medicare Administrative Contractors and their sub-contractors to determine if federal payments are appropriate. Dont be left in the dark waiting to see if your medical records support the claims of a MAC audit. We provide two levels of service: basic and comprehensive, both of which will provide an objective overview of the status of your clinical records and quality of your MDS assessments. Basic Audit: This process involves a medical record audit of both current and discharged residents, and then compares the findings to the data on the UB04 billing submissions. It includes a verbal exit report and a written report following the audit. We are able to provide offsite medical record audits either using remote access to the EMR system or using chart copies. We apply the same procedures as with the onsite reviews. Our report can be provided via a live webinar, a conference call or through a written report only. Record access and audit procedures can be performed through scanning of documents, mailing of documents and/or by remote access to the computer based medical records with appropriate access approvals. Comprehensive Audit: This process typically involves two onsite days depending on the level of consulting services required. At a minimum, it entails an entrance and exit conference with management and/or members of staff and a written report on findings with recommendations made. It provides the services of the basic audit plus it is onsite with an in-person exit conference. Additionally, it is customizable to the specific facility requirements or problem areas. Additionally, we provide assistance in submission of a thorough and comprehensive package responding to Additional Documentation Requests (ADRs) by Medicare and its subcontractors and education on documentation requirements to support medical necessity of services and items billed to Medicare. Examples of Customized Programs are: Analysis of the in-house or contracted rehab staff for Medicare Compliance purposes regarding both Medicare Part A and Medicare Part B programs Determining clinical competencies of various staff members Development of new in-house programs to increase Medicare census and reduce hospital readmissions Enhancing Medicare specific staff competencies
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Medicare Compliance and Record Audits continued

On-Call Consultation Services: We provide consulting on any Medicare topic related to Part A and Part B regulations for compliance, documentation and coding. We offer these services via phone, e-mail or through a web meeting format.

Billing Triple Check

What is Triple Check and Why Do You Need It? Triple check is a process that helps ensure your facility Medicare bills are accurate and as Medicare audit ready as possible. It facilitates complete capture of the permissible costs the facility has incurred, while providing skilled care to your residents. With our complex healthcare reimbursement system which includes the Prospective Payment System Model and the Minimum Data Set 3.0 details, it is not difficult to find your organization entangled in an unintentional web of Medicare reviews precipitated by erroneous transaction data sent via the billing system. The UB04 is the first document your MAC (Medicare Administrative Contractor) receives. Inaccurate and/or missing coding requirements can increase your risk for audits and reviews. The Triple Check Process helps ensure that your staff sends the correct information to support the billed services, such as skilled nursing and rehab services. We at VISUM SOLUTIONS focus on compliance and accuracy of claims submitted for payment purposes. Our goal is to minimize the providers risk of re-payment and post-payment financial scenarios. Revenue retention is the goal! Triple Check Process methodology and program consists of the following elements: Onsite training and education have one of our experts work first hand with your team Policy and procedure development assistance for a comprehensive Triple Check program Review of billing claims for omissions and repeat patterns which can raise red flags Diagnostic coding and sequencing to support services billed Review of financial business office files to ensure technical compliance Review of clinical records for supporting documentation of services billed and technical compliance Educational seminars for the entire team to enhance future compliance Step-by-step instruction on completion of each field of the UB04 and the related rationale Interdisciplinary approach the role of various disciplines in the team process Evaluation of your current Triple Check Process if one already exists A comprehensive Triple Check Process equates to REVENUE RETENTION $ Triple Check has always been regarded as a necessary component of the billing process, but never more than it is today. The MDS 3.0 program instituted in 2010, followed by the October 1, 2011 alterations to Change of Therapy OMRAs and End of Therapy OMRAs caused the Triple Checks to become an essential element to ensure accurate documentation. Customer Testimonials
Besides being extremly knowledgeable, they are delightful educators and trainers. They have been incredibly patient when training our staff in Medicare documentation, MDS 3.0. and triple checks for our UB04s. They have even helped the contracted therapy companies improve their Medicare documentation for us. M.F., Vice President Compliance, Beverly Hills,CA

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Claims Defense
Has your facility received a letter requesting additional information before a claim is paid? The Centers for Medicare and Medicaid Services (CMS) is focusing on coding accuracy to prevent overpayment. Has your facility received a letter from any of the recovery or integrity auditors requesting medical records on a post-payment review? The Office of Inspector General is actively looking for fraud. What SNFs get targeted? The answer is anyone who files a Medicare claim. It is critical that your medical records support the services provided and billed. We at VISUM SOLUTIONS are prepared and trained to help. The Office of Inspector General (OIG) releases its Work Plan of initiatives for each fiscal year at the beginning of the year. The release typically includes a review of the objectives for the year and the hot topics for SNF Medicare Part A claims. The OIG will evaluate the extent to which payments to SNFs meet Medicare coverage requirements. The OIG procedures include a medical review to determine the extent to which claims are medically necessary, have sufficient documentation, and are properly coded. This is only one of the many initiatives targeting SNFs. CMS has outlined the four primary reasons for improper Medicare payments: Lack of medical necessity for claims Improper coding Insufficient documentation to support claim Failure to respond How can we help? Have your records reviewed by a team of experts to ensure the proper documents are sent and avoid a costly first level denial. Records are reviewed for technical compliance issues. Evidence of medical necessity Accuracy of services billed and coded on the MDS. VISUM SOLUTIONS will act as your representative during the entire appeals process including the first level redetermination, second level Reconsideration and third level Administrative Law Judge (ALJ) hearing. Based on our appeals experience we have had the opportunity to assess which appeal strategies have the most success at each level of the appeal process. VISUM SOLUTIONS not only fights to recover denied claims but is also available to resolve the coding and billing issues that create the denied Medicare claims. (See Medicare Compliance Section for additional information.) Customer Testimonials
I have used them in the past and I will continue to use them in the future! D.F. Health Information Systems, San Diego, CA

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Operational Workflow/Re-engineering
VISUM SOLUTIONS has a team of expert clinicians and experienced operators to help our clients evaluate their current workflow and gain operational improvements. Each facility has its own environment and the workflow must be custom tailored to maximize the results and enhance patient care which leads to the greatest opportunity for success. No detail is overlooked as the team evaluates your complete process flow; from pre-admission screening to discharge with all clinical documentation and billing processes included. Fundamentals of workflow design and re-engineering We recognize each provider is unique and the current systems or processes have been designed to address those nuances. Some processes may be specific to regional requirements, past survey plans of correction, environmental, or perhaps just old habits that may no longer be appropriate today. We also appreciate that our clients team has the specific expertise needed to be successful and that we have the opportunity to work together to brainstorm and establish new ideas based on our experience. It is this team approach that will yield the highest level of success. The only way to be effective and truly take advantage of our expertise is to immerse our team into your environment and work collaboratively with your team. Our Process Each evaluation includes a historical review of survey results, RUG IV trends, and Case Mix scores. This information provides us with the general background needed to then come on site to meet with your team. We conduct round table sessions with your key leadership, both administrative and clinical, in order to understand your current workflow and potential challenges. We also break down the larger group by discipline in order to fully explore the detailed process used by each group. The information gathered to this point helps us to make detailed recommendations as it relates to the specific programs and workflow that should be used to increase revenue and protect the facility. Areas of focus for recommendations are: Streamline clinical staff workflow Develop efficient and distributed auditing practices Development and/or refinement of Medical Records Policies and Procedures Establish sustainable monitoring to ensure long term success RUGs Analysis Identification of patterns and trends Identification of uncaptured revenue Part B utilization Formal Program utilization Setting up a process to monitor utilization Customer Testimonials
The VISUM SoLUTIoNS team came prepared. They really looked at our organization as a whole, which started with an analytical review of our past survey results, Case Mix score, our RUG grouping distributions and systems used. They spent time in round table discussions with our leadership and really got to know us through the process. In the end, they identified whole programs that were being underutilized and money being left on the table. We always knew our staff did a great job and now we are documenting it thanks to the VISUM SoLUTIoNS review and recommendations. U.M., CTo New York, NY

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Survey Readiness/Response
The annual survey process performed by state and sometimes federal surveyors is a necessary compliance activity that also affects facility ratings. Being prepared at all times is the best solution. The annual scramble and fire drill approach is inefficient and not as successful. Incorporating the required processes into daily facility operations provides comfort that surveys should not be feared and that impromptu visits will validate compliance. If you need assistance or are concerned about your readiness we can help with any of the following: QIS survey strategy and preparation Management preparation Staff Preparation Resident and Family Preparation Plan of Correction (POC) assistance Development of audits Staff Education Identification of Potential Survey Areas and Risks Mock surveys Quality Measures analysis Five Star Program assistance with improvement in star rating Policy and Procedure Development assistance Staff competency assessment and testing Minimum Data Set reviews for clinical accuracy reflective of the resident Quality Improvement Program Development Case Management Models Topic specific staff education and training VISUM SOLUTIONS can help you become better prepared for survey through a detailed needs analysis, the custom design of systems that promote a sound distributed QA process, and the implementation of those systems. We will also work with you to evaluate the effectiveness of those systems and your teams adoption of the processes established to make you comfortable leading up to this potentially stressful time. There is another side to survey and that is the way you respond and the Plan of Correction. Our team can help you evaluate the root cause of the issue and create a meaningful plan that promotes ongoing quality, education, and improves resident care. Ultimately, the honest inspection of the items listed above and the implementation of easy to use systems go beyond the simple survey readiness. It goes to the ease of management, the ease of marketing, the bottom line, but most importantly, the peace of mind that the residents are getting the absolute best.

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Consultant Biographies
All of the consultants listed below have particular areas of expertise and strengths. As a group they are particularly well suited to be the nucleus of the VISUM SOLUTIONS consulting team. Lisa Conrad, RN, RAC - CT Before starting with VISUM SOLUTIONS Lisas experience ranges from direct care in acute hospitals to orthopedic surgery centers, being a DON of a large sub-acute facility and most recently managing the clinical customer service and support training for Optimus EMR. Lisa has a very successful track record clinically, managing staff and communicating with clinicians to help re-engineer clinical workflow. Elizabeth Milton, RN, ET, GNP, RAC - CT Lizs early career was involved in moving through the ranks clinically and into clinical management. She then returned to academia to earn a degree of Nurse Practitioner with an emphasis in Geriatrics. Liz used her credentials and experience as a regional nurse consultant in LTC, a clinical director for a health services organization and later by consulting to facilities on reimbursement and compliance. Liz is a recognized and often requested educator. Jeannette Munkittrick, Nurse Consultant, RAC - CT Jeannettes experience as a nurse started with hands on clinical care that evolved into case management at the provider level. Through this experience Jeannette became very adept at creating reports and controls to improve patient care for the provider organization while obtaining proper reimbursement for the care provided. More recently, Jeannette has been involved with managing a therapy companys internal controls and performance tools and consulting with SNFs on Medicare reimbursement and compliance. Specific client references are available upon request.

VISUM SOLUTIONS is a division of Optimus EMR, Inc. For more information, please contact VISUM SOLUTIONS at: 949.255.2272 www.optimusEMR.com

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