State Home Per Diem Program Monthly National Call - Wednesday, October 10, 2018 - The National Association of State Veterans ...
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State Home Per Diem Program
Monthly National Call
Wednesday, October 10, 2018
REMINDERS • Please keep your phones MUTED (*6) • For VA employees, the National Call is held on the second Wednesday each month at 3pm ET • For SVH Staff, the Quarterly National Call is held every three months on the second Wednesday at 3pm ET • Attachments • Adobe Connect- Attachments available in the download pod • For VA employees, the minutes are on the Pulse Page • If you have additional questions or suggestions, please email us VHA10D1B3StateHomePerDiemInquiries@va.gov
AUDIENCE
• State Veterans Homes
• VISN BIMs
• VISN State Home Liaisons
• VAMC of jurisdiction SHPD Points of Contact
• VAMC of jurisdiction staff who process admission
applications and payments to State Homes
THIS IS NOT THE CALL WITH GERIATRICS AND
EXTENDED CARE (GEC)
MAILING LIST
• Need to be added?
• Email Dezi Melendrez at
VHA10D1B3StateHomePerDiemInquiries@
va.gov
• Want to be removed?
• Website
https://vaww.myprofile.portal.va.gov/Iden
tityManagement/aspx/groups/MyDLMem
berships.aspxROLL CALL • VAMC employees, please enter your name, VISN and station # in the chat pod • VISN level employees, enter your name and VISN # • State Veterans Homes, please enter your name and your facility name
Colette Alvarez NEW BUSINESS
NEW BASIC AND PREVAILING RATES FOR FY19 • The “unofficial” FY19 Basic Rates are: – Nursing: $109.73 daily per Veteran – Domiciliary: $47.36 daily per Veteran – Adult Day Healthcare: $87.42 daily per Veteran • The final rule was published August 5, 2018. In the final rule, the percentage increase is 2.4%.
Department of Internal Audits IPERA AUDIT UPDATE 2019 OVER FY18 DATA
2019 OVER FY18 DATA SH IPERA AUDIT
• Q1 & Q2 Samples
o 200 Monthly Invoices
o 71% complete
o Preliminary Improper Payment = $1,202.766.64
o Leading causes of error
o Missing Documentation
o Incomplete Documentation2019 OVER FY18 DATA SH IPERA AUDIT
• Q3 Samples
o 100 Monthly Invoices
o Were released October 2nd
o Documentation due October 16th
o Ensure all forms are uploaded to SP site
o Ensure all forms are completed in their entirety
VHA_CC_DAIC_SHPAT vhaccdaicshpat@va.govSteve Pellicer ELECTRONIC TRACKING TOOL (ETT) REVIEW FINDINGS
REVIEW CRITERIA
• For the month of August, 25 ETTs were reviewed to determine the following:
– Usage of the ETT and currency
– Does the ETT support the numbers reported on the 10-5588?
– Was the payment in the correct amount?
Percentage
88
100
60
Usage Matching 10-5588 Correct PaymentERRORS
Percentage
1.4
11
17
Days of Care Direct/Indirect Cost Daily cost of careREMEDY • Don’t stop checking the ETT because the money matches • Pay close attention during the reconciliation of the 10-5588 • Ensure all line items of the 10-5588 are supported by the ETT • Remember, the ETT is a system for the VA to verify accuracy of the claim being submitted by the SVH
OTHER OBSERVATIONS OF THE ETT
• Payments are being made when there is missing
application information and/or administrative and
clinical review
– Payments should not be made until all data on the ETT is
complete
• Possible improper use of Annual Leave (AL) for residents
in the hospital
– Annual Leave is only authorized for purposes other than hospital
staysUPCOMING CHANGES TO THE ETT In an effort to draw attention to the reconciliation process, we have added a 10-5588 Audit column mimicking 10-5588 entry fields. If a number does not match, the cell will turn red; if the cell matches, it will turn green. The process is similar to making the entries in the Web Application (WA).
Colette Alvarez ACCOMPLISHMENTS IN 2018
SHPD ACCOMPLISHMENTS FY 2018
• Established and improved • Worked to reduce overpayments
Financial Management reports to the SVH and subsequently
providing a better way to view future Bills of Collection
each station’s 10-5588
• Conducted Overview Training
• Worked with Finance to establish twice a month describing the
2019 Payment Rates process from application through
payment
• Educated VAMC POCs to better
assist each SVH in maximizing • Approval for use of alternative
available benefits to our Veterans documentation in determining
correct payment amounts with
• Published 16 Fact/Resource respect to the 10-10SH and 10-
Sheets for SHPDP 5588SHPD ACCOMPLISHMENTS FY 2018
• The SHPD Program Office • Provided input to VHA Office of
answered over 730 inquiries with Regulatory and Administrative
Affairs to further develop AO88
an average response time of less
than one day • Published over 32 NNPO articles,
more than any other Program
• Approximately 11,300 Office in OCC
applications have been reviewed • Produced 12 Monthly SHPDP
from 80 stations since April 2018 National Calls providing training
and essential information for the
• Continually developed updates field
for the Web Application • Offered extensive nationwide
training to over 550 participants
• Worked with IT to provide Virtru and successfully launched the
Pro, a source for secure Automated 10-10SH
communications between the
VAMC and SVHColette Alvarez APPROVAL/DENIAL LETTERS
VA APPLICATION DECISION NOTIFICATION • After Administrative and Clinical reviews are complete, the VAMC of Jurisdiction Per Diem POC must promptly notify the SVH in writing, the decision made for a Veteran’s admission application for per diem payment • For the VAMC, remember to upload each approval/denial notification to the SHPD SharePoint Documentation Storage Site
Brenda Wiggins FUTURE VHA SHPD FORMS
FORMS UPDATE • All forms expire February 28, 2019 • OMB process is not complete • Continue using current forms until the Program Office provides notification of change • Start date for the Medical Model ADHC prevailing rate has not been determined • Pending VA release of ruling • Any new processes will be communicated...stay tuned
Robin Lateef FUNDING STATUS UPDATE FOR THE NEW YEAR
FUNDING UPDATE FOR NEW YEAR • TDA funds will be distributed once the budget is approved • Please reach out if you need clarity or have questions regarding Obligate to Pay as this is new for State Homes • FY12 and FY13 dates of care are paid out of FY19 funds • FY14, 15, 16, 17, and 18 dates of care are paid out of their respective FY funds
Robin Lateef 10-5588 INVOICE DUE DATES
10-5588
• 10-5588 Due Date
– September 2018 invoice data must be entered
into the Web Application Portal no later than
October 22, 2018
• Timeliness report
– Sent to leadership through Active Strategy
– SECVA Pocket Card, USA Spending Report, and
reconciled with FMS for budget purposes
• August 2018 Timeliness Report
– 152 out of 156 on time – 97%Jim Peters STATE HOME PER DIEM PROGRAM “OVERVIEW” TRAINING
OVERVIEW TRAINING • Two training sessions are held each month • Who can/should attend? – New VHA State Home Per Diem POCs – Anyone who would like a refresher
OVERVIEW TRAINING TOPICS
• Sample of topics
– Resource information
• Pulse Webpage, KMS, Web Application
– VA Forms (10-10SH, 10-10EZ, 10-5588)
– Supporting documentation
– Approval/Denial Notifications
– ETTTRAINING DATES • October training dates – Tuesday, October 16 and Friday, October 19 – All sessions start at 1pm MT • Email VHA10D1B3StateHomePerDiemInquiries@ va.gov
Colette Alvarez PRIVACY REMINDER
PRIVACY REMINDER
• VHA Directive 1605.01 Privacy and Release of Information specifically references
State Veterans Homes on pages 88-89, and partially states:
• VHA may disclose a Veteran’s individually-identifiable health information,
excluding 38 U.S.C. 7332-protected information, to a State Veterans Home for
medical treatment or follow-up at the State Veterans Home, if VA is paying a per
diem rate to the State Veterans Home for the resident receiving care at such
Home and the patient is receiving VA medical care.
• VHA may disclose 38 U.S.C. 7332-protected information to a State Veterans Home
with the signed, written authorization of the individual.
• If there is no written authorization, VHA may disclose 38 U.S.C. 7332-protected
information to the State Veterans Home when a State Veteran Home refers an
individual for treatment of 38 U.S.C. 7332 conditions to a VA medical center and
the individual returns to the State Veteran Home in order for the State Veterans
Home to provide continuity of care and treatment to the resident.Colette Alvarez PRE-ADMISSION PER DIEM ESTIMATES
PRE-ADMISSION PER DIEM ESTIMATES • VA should not provide pre-admission per diem estimates. Doing so may give the appearance that the SVH is trying to discriminate against Veterans who are eligible for lower per diem payment rates; therefore, attempting to select Veterans of higher per diem payment rates. • It would be considered a violation of the Health Insurance Portability and Accountability Act (HIPPA) if a HINQ or any other Veterans privacy data is provided to the SVH prior to the Veteran being admitted.
Colette Alvarez MAIL BAG
MAIL BAG – QUESTION 1 Can a nursing home Veteran who is receiving the Prevailing Rate per diem at a SVH, who sees a specialty provider at the VAMC, and the specialty provider orders a medication, receive the medication from the VAMC in which the VAMC pays for such medication?
MAIL BAG – QUESTION 2 Can you provide information regarding rules that govern the role a State employee must follow at a SVH that is contracted?
DO YOU HAVE A QUESTION?: You can unmute yourself by entering *6 or type your question into the chat pod
NEXT SHPDP NATIONAL CALL
November 14, 2018 at 3pm EST/1pm MST
VAMC’s and VISN’s
January 09, 2019 at 3pm EST/1pm MST
State Veterans HomesSUGGESTIONS, QUESTIONS, AND TOPICS Do you have a suggestion, question or topic you would like covered during our next National Call? Please submit your ideas to the SHPD Inquiries Email Group no later than October 26, 2018 VHA10D1B3StateHomePerDiemInquiries@va.gov
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