R5 CBFS Sessionfor DMH Providers

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Session Topic

Date Dial-In Time

Dial-In Number

R5 CBFS Wednesday, 7/15/09 2:00 PM 1-866-790-1368; access code 9877116

R5 CBFS Wednesday, 7/22/09 10:00 AM 1-866-790-1368; access code 9877116

CBFS Alert #1 Attachment D

How Live Meeting Works

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Please avoid putting the call on “hold.”2

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Agenda

• Overview of the CBFS Program

• Requirements for Invoicing CBFS Services through EIM/ESM

• Requirements for Claiming of Rehab Option Reimbursement through EIM/ESM

• Questions

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CBFS Program Overview

Program Objectives

Business Impacts Tied to EIM/ESM

Provider payments are based on number of enrollment days per client, per month regardless of the types of services rendered

Providers can use ‘Apply Pattern’ functionality to submit their SDR Providers are required to submit a separate, non-payable SDR to capture service delivery

information SDRs now have an ‘SDR Mode’ to indicate ‘Payment’ vs. ‘Service Reporting’ SDR

Consolidation of contracts has lead to much higher client counts per contract EIM is being enhanced to handle processing of over 1,000 enrollments per SDR

The CBFS procurement is the consolidation of Adult Residential Services (3049), Rehabilitative Treatment in the Community (3013), and Community Rehabilitative Support (3059) activities into a single,

comprehensive activity

New Terminology for Billing CBFS Contracts in EIM

• The ‘Payment’ SDR is for Invoicing payable days to the provider (i.e. all active enrollment days per client)

• The ‘Service Reporting’ SDR is for Claiming federally re-billable services (i.e. rehab)

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Overview of CBFS Invoicing/Payment Process Changes in EIM/ESM

Description

• Providers submit 1 SDR per contract, per month• Attendance status codes are used to differentiate services and are configured as payable or non

payable• Provider payment is determined by the number of payable services reported per month• Supplemental SDRs are used to adjust previously reported services for the time period

As Is Process

• The basis for provider payment for CBFS services is a client enrollment day• With this change, providers are required to submit 2 SDRs per month, one for

payment/invoicing and one for service reporting/claiming, which allows for additional time to compile more specific service information

• The first SDR is indicated by the ‘SDR Mode’ of ‘Payment’

Technology Supports

• An ‘SDR Mode’ dropdown is now available on the SDR Summary Screen• The SDR Search Results have been updated to include an ‘SDR Mode’ indicator• Attendance status code (E) has been configured to be payable for the ‘Payment SDR.’

Note that both E and R will on the SDR display regardless of which mode the provider is in

• Providers submit a ‘Payment’ SDR by the 10th of the month with “E’s” to indicate enrollment day, automatically populated to every active enrollment day using apply pattern functionality

• Supplemental SDRs should be submitted as per current process but ‘Payment’ and ‘Service Reporting’ should never be combined

• A PRC will automatically be generated for the amount of the contract rate times the number of active enrollment days

To Be Process

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Overview of CBFS Claiming/Service Reporting for Rehab Process Changes in EIM/ESM

Description

• Providers submit 1 SDR per contract, per month• Attendance status codes are used to differentiate services and are configured as payable or non

payable• Provider payment is determined by the number of payable services reported per month• Supplemental SDRs are used to adjust previously reported services for the time period

As Is Process

• The second SDR is indicated by an ‘SDR Mode’ of ‘Service Reporting.’ Providers should use this SDR to claim rehab services provided in a given month

• Providers have additional time to complete the ‘Service Reporting’ SDR. It is due with the following month’s ‘Payment’ SDR (e.g. July ‘Service Reporting’ SDR is due with the August ‘Payment’ SDR on Sept 10th)

Technology Supports

• An ‘SDR Mode’ dropdown is available on the SDR Summary Screen• The SDR Search Results have been updated to include an ‘SDR Mode’ indicator• Attendance status code “R” has been configured to be non-payable for the ‘Service

Reporting’ SDR. Note that all attendance status codes will display regardless of which mode the provider is in

• Providers use the ‘Service Reporting’ SDR to claim rehab services delivered per client per month, indicated by an “R” for the day services were received

• The SDR will not generate payment, but will result in a $0 PRC• Supplemental SDRs should be submitted as per current process but ‘Payment’ and ‘Service

Reporting’ should never be combined

To Be Process

Sample Billing Timeline for CBFS

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• The billing timeline for the ‘Payment SDR’ remains the same as the process today. The SDR must be submitted in ‘Authorized’ status to the agency by the 10th of the month following service delivery and agency approval should occur by the 24th of the month• Additional time will be given to providers to collect information for the ‘Service Reporting’ SDR for claiming rehab services. The ‘Service Reporting’ SDR must be submitted in ‘Authorized’ status before the agency will approve the following month’s payment SDR. For example, the July ‘Service Reporting’ SDR needs to be submitted before DMH will approve the ‘Payment’ SDR for August services

Completing the ‘Payment’ SDR for Invoicing

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1) Create a ‘Draft’ Regular SDR for the service period2) The ‘SDR Mode’ is a dropdown box at the top of the SDR Summary Screen with a default value of ‘Select

Below.’ Select ‘Payment’ as the mode click the new ‘Save Changes’ button. Note: The ‘SDR Mode’ field is only editable when the SDR is in ‘Draft’ status

3) Click on ‘Service Delivery Pattern’ in the left hand navigation bar

Completing the ‘Payment’ SDR for Invoicing (cont.)

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4) Select all days of the week, 1 Unit, and E-Enrollment Day5) All clients on the SDR will appear in the ‘Client Selection’ table. Use the ‘Select All’ checkbox and click

‘Apply Pattern.’ This action will populate every active enrollment day for every client on the SDR with a “1 E.” Note: Similar to release, using apply pattern will take a few minutes and a screen will appear to indicate the user should check back in a few minutes while it is processing.

Completing the ‘Payment’ SDR for Invoicing (cont.)

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6) The user will be returned to the SDR Summary screen and all active enrollment days will be populated with “E’s.” Clicking on the ‘Display Totals’ button will calculate totals at the bottom of the screen

Important: Meditech feeds EIM/ESM all enrollment data. Providers should scroll through all pages of the SDR to review the data for accuracy (i.e. missing or incorrect enrollment start/end dates, missing enrollments, etc.) or preferably, run the Client Enrollment Status Report at the end of the month prior to completing the SDR. If enrollment changes are needed, the provider should contact the agency to update Meditech. “E’s” can be manually deleted by clicking into the calendar if an enrollment should have been end dated in MHIS but was not.

7) Provider should release and authorize the SDR

Completing the ‘Service Reporting’ SDR for Claiming

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1) Create a ‘Draft’ SDR for the service period. The system will enforce the type to be ‘Supplemental’ since the ‘Payment’ Regular SDR has already been submitted

2) The ‘SDR Mode’ is a dropdown box at the top of the SDR Summary Screen with a default value of ‘Select Below.’ Select ‘Service Reporting’ as the mode click the new ‘Save Changes’ button. Note: The ‘SDR Mode’ field is only editable when the SDR is in ‘Draft’ status.

Completing the ‘Service Reporting’ SDR for Claiming (cont.)

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3) Click into the calendar of each enrollment and enter a “1 R” for each day the client received rehabilitative services and save changes. Notice that the enrollment information from the ‘Payment’ SDR will appear on top for reference

Completing the ‘Service Reporting’ SDR for Claiming (cont.)

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4) Click on ‘Display Totals’ and verify the number of ‘Claimed Grand Total Units.’ Note: ‘Claimed Grand Total Amount’ and ‘Claimed Grand Total Payable Units’ will be $0/0 because this SDR is for reporting purposes only, not for payment

5) Release and Authorize the SDR

SDR Mode: SDR Search Screen

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Within the SDR search results, the ‘SDR Type’ field has been appended with the ‘SDR Mode’ that has been selected for that SDR. If no mode has been selected, the ‘SDR Type’ will simply display as ‘Regular’ or ‘Supplemental’ as is the case today.

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Overview of Client Enrollments for CBFS Contracts

Description

• There are multiple sites per contract as well as multiple types of services (e.g. 24 hour residential vs. supported housing). DMH enrolls each client in Meditech to a particular service, denoted by sub-activity code, as well as to a particular site within the contract, denoted by MHIS mnemonic

• Sub-activity code and site location per enrollment appear on the SDR. Providers can either log-in at the parent level or the site level to complete attendance information

As Is Process

• Clients are enrolled to the parent level provider organization rather than to individual site locations

• Clients are enrolled directly to the CBFS activity code 3054 rather than to a sub-activity code that designates a specific service type (e.g. 304924, Adult 24 Hour Residential)

Technology Supports • N/A

• All clients are enrolled to a single activity and a single site per contract. All clients on the SDR will show as being enrolled to the parent level (i.e. the contracting provider organization)

• Provider users will need to log-in at the parent level in order to complete both the ‘Payment’ and ‘Service Reporting’ SDRs

To Be Process

Important Rules About CBFS Billing

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Item Description

Verification of Enrollment Data

Providers are encouraged to run the ‘Client Enrollment Status Report’ at the end of every month. This will allow them to validate enrollment details per contract and communicate any needed changes to the agency so they can be updated in Meditech and flow through to EIM prior to completing billing

Order of Submission

‘Payment’ SDRs always need to be submitted before the ‘Service Reporting’ SDRs. This is especially important for Ready Pay contracts so the payments can reconcile correctly

SDR Mode The SDR Mode must be selected and saved while the SDR is in Draft status. Without the mode, it will be difficult to tell which SDRs are for payment vs. reporting without clicking into them. Hint: If the SDR has already been released, you can disapprove to put it back to Draft and then the mode will again be editable

Supplemental SDRs

SDR’s are always exclusively for payment or for reporting (based on SDR Mode). Therefore, separate supplemental SDRs need to be created for the ‘Payment’ SDR and ‘Service Reporting’

Attendance Status Codes

SDR’s are always exclusively for payment or for reporting (based on SDR Mode). Therefore, “E’s” and “R’s” must never appear simultaneously on the same SDR, even for supplementals

There are a few important guidelines that need to be followed when billing specifically for CBFS contracts in EIM

Session Close

• Are there any final questions?

• Do you know where to find additional information? www.mass.gov/vg/eimesm– Unit Rate Billing User Manual– Job Aids– EIM/ESM Newsletters– EIM/ESM Frequently Asked Questions

• Computer based training can be accessed anytime as a “refresher.” Consult the EIM/ESM Training Events section of our web site for the EIM/ESM CBT Refresher job aid.

• Please share your feedback about this session with us; we’ll be sending a quick survey to get your thoughts!

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