Understanding The Provider Registration Scorecard. Powered By
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1 Understanding The Provider Registration Scorecard Powered By
2 Understanding Your Scorecard The provider registration scorecard is divided into section scores based on the information that your facility provided during the registration process. The scores are based on the following categories: Site Score The Site Score measures basic performance indicators that are applicable for the facility as a whole, independent of any individual modality. These indicators include items such as: general site access, quality assurance and staffing. The Site Score is not displayed, but is a contributing factor for the individual Modality Scores that are displayed in the application. Score Weight/ Raw Score/ Weighted Score The Site Score and individual modality-specific Scores are calculated using a weighted scoring system. Based on the responses submitted, facilities receive a Raw Score between 0 and 100 for each factor. For multiple machines within a modality, values are averaged. Each factor is then multiplied by a Score Weight to produce a Weighted Score. For example, the factor Site QA on the Site Score has a Score Weight of 20%. A facility receiving a Raw Score of 100 would earn a Weighted Score of 20 (100 x.20) for that factor. Once all of the Weighted Scores are calculated, they are added together to determine the overall score. The maximum score that a facility can attain is 100. Modality Score(s) Modality Scores measure basic performance indicators specific to each modality within the facility. The Modality Score is comprised of two components: the facility s Site Score and modality-specific scoring. The modality-specific scoring is based on indicators such as: MD certification, technologist certification, modality accreditation, and equipment quality. OptiNet Sample Medical Center 001 N. Bay Street Anytown, WI HEALTH PLAN GENERIC REGISTRATION STATUS Completed ( ID ) REGISTRATION ID QUESTIONS? Contact Customer Service for Assistance by calling (800) or optinetsupport@aimspecialtyhealth.com UNDERSTAND YOUR SCORE Download our handy guide to gain a better understanding of how scores are calculated Download SCORECARD Print SITE CT MR NUCLEAR PET CT SCORE FACTOR RAW SCORE SCORE WEIGHT WEIGHTED SCORE Equipment Quality Modality Accreditation CT Peds Availability Section Sub- Totals CT Score CCTA DETAIL 0/100 0/100 5% 20% 10% 15% 25% 25% 2.5% View: Score 73.2 (Maximum 100 points) Cost Detail % 67.5 FACTOR RAW SCORE SCORE WEIGHT WEIGHTED SCORE Equipment Quality Modality Accreditation 0/100 0/100 5% 20% 10% 15% 25% View: Score Cost Detail Home - Log Out MODALITIES TECHNOLOGISTS High score for current Yes Medium score for expired Yes No score for No The Modality total is calculated using the following formula: (Site Score * 1/3) + (Modality-specific Score *2/3) = Modality total. CT Peds Availability 25% 2.5% Section Sub- Totals % 67.5 CT Score 78.2 (Maximum 100 points) Grade Ranges: A = B = C = < 76 Page 2
3 OptiNet Home - Log Out Your Scorecard Costs Sample Medical Center SCORECARD Print SITE CT MR NUCLEAR PET The displayed values represent the average allowed amount for the combined professional and technical components based on previously billed services: 001 N. Bay Street Anytown, WI HEALTH PLAN GENERIC REGISTRATION STATUS Completed ( ID ) REGISTRATION ID CT COST DETAIL View: Score Cost Detail PROCEDURE CODE CURRENT COST Pelvis CT CTA Chest (Noncoronary) Abdomen (CT) Angiography, Abdomen CT $ $ $ $ Body Part For each body part, AIM groups similar CPT codes within each category (for example, the codes include those with and without use of contrast agents). The body parts listed on your score card may not include ALL covered body parts in the AIM program. The score card will only display those body parts for which there is historical claims activity from this provider TIN. Angiography, Head CT $ QUESTIONS? Contact Customer Service for Assistance by calling (800) or optinetsupport@aimspecialtyhealth.com UNDERSTAND YOUR SCORE CTA Abd Aorta w Low Ext Runoff CT Cervical Spine CT Head/Brain CT Lower Extremity $ $ $ $ Average allowed cost by CPT grouper The displayed values represent the average allowed amount for the combined professional and technical components based on previously billed services. Download our handy guide to gain a better understanding of how scores are calculated Lumbar Spice CT $ Download Maxillofacial Area (Sinus) CT Neck (Soft Tissue) CT $ $ $ Orbit/Sella/Ear CT $ $ Thoracic Spine CT $ $ Thorax (Chest) CT $ $ Upper Extremity CT $ $ $ Page 3
4 How Will Scores Be Displayed? ( Display List ) The modality scores will be displayed to ordering providers when they submit order requests. Only providers who have completed an registration will be on the initial display list. 1. Display List The system shall display a list of up to 10 Servicing Providers that are defined based on health plan business rules. Cost and site scores will be shown in 2 columns, sorted first by Site Score and then in ascending order by cost. 1. ( Provider Search Results List ) 2. Provider Search Results List If a user searches for a specific provider, and that provider has an incomplete registration, the cost and/or Site Score columns may display a - or -- to indicate that there is no data to display for that provider. For cases where multiple modalities are ordered (CT and MR, for example), Site Scores are averaged and the costs are summed. 2. Site Score Index: Displays the composite score Cost Index: Displays the average price for exams Page 4
5 Scorecard Legends These screens illustrate the scoring legends for each component of your scorecard. This information is also displayed when you select the information ( i ) icon on the scorecard. SITE SCORE Site Hours Sum of total hours open for services. High score for 60 hours or more per week. Medium score for between 40 and 59 hours per week. Low score for less than 40 hours. Site Accessibility Site Quality Measures Wheelchair accessibility. Policies and procedures QA and tech staffing. High score received for a YES response. No score received for a NO response. percentages of YES response. CT SCORE Site Accreditation Joint Commission HFAP, or DNV Accreditation. responses Medium score for expired YES No score for NO Age in years of machine(s). High score for 5 years of less. Medium score for 6 to 10 years. No score for more than 10 years. Site CAQs Additional physician radiology certifications. responses Medium score for expired YES No score for NO Equipment Quality Number of channels. High score for 16 slices or more. Medium score for 4 to 15 slices, or Cone Beam. No Score for less than 4 slices. Site Number of Modalities Site MD Location Number of modalities offered. Onsite or offsite physician. High score for 3 or more modalities. Medium score for 1 to 2 modalities. No score for 0 modalities. High score for onsite physicians. No score for offsite physicians. Modality Accreditation Machine/modality accreditation for PENDING or expired Yes No score for No Policies & Procedures, QA, and Tech Staffing. percentage of YES Modality-specific technologist certification. Physician staffing with radiology, neurology, of neurosurgery board certification. for expired Yes No score for No for expired YES No score for NO CT Peds Availability Pediatric testing availability. High score for a Yes No score for a NO Page 5
6 Scorecard Legends These screens illustrate the scoring legends for each component of your scorecard. This information is also displayed when you select the information ( i ) icon on the scorecard. MR SCORE CCTA SCORE Age in years of machine(s). High score for 5 years of less. Medium score for 6 to 10 years. No score for more than 10 years. Equipment Quality Age in years of machine(s). Number of channels. Policies & Procedures, QA, and Tech Staffing. Modality-specific technologist certification. Physician staffing with radiology, Cardiology board certification. High score for 5 years of less. Medium score for 6 to 10 years. No score for more than 10 years. High score for 64 slices or EBCT. Medium score for 0 slices. No Score for less than 64 slices. Modality Accreditation Machine/modality accreditation for PENDING or expired YES No score for NO percentage of YES for expired YES No score for No High score for current Yes for expired Yes No score for No MR Equipment Quality Magnetic Field Strength. Modality-specific technologist certification. Physician staffing with radiology, Cardiology board certification. High score for 1.5 T or more. Medium score for 1.0T and up to 1.5T. No score for less than 1.0T. Modality Accreditation Machine/modality accreditation. for PENDING or expired YES No score for NO Policies & Procedures, QA, and Tech Staffing. percentage of YES for expired YES No score for No High score for current Yes for expired Yes No score for No MR Peds Availability Pediatric testing availability. High score for a Yes No score for a No CCTA Peds Availability Pediatric testing availability. High score for a Yes No score for a No Page 6
7 Scorecard Legends These screens illustrate the scoring legends for each component of your scorecard. This information is also displayed when you select the information ( i ) icon on the scorecard. PET SCORE Age in years of machine(s). High score for 5 years of less. Medium score for 6 to 10 years. No score for more than 10 years. Equipment Quality Type of ring. High score for Full Ring. No score for Partial Ring. NUCLEAR MEDICINE SCORE Age in years of machine(s). High score for 5 years of less. Medium score for 6 to 10 years. No score for more than 10 years. Modality Accreditation Machine/modality accreditation Policies & Procedures, QA, and Tech Staffing. for PENDING or expired YES No score for NO percentage of YES Modality Accreditation Machine/modality accreditation Policies & Procedures, QA, and Tech Staffing. Modality-specific technologist certification. for PENDING or expired YES No score for NO percentage of YES for expired YES No score for No Modality-specific technologist certification. Physician staffing with radiology, hematology, oncology, nuclear medicine, or cardiology (when Cardiac PET procedure is selected) board certification. for expired YES No score for No High score for current Yes for expired Yes No score for No Nuclear Peds Availability Pediatric testing availability. High score for a Yes No score for a No Physician staffing with radiology, cardiology or nuclear medicine board certification. High score for current Yes for expired Yes No score for No Nuclear Peds Availability Pediatric testing availability. High score for a Yes No score for a No Page 7
8 OptiNet Key Points: While the provider registration collects a wide range of data, there are a few key factors that drive the overall modality scores. In order for a site to receive a score of an A or a B, the following key factors need to be in place: Machine quality: (15% of weighted modality score) Machine quality does contribute to the overall score. The following attributes are key factors for equipment quality: Physician staffing: (25% of weighted modality score) There should be at least one Board-certified radiologist on-site at the facility. In addition to radiologists, other specialties are also recognized for specific modalities. CT Neurology, Neurosurgery CCTA Cardiology MR Nuc PET Neurology, Neurosurgery and Orthopedics Cardiology, Nuclear Medicine Hematology and Oncology Technologist staffing: (25% of weighted modality score) There should be at least one technologist with modality-specific certification. Technologists with basic radiology certification (ARRT(R) certification) earn zero points. Machine accreditation: (10% of weighted modality score) Machines should be certified by ACR, IAC or one of the other recognized accrediting bodies. Age of Machine Machines more than 10 years old earn zero points If an MR machine has undergone a major software upgrade the system will calculate the age based on the upgrade year, not manufacturer date. CT Non-helical machines do not score high 16-slice and higher machines get the highest score; below 4-slice the lowest CCTA 64-slice and higher or EBCT machines get the highest MR score; below 64-slice the lowest Magnet strength of 1.5T or greater gets the highest score; below 1.0T the lowest PET Full ring machines score highly while partial ring machines do not Page 8
9 Frequently Asked Questions AIM understands that there may be questions about this program. We hope this page will help answer yours. Should you need to contact someone regarding your scores or report, please contact your AIM Network Management Representative.???? What is the source of my cost value(s)? Cost value is based on the allowed amounts of paid claims from the previous year for both professional and technical component claims. Costs were averaged for each hightech body part/cpt grouper. What is the difference between the Site Score and the Modality Scores? The Site Score measures basic performance measures that are applicable for the facility as a whole and are independent of any individual modality What information was used to calculate my scores? Scores are calculated using information submitted by each facility through the online registration assessment. Facilities can view, edit and update their responses by accessing their registration results online. How can I improve my scores? Modality scores are determined from the range of indicators listed in the score card. Modality-specific scoring is largely driven by a facility s results in three key areas: Modality MD Certification (25% of weighted scoring): Presence of at least one Board-certified radiologist or physician of another recognized specialty 7. The Modality Scores are comprised of two (2) components. One-third of each Modality Score is based on the overall facility Site score. Two-thirds of each Modality Score is based on the facility s results in basic performance indicators specific to each modality used at the site. See your scorecard for further details on score factors and weightings. How are the Site and Modality Scores calculated? Site Scores are based on the facility s results for eight (8) factors. Facilities can receive a Raw Score between 0 and 100 points for each factor based on the responses submitted through the online registration. For multiple machines within a modality, values are averaged. Each factor is then multiplied by a Score Weight to produce a Weighted Score. For example, the Factor Site QA has a Score Weight of 20%. A facility that attained a Raw Score of 100 would receive a Weighted Score of 20 (100 x.20) for that Factor. Once all of the Weighted Scores have been calculated, they are added together to attain the overall Site Score. The maximum Site Score that a facility can attain is Modality Technologists (25% of weighted scoring): Presence of at least one modality-certified technologist (beyond general ARRT(R) certification) Modality Certification (10% of weighted scoring): Accreditation of machine by a primary accrediting body Will purchasing a new piece of equipment improve my score? Equipment age and quality each account for 10% of the total weighted score for each modality. Based on the facility s current results in these categories, new equipment may or may not increase the facility s score(s). It is also important to note that several other factors such as MD and Technologist certifications have a greater impact on a facility s score(s) than its equipment. Modality Scores are calculated based on the facility s Site Score and modality-specific scoring. Modality-specific scoring is generated in a similar manner to the Site Score. Each modality has 6-7 modality factors. Facilities can receive a Raw Score between 0 and 100 points for each factor. Each factor is then multiplied by a Score Weight to produce a Weighted Score. Once all of the Weighted Scores have been calculated, they are added together to attain the overall modality specific score. The maximum modality specific score that can be attained is 100. The modality-specific scoring is then multiplied by 2/3. This product is then added to the product of multiplying the Site Score by 1/3. The total is the Modality Score. An example of this scoring is provided below: 4. I ve updated my information online but my score didn t change. Why didn t my scores change? Provider data changes are processed on a daily basis. New provider scores are Sample Modality and Site Score: Modality Specific Score: 65 Site Score: 50 processed overnight, with updated scoring appearing the next day. Modality Score Calculation: 65 x 2/3 = x 1/3 = 16.5 Total = 60.0 Page 9
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