Closing the Loop: From Data Entry to Payment Reconciliation. Topics in Contracting Web-Conference. October 21, 2015

Transcription

1 Closing the Loop: From Entry to Payment Reconciliation Topics in Contracting Web-Conference October 21, 2015

2 Web-Conference Logistics Please remember to dial in Access Code Your phones will be muted during the presentation. Please type your questions in the chat box on the lower left corner of your screen during the presentation and we ll address them during the Q & A section. During the question/answer period only, if you d like to further clarify your question, press *7 to unmute your phone to speak and *7 again to re-mute. Slides will be sent to all participants.

3 Introductions Cycle Review Entry Agenda Transfer to Public Health Solutions Payability Guide Recognition Automatic Flagging Manual Flagging of Services Based on Site Visit Findings Feedback to Service Providers Handling Discrepancies Payment Processing Closeout Best Practices Resources Q&A

4 Cycle Payment Entry Transfer to PHS Manual Flagging Feedback to Service Providers Automatic Flagging Recognition

5 Entry Payment Transfer to PHS Manual Flagging Feedback to Service Providers Recognition Automatic Flagging

6 Entry Contractors in all performance-based service categories use eshare (web-based data system developed and operated by New York City Department of Health and Mental Hygiene-NYCDOHMH) to enter data. Services reported must be entered by COB on the 15 th of the following month (or the next business day, if a weekend or holiday). Example: September s services need to be entered into eshare no later than October 15 th. Exceptions during Closeout NYCDOHMH s policy on data entry: Contractors should report all services provided under a contract even if the reported services are above projected targets for the contract period and/or even if the reported services are not payable because they exceed client-level limitations.

7 Payment Entry Transfer to PHS Manual Flagging Feedback to Service Providers Automatic Flagging Recognition

8 Transfer to Public Health Solutions are transferred monthly to PHS in an extract file (meaning there is no submit data process per se). Service data is uploaded to PHS payment system, where it is automatically quality-reviewed for payability standards.

9 Payability Guide Developed by Public Health Solutions (PHS) and NYCDOHMH to provide guidance on submitting data for all performance-based contracts (Ryan White and HIV Prevention) Emphasizes requirements for payment, certain requirements for contract compliance, and information on other data reporting and evaluation requirements. Updated generally quarterly (PHS sends a Contractor Newsflash when the Guide is updated) Available on the PHS/CAMS website: healthsolutions.org/hivcare Forms, Resources & Procedures Manuals and Guides

10 Entry Payment Transfer to PHS Manual Flagging Feedback to Service Providers Recognition Automatic Flagging

11 Recognition First stage of automatic data processing: records from eshare are assessed against minimum data standards. DOHMH distributes mapping documents that articulate which eshare record types correspond to which PHS payment points. The Payability Guide specifies certain Payment Processing Rules which are prerequisites for recognition. (Example: A confirmatory test that does not have an earlier HIV antibody test entered in eshare under the same Form ID will not be processed for payment. ) processing at this point also creates certain payment points that are based on sets of eshare records. (Examples: Care Coordination PMPD; TCC client graduation; Condom monthly distribution fee.) Those records which pass, and those which are created, are given a Service Type Code, appear on the MIR, and are counted in monthly payment vouchers.

12 Entry Payment Transfer to PHS Manual Flagging Feedback to Service Providers Recognition Automatic Flagging

13 Automatic Flagging Recognition of Services Automatically by Software Routines Duplicate items (services) (or possible duplicates) are marked, as are items requiring data corrections or violate programmatic rules. For each service category, the kinds of issues reviewed automatically are different. Note that the automatic review identifies both definite duplicates and possible duplicates. Definite Duplicate - More than one item of the same PHS service type for the same client on the same day, and that service type is such that no programmatic or clinical scenario could make it valid to provide more than one service. (Permanent Housing Placement would be an example.) Possible Duplicate - More than one item of the same PHS service type for the same client on the same day, but it is programmatically possible that the second service is a valid separate service. (For example, some individual counseling service types could occur more than once on the same day.) Possible duplicates which are really separate services must be attested during closeout in order to avoid recoupment.

14 Entry Payment Transfer to PHS Manual Flagging Feedback to Service Providers Recognition Automatic Flagging

15 Manual Flagging of Services Based on Site Visit Findings Prior to Site Visit During Site Visit During Exit Interview Contract Managers/Contract Coordinators select records from a recent MIR for review PHS staff note any issues (recoupable or non-recoupable discovered with service tracking & documentation) PHS staff review any necessary recoupment and/or corrective actions PHS staff enter issues (if applicable) into the PHS payment system, attached to each specific item s record. After Site Visit PHS sends a Site Visit Report including a recoupment summary (if applicable) detailing the number of units and dollar value to be recouped, which matches services in the Summary of Issues Noted section in the next MIR.

16 Correction/Recoupment/Validation Reasons Resulting From Site Visit Findings

17 Entry Payment Transfer to PHS Manual Flagging Feedback to Service Providers Recognition Automatic Flagging

18 Master Itemization Report (MIR) Produced from the monthly eshare extract Provides an itemized listing, as well as a summary, of services recognized by PHS payment system (those which meet minimum threshold for correct data). Compares actual services to projected services. Presents information about services recognized by the payment system that have been found to be problematic. Sent monthly to Program Managers with a separate notification to the Senior Administrator and Fiscal Manager.

19 MIR Review Section I: DATA INCLUDED contains information about when the MIR was run and the most recent data extract file that affected the service count.

20 MIR Section I-A: PHS INFORMATION SYSTEM ACCOUNTING DISCREPANCIES UNDER INVESTIGATION Notes any discrepancies that may arise in the aggregation of item-level data into PHS payment system. This section is for informational purposes only and is usually blank. Any discrepancies are investigated and corrected by PHS..

21 MIR Section II: YEAR-TO-DATE TOTALS BY SERVICE shows, for each service type, the year-to-date total count of services, and their value, recognized by PHS payment system, and compares them to year-to-date projections.

22 MIR Section III: Summary of Issues Noted (SIN) Report Summarizes service records that have been recognized for payment but have subsequently been marked (automatically or as a result of Site Visit findings).

23 MIR Section IV: MONTH TOTALS FOR SERVICES SUBMITTED AND RECOGNIZED Displays monthly total counts of services and their value recognized by the PHS payment system, and compares them to monthly projections. Some of these services may have already been paid, while others may be in the queue awaiting payment.

24 MIR Section V: ITEMS RECOGNIZED. Shows item-level data. The client ID, date of service, service type & units of service are included. Items identified as problematic are shaded in color & the nature of the problem is noted.

25 MIR Section VI: GROUP ATTENDEES RECOGNIZED shows the Client ID numbers and Collateral ID numbers associated with each Group Event ID..

26 Care Coordination Client Trajectories Monetary Value Report Lists each client in order of client ID and shows the trajectory periods in different Care Coordination tracks from the start of the current contract period.

27 Care Coordination Income Predictor Tool Care coordination contractors are paid for Per-Member-Per-Day enrollment and for meeting minimum thresholds of service. Income Predictor Tools helps agencies predict monthly and annual program income.

28 Handling Discrepancies

29 Handling Discrepancies In instances where you believe that items (services) submitted for payment have not been recognized by PHS, please follow these steps: 1. Find specific examples that DO NOT appear on the MIR. 2. Verify that the examples have been properly entered in eshare. Please consult the Payability Guide sections on Requirements and Special Issues for that service type, with special attention to Payment Processing rules; these rules articulate the minimum threshold of data quality without which an item will not be processed for payment. 3. If the examples appear to be properly entered, send them with the client ID number, date, and service type via to your PHS Contract Manager. Note: eshare data is the basis of payment; however, payment logic resides in Public Health Solutions information systems, not in eshare. Please contact your PHS Contract Manager (not NYCDOHMH) about apparent payment discrepancies. If necessary, PHS staff will reroute questions to NYCDOHMH eshare staff.

30 Payment Entry Transfer to PHS Manual Flagging Feedback to Service Providers PHS Recognition Automatic Flagging

31 Payment Processing Once the PHS payment system receives data: Your PHS Contract Manager reviews the data and contract status. If all prerequisites are present, payment is approved, entered into the PHS payment system and forwarded to PHS fiscal department Factors that can prevent a payment from being approved include, among others: Non-executed contract or renewal Lapsed insurance Non-submission of required monthly reports Audit report PHS aims to pay contractors within 30 days of receipt of data and all required reports Note: PHS processes payment for services that meet a basic threshold of data correctness. However, services included in payment may subsequently be assessed as non-payable, as previously described

32 Closeout

33 Closeout Occurs towards the end of the contract year to reconcile services reported and determine a final payment. Final opportunity for contractors to reconcile and submit additional services or correct services reported. Two data entry deadlines around the 7 th of the month and around the 20 th of the month (as opposed to the 15 th ). Additional MIR is sent between the two dates to review data and make corrections Closeout Reports: Initial closeout MIR Potentially Payable Services (PPS) Report Attestables Report Final MIR

34 Potentially Payable Services Report (PPS) Service records that initially fail to meet requirements needed for payment (not recognized and not on MIR) are included in the end-of-year Potentially Payable Services (PPS) report. Generated before closeout & lists all services that could have been recognized for payment. Contractors receive this report a month or so before closeout and are given time to make adjustments in eshare which might render a service payable.

35 Example of PPS Report

36 Attestables Report Possible duplicate reported services (and other issues) Require contractor feedback

37 Best Practices

38 Best Practices When your organization receives the monthly MIR, Program and Fiscal staff should meet and discuss each contract s spending (drawdown), performance and data quality. Be in frequent contact with your PHS Contract Manager for contract-related concerns, and your NYCDOHMH Project Officer for technical assistance about the service model. Understand your service category s payment rules! Review the Payability Guide if you are unsure. PHS notifies you with a Contractor Newsflash communication when updates are made to the Payability Guide.

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40 Resources

41 Resource Contacts Problem Alleged discrepancies between clientlevel data from eshare and MIR or Care Coordination Trajectory Report Need for an MIR outside of the regularly scheduled mailing from PHS General MIR questions Resource PHS Manager of Systems: Nagla Bayoumi (646) or Your PHS Contract Manager Your PHS Contract Manager eshare questions/problems eshare Service Desk: (Monday-Friday 8am-6pm, Saturday 10am-2pm)

42 Questions? **Please complete the brief survey about this web-conference, which will be automatically sent to you via after you log off. Thank You.