DMH CPTT Meeting Notes - March 18, 2008

Note: These notes do not reflect the opinion of the author, but simply notes taken during the presentations.

The CPTT Meeting featured presentations from two agencies in EDI production with LACDMH. This month’s theme was “EDI Pioneers”, referring to agencies who led the way with EDI, and the presenters included representatives from Hathaway-Sycamores and Pacific Clinics.

Hathaway-Sycamores offers a full range of services at 9 locations through Southern California, providing service to over 1400 LA DMH clients, and over 300 billable staff (Clinicians, Case Managers, Specialists, Psychiatrists, Nurses, etc.). Hathaway-Sycamores currently operates the Netsmart Avatar product, which replaced their previous EHR-S called Tier from Sequest. Presenters Angela Jones (EHR-S implementation) and Shaulon Shanklin-Decuir (billing) stated that Avatar was purchased in 2003 to replace the Tier system, as Tier could not adequately support the agency’s billing needs. Per Keely: they presented some costs, but without further details it is not clear what the total costs were, nor what the costs for the product itself were.

Implementation of the Avatar system had many delays both due to a merger between formerly separate entities, Hathaway and Sycamores, as well as the significant set-up and configuration needed for the Avatar system to be fully DMH compliant, e.g. the 837 transaction customization was significant. Because the County and State 835 remittances are delayed from one to six weeks, the agency is using the SIFT LE Extracts to manually reconcile 837 claims to remittances. Per Keely: Keep in mind that the current EDI implementation with LACDMH is not the national standard and required much customization initially, this should not be the case with the new IBHIS EDI formats if your vendor has 837 experience.

Hathaway-Sycamores launched billing first, with billing staff entering all required billing data from clinical documentation provided on paper. Then launched the clinical functions in a phased roll-out. As such, the implementation kick-off was in February 2004, the initial EDI billing launch was in November 2005, the EDI implementation was completed in December 2007, and the clinical roll-out was completed in February 2008.

The agency reported success going through an electronic audit since implementing Avatar, including an EPSDT audit with no need to print so far. Paper records are retained for client signatures, as they have not purchased signature pads yet. Digitized provider signatures are used, but no signature shows on the screen so the forms simply state ‘provider e-signed, date/ time’.

Hathaway-Sycamores thought implementing EDI would allow them to eliminate some data entry staff and that the claims and reconciliation process would be faster. Not so, the data entry (DDE) staff were retrained as analysts/coordinators doing claims monitoring and analytical work, e.g. reconciliation using SIFT Extracts. They actually added staff for the Help Desk, report design/admin., as well as some forms/screens administration work which they can do now themselves with administration tools Avatar provides. The claims data entry department started with 2 staff, and now is up to 11. Product management staff (Angela’s) went from 1 to 5 staff. Per Keely: The new roles are not a surprise, as each is new for an EHR organization. The claims/analysis staffing size here is due to the manual 835/reconciliation processing they are doing and the manual eligibility verification, etc., as well as the volume of transactions and users, and the condition/age of the network and PC's.

The agency delivers 2 days of hands-on new hire training including: PC 101 skills, intro. to Avatar, and clinical documentation training. Per Keely: PC 101 can be outsourced for smaller organizations and should become a prerequisite for hiring.

Based on Hathaway-Sycamores’ experiences, Angela strongly advised other agencies to test every possible billing scenario and make sure to offer hands on training for all staff. She added that agencies need a thorough understanding of what is included in the vendor’s system, including what an agency may need to pay a vendor extra to configure.

Hathaway-Sycamores’ Lessons Learned:

• Test everything. Do not sign-off until all billing scenarios are tested.
• Have all your documentation and workflows understood before meeting with vendor.
• Form a cross- functional team, and get user buy-in.
• Do reference checks, and site visits; try to get complete client list.
• Understand ‘customization’, some products have admin. tools so you can do it yourself, others require you to engage vendor for these changes. Demo the admin. tools to assure they are user friendly and what level of control you will have.
• Have vendor document the 837 set-up, so when you get errors you know where to go to fix the issues. Ask vendor to produce an 837, then look at it in comparison to the County format. E.g. They took the standard 837 and put it into a spreadsheet and compared it to the LACDMH current 837, that way they could see the GAPs that Netsmart needed to program to comply with the County 837.

Hathaway-Sycamores continues to work independently as well as with their vendor to get the next features developed and tested, such as verification of eligibility and a pre-billing routine. Both presenters revealed many challenges with their EDI process thus far, but pointed out that the DMH transition to IBHIS, although yet another hurdle, should be much easier than their previous EDI implementation efforts.

(See slides at http://dmh.lacounty.info/hipaa/downloads/HATHAWAY-SYCAMORESCPTTpresentation.pdf )

Pacific Clinics has been live with EDI for some time now, beginning with the MIS system and now with the IS. They have over 55 service locations, over 800 clinicians, and serve over 12,000 clients.

Presenter Ruby Kadri, Director of Data Management discussed Pacific Clinics' current configuration, which includes the use of a combination of databases and systems to record client and claims information, including the ECHO system and Health Software Technology Consulting's custom Progress Note and EDI solutions. The ECHO product could not support the Clinics' need for high volume Progress Notes, nor the 837 EDI transactions, so a custom EDI solution from Health Software Technologies was added to the workflow. Pacific Clinics also recently merged with Portals, where they continue to use the SeginusABC product for both the clinical and billing tasks. SeginusABC is currently in the DMH EDI certification process for the Portals Division.

Pacific Clinics is working with Keely McGeehan of Sahara Management Solutions to develop a long term strategic plan and select a new, integrated EHR/EDI solution. They are still several months away from selecting a new EHR-S. Ruby stated that such a system will serve to unite the two merged agencies' clinical and billing records and alleviate much of the manual data manipulation they are currently doing. A Revenue Management Department was created for centralized reconciliation work.

Ruby reported ongoing external costs of $10,000 per month. Per Keely: without further details it is not clear what the total product, implementation, or maintenance costs were/are.

Ruby mentioned that there has been a reduction in manual work since Pacific Clinics implemented EDI, and the agency looks forward to implementation of an integrated system. Their EDI claims produce less than a 1% rejection rate now, and provide for a faster reconciliation process, thus EDI has been a big improvement for Pacific.

Pacific Clinics currently reconciles claims manually and is conducting audits using paper charts, but plans for a paperless workflow with their new EHR-S implementation.

Please contact Keely@4Sahara.com if you are interested in knowing more about Pacific Clinics’ ongoing vendor selection process.

(See slides at http://dmh.lacounty.info/hipaa/downloads/EDI-LongTermLessonsLearned-PacificClinics.pdf )

by Keely McGeehan, Sahara Management Solutions, Inc.