in-home supports assurance system overview
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In-Home Supports Assurance System (ISAS)John WilsonWhitney Moyer
Introduction• In-home Support Assurance System (ISAS)
▫ Phone Based Billing System for in-home personal care providers
• Purpose▫ Simplify billing▫ Monitor provision of services
• Process▫ Provider calls ISAS to clock in/out▫ Calls matched with provider, participant, and Plan of Care▫ Claims automatically generated▫ All claims are processed on a weekly basis
Background System Benefits Lessons Future
Background• Why ISAS?
▫ Recommendations from compliance report done by Lewin (Dec. 2010)
▫ Goals of Report: Decrease improper in-home personal care provider payments Maintain and improve quality of care delivered Limit burden on participants
• Current in-home personal care expenditures▫ See Figures 1.1 and 1.2 on following slides
Background System Benefits Lessons Future
Figure 1.1 Distribution of Personal Care, Attendant Care, and State Plan Personal Care Services Users and Expenditures, FY 2011
Participants = 10,315 Total Expenditures = ~ $128,500,000
$66.1 52%
$32.6 25%
Living at Home, 965
10%
2,39823%
State Plan Personal
Care, 6,95267%
State Plan,$29.823%
Background System Benefits Lessons Future
Figure 1.2 ISAS estimated to save 8-9% of total expenditures
Total Expenditures = $128,500,000 Estimated Total Expenditure under ISAS = $118,220,000
Estimated Savings (8%) = - $10,280,000
Living at Home, 965, 10%
2,398, 23% State Plan Personal
Care, 6,952, 67% $66.1, 52%
$32.6, 25%
$29.8, 23%
Background System Benefits Lessons Future
Background Cont’d• States with Similar System
▫ South Carolina, Oklahoma and Tennessee
• Model Used▫ South Carolina implemented a similar system years ago and
achieved a 10% savings in claims reimbursement at a program cost of 1-2%
Background System Benefits Lessons Future
Provider Setup• General Identification
▫ Name, NPI, SSN
• Voice Recognition▫ Required for all provider calls▫ Providers uses same phrase▫ Authenticate providers
• One Time Password (OTP)▫ Only needed when provider calling from non-participant
phone▫ Keychain sized device▫ Randomly generated number▫ Number changes every minute ▫ Numbers traced to a specific timeBackground System Benefits Lessons Future
Provider Setup Cont’d• Training
▫ In-Person Training Regional sessions available statewide
▫ Webinars www.ltsstraining.org
▫ DVDs Requested by calling the Help Desk
Background System Benefits Lessons Future
Claims and Reports• Claims
▫ Nightly Process▫ Ability to View Claims▫ Ability to Adjust Claims
• Reports▫ Service-based reports▫ Claim-based reports
Background System Benefits Lessons Future
Exceptions• Exceptions
▫ ISAS creates exceptions for inconsistencies Example exceptions: missing clock-in/out, participant ineligible,
inactive POC, etc.
▫ ISAS staff on-site and staffed within OHS Coordinates with program staff to handle exceptions workflow
Policy & Compliance, LAH, WOA, MAPC, MDoA and eventually CFC
More proactive approach to handling claims issues
▫ ISAS staff can resolve certain inconsistencies before claims generated Identify fraud Retraining needs Gaps in services
Background System Benefits Lessons Future
Exceptions Data• ISAS staff will use exceptions data to:
▫ Ensure providers servicing participants appropriately▫ Ensure claims accurate▫ Proactively handle claims issues▫ Process claims more efficiently▫ Track all steps of claims process and resolution
Background System Benefits Lessons Future
Help Desk• Offsite and vendor staffed
▫ Register providers for ISAS▫ Answer provider technical issues and requests
• Providers directed to Help Desk after three failed clock in/out attempts
• Live operator hours: ▫ 6 a.m. – 8 p.m., Monday-Friday
• Outside of live operator hours: ▫ Providers are prompted to leave necessary information via
voicemail
Background System Benefits Lessons Future
Benefits
• More efficient billing▫ Daily claims and weekly processing
• Provider accountability▫ Participants want greater provider oversight
• Faster communication▫ Emailing directly with all agency providers, and most
independent providers
Background System Benefits Lessons Future
Benefits Cont’d
• Department oversight▫ For the first time, Department will know agency staff
providers’: Names
Social Security Numbers
Voiceprints 4,976 agency staff currently using ISAS
▫ Greater compliance Agency provider staff turnover, provider retraining and
corrective actions
Background System Benefits Lessons Future
Current Stats• Calls
▫ 5,500 (approx.) clock ins and outs per day▫ 98% (approx.) calls go through automated system without
live operator assistance
• Plans of Care▫ 927 POCs updated since July 15 launch
• Users▫ 4,976 agency staff currently using ISAS▫ 1,000+ ISAS users trained
Includes: Case Managers, Agency Administrators, LAH Independent Providers, OHS staff
Background System Benefits Lessons Future
Lessons Learned• Misconceptions
▫ Providers billing inappropriately for travel, shopping and time spent waiting without participant
▫ “Big Brother”
• Culture Change▫ Examples:
Participants – “From personal companionship to personal care” DHMH – “All hands on deck” Family Providers – “From a helping hand to a job”
• Buy-In▫ Better communication with our stakeholders, including
provider union, participants, providers, and even within DHMH itself
Background System Benefits Lessons Future
Lessons Learned Cont’d• System Readiness
▫ Clean data▫ Implement program in phases
LAH/WOA Agencies LAH Independents WOA Independents MAPC
Dual-billing ▫ Ensure that short term fixes do not lead to long term problems
E.g. Softening voiceprint More providers entering SSN
• Go-Live Readiness▫ Issues/Findings
More transparent metrics for assessing launch readiness More viable plan to reach the deployment date Better identify backup plan
Background System Benefits Lessons Future
Lessons Learned Cont’d• Go-Live Readiness Action Items
▫ Metrics Measure staffing, known issues, and expected call volume
▫ Viable Plan Develop deployment plan of important milestones before going
live Identify external dependencies that are not in vendor/DHMH
control (e.g. integration with MMIS) Setup vendor/DHMH meeting to make final go-live decision
▫ Backup Plan Develop key failure scenarios and develop backup plans Identify process for making plans effective
Background System Benefits Lessons Future
Future Potential• Baseline for quality measures
▫ Change from simple timesheet data to detailed data
• Plans of Care▫ More accurate and standard information▫ Standard plans can help improve care
Background System Benefits Lessons Future
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