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Aging Well PA, LLC525 S. 29th St. - Suite BHarrisburg, PA 17104

Desk ReviewsIn the PIA System

May 2020

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Agenda

What is a desk review?

Who can do desk reviews?

When is a desk review required?

How will I know a desk review is needed?

How are desk reviews done?

Other FAQsAging Well PA, LLC

525 S. 29th St. - Suite BHarrisburg, PA 17104

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What is a Desk Review?

A desk review is a comparison between two sets of MCO-FED data.

MCO FED data are FED questions pulled from the interRAI-HC assessment completed by one of the MCOs interfaced with PIA.


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How are the Data Sets Created?

The MCOs upload the interRAI-HC to PIA & PIA extracts FED data from it & generates the FED. This is done on a nightly basis.

You may see more than two data sets within a year. The MCOs can administer the interRAI-HC whenever they think it is needed.


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Who can do a desk review?

• Any agency personnel who are already users in PIA with the role of assessor.

• If you want additional people doing desk reviews, they must complete the FED & PIA training, have a b-account, & be given access to PIA.

• Desk reviews DO NOT have to be completed by an assessor, but they must have the assessor role in PIA.

When is a Desk Review Required?

As a part of the redetermination of clinical eligibility for long-term supports & services through CHC, desk reviews must be done on a yearly basis.

If there are two sets of data & the most recent one is a change from NFCE to NFI.

Program type will always be redetermination and the assessment type will either be initial, significant change or annual.


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When is a Desk Review Required? Continued

An Annual assessment (333-365 days from the initial MCO-FED and subsequent annual MCO FEDs). If an annual desk review is done after 365, make a note in the comments that the assessment was late and proceed with completing the desk review. The annual desk reviews are when you will compare an initial to an annual or an annual to an annual.

When an individual goes from NFCE to NFI (a priority review). These cases can be Initial to an annual, initial to a significant change, significant change to significant change, or annual to significant change.


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When is a Desk Review Not Needed? DO NOT use previously completed FEDs with HCBS, Nursing Facility, PCH,

Personal Care, Dom Care or other Waivers as the Program Type when making desk review comparisons. These FED’s cannot be used for desk reviews.

If there are two sets of MCO data & both are NFI or the most recent one is a change from NFI to NFCE a desk review cannot be completed.

***Reviewers should no longer complete desk reviews for significant changes that go from NFCE-NFCE ***

Do not complete a desk review if only one set of data is from the MCO. We do not compare data between AAA FEDs and MCO FEDs.


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When is a Desk Review Not Needed? Continued OLTL is asking that you not complete a desk reviews during the following scenarios, but rather include this information on the NFI tracking sheet to your QCSS by the end of the day eachFriday.

The initial FED is NFI and the annual is NFCE

The Initial FED is NFI and annual is NFI

The initial FED NFI and significant change is NFI or NFCE


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How will I Know a Desk Review is Needed?

There are two answers to this question.

The first one deals with a “normal”

process. The second deals with the

backlog of needed desk reviews. Aging Well PA, LLC


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Normal Process for a Desk Review.

• An alert, much like the alert for the FED, will occur in PIA.

• There are two kinds of alerts. The first is a priority alert when the determination has changed from NFCE to NFI. These must ALWAYS be given priority.

Second Type of Alert

The second type of alert is an alert that states Information for Desk Review is available. These alerts are triggered when the MCO completes an assessment or there has been a significant change.

The next slide shows how to look for both kinds of alerts.


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From the menu bar, click on

“Alerts.” Then look at the

“Alert Description column.”

A. Johnson.123lu7k3409 Desk Review

Assigning Desk Reviews

When an alert arrives, it must be assigned to someone to complete.

This is done in the same way FEDs are assigned.


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Email Alerts

In addition to the alerts in PIA, there is an option of having an email alert sent.

This will be covered under FAQs.


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How Are Desk Reviews Done?

In order to do a desk review, you must have the two sets of FED data open at the same time.

The next series of slides will show you how to do this.


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After opening the person’s

record click on “Assessments”

& then “Desk Review.”


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You will now see this

screen. Click on

“Create New” in the

upper right corner.


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In order to complete a desk review,

you must compare the two most

recent MCO FEDs. You will select the

FEDs by marking the radio box to the

left of the FED and then click Create

New


Integrity

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you must compare the Older

Fed data with the Newer FED

data. Right click on “Bucks

County AAA.” Then click on

“Open in New Window.” This

will open a new window and

should look like the next

slide.


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Now return to the other

window.


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Now click on “PHW”


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Both windows should

now be displaying basic

information. For each

of the open windows,

click on “Summary.”


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You should now have two windows open that both look like this. Your

next step is to place the windows side-by-side to make review easier.

The quickest way to do this is to drag the screen’s title bar to one

side of your screen. When the cursor touches the screen edge,

release the mouse button. Now do the same thing dragging the title

bar to the opposite side of the screen. If you are using Windows 10

you can do this even quicker. See the directions located here for

these procedures. https://support.microsoft.com/en-

us/help/4027324/windows-10-snap-your-windows

https://support.microsoft.com/en-us/help/4027324/windows-10-snap-your-windows


Integrity

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opened and side-by-side, you can

begin the desk review. It may be

easier to make notes outside of PIA to

keep track of any discrepancies you

might find.

What Will You Review?

For all desk reviews:

Look to see if the MCO completed assessment was on time. This means, an assessment was done on one or more

occasion by the MCO within the past 333-365 days.

Determine if there are any factual discrepancies in the personal information (correct name, date of birth, gender, etc.)

Determine if the FED is complete; are all the items in the original FED in the new assessment?


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For Priority Reviews NFCE to NFI

When you have a case that has gone from NFCE to NFI, you complete all the items listed on the previous slide.

Additionally, you must complete the template presented on the next several slides & add it as an attachment to the person records.

The template should not be used for non-priority reviews. Aging Well PA, LLC


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Desk Review Template Description

The template includes only the FED items that are used by the translator to calculate a final determination.

It includes scoring values for a partial deficit & values for a full deficit.

It provides a place to enter information comparing scores & a way to identify if any change in scores has changed deficit level.


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Desk Review Template

The most up to date fillable PDF copy of this form can be found on the Aging Well PA Website.

When filling in the answers to the “Current Scores” column, you may write each score in that section with a comma in between as shown in the picture.


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Option 2

XYZ


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Using the Comments Section

For any discrepancy with the person’s identification information, use the comments section to describe the discrepancy. See the next slide for an example.


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To complete the desk review, return

to the Desk Review Summary page

&click on “Desk Review.” Indicate if

there was a delay or any

discrepancies. Include comments

when there are discrepancies or a

delay. The next several slides will

elaborate on doing this.


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The gender did not match. Previous FED was male. Current FED

female.

Using the Comments Section

For any NFCE to NFI situation complete the comments section with the following:

“See Desk Review Template attachment for details.”


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Integrity

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How to Attach the Desk Review Template

For Priority Cases where you will need to attach the Desk Review Template within the Desk Review “Attachments” section. The next slides will outline the steps taken to attach your template.


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Once you have typed your desk review attachment comment, you will then go to click save at the top right corner.

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Next, you will open the attachments tab and click “upload.”


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Next, this box will pop up. Click on choose file to upload your Desk Review Attachment form. You may write a comment if you choose. Then click continue.


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As the final step to upload your attachment you must go to the top right of your screen and hit submit.


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Alerting Aging Well

All NFCE to NFI situations should be brought to the immediate attention of your QCSS by sending an email with “Priority Desk Review” in the subject line. These will be sent for a MDR.

The email should include the participant’s ID number. Do not include any additional identifying information.


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Alerting Aging Well

Any desk review alerts you receive where there are two MCO FEDs and the initial FED is NFI. This should be documented using the NFI Tracking Template and is submitted to your QCSS each week by the end of the day Friday.

FAQ #1

What is the payment for a desk review & how do we bill for it?

The payment rate for a desk review is the same as your FED rate. You will generate a report in PIA in the same way you create reports for the FED. These will be reconciled with your QCSS.

Desk reviews should be entered on the Redetermination line on your monthly invoice. Aging Well PA, LLC


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Integrity

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click on “Reports.”


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This opens the list of

reports including the

Desk Review Summary

Report. Click on “View”

for this report.


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You are now on the

report viewer screen.

Make sure to enter the

start & end dates & then

click on “View Report.”


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Please note the headings in the blue bar area.

The column “Total” will give you the number of

completed desk reviews for the time period

between your start date & end date.

FAQ #2

How do I request an email alert?


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Integrity

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on “Menu” then “My

Information” & then “My

Profile.”

①

②③


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Click on the “Edit” hyperlink

across from “General

Information.”


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To receive email alerts click

on “yes” to the right of

“Receiving Email Alert.”


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FAQ #3

What if I receive multiple requests for a desk review?

Always check two things.

1. Is the request due to a determination going from NFCE to NFI?

2. Is the program type redetermination or significant change?


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FAQ #3… continued

If there is a shift from NFCE to NFI, a desk review is completed regardless of the time between the two sets of data.

In all other situations complete a second desk review if the program type listed is significant change (NFCE to NFI) or redetermination.


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FAQ #4

What steps do I take if I see someone has gone from NFCE to NFI?

1. Immediately inform your Quality Compliance & Support Specialist via email.

2. State the change from NFCE to NFI and provide the participant’s ID # only.


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FAQ #5

Can I complete desk reviews for UMPC data now?

UPMC data is now available in PIA to complete desk reviews. You can complete desk reviews, when needed, for both ACFC and UPMC.


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FAQ #6

How do I know when to do a desk review for significant changes?

Reviewers should only complete desk reviews for significant changes if it involves an NFCE to NFI priority. Reviewers should no longer complete desk reviews for significant changes that go from NFCE-NFCE.

Additional Information

This presentation is available in a PDF format & posted on the Aging Well website.

If you have additional questions or need assistance, please contact your Quality Compliance & Support Specialist.


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