Automated Service Connected Determination ASCD Best Practices

1. Automated Service Connected Determination (ASCD) Best Practices VeHU Session 162 Karla: Welcome to ASCD Best Practices Reminder to write any questions you might have as we go through the session on the cards provided. This is a f/u to the Hands-on session that was provided last year that introduced you to the Automated Service Connected Determination software. Now that sites have had a time to work with the software, we wanted to provide you with some best practices that might help you in implementation or bettering your own processes.Karla: Welcome to ASCD Best Practices Reminder to write any questions you might have as we go through the session on the cards provided. This is a f/u to the Hands-on session that was provided last year that introduced you to the Automated Service Connected Determination software. Now that sites have had a time to work with the software, we wanted to provide you with some best practices that might help you in implementation or bettering your own processes.

2. 2 Karla: The HIM Program Office has led the initiation of this software with the endorsement of the CBO office. Elena: Was a test site for ASCD and have honed their processes through continued use of the product. Mary: Used the SCAM software and has been with us through the development and implementation of ASCD. Karla: The HIM Program Office has led the initiation of this software with the endorsement of the CBO office. Elena: Was a test site for ASCD and have honed their processes through continued use of the product. Mary: Used the SCAM software and has been with us through the development and implementation of ASCD.

3. 3 ASCD Implementation Purpose: Software that recognizes potentially billable encounters for SC veterans that cannot be automatically matched to Rated Disability codes and potentially non-billable encounters which were designated NSC but should be SC � These encounters are displayed in reports for coders and/or utilization review staffs to review the patient visit information and change the incorrect SC/NSC designation so they can be billed appropriately Released: October 2007 ASCD FAQ Future development: Enhancements have been identified but were not funded for FY 08. Still on the books for FY 09. Major enhancement is to integrate this software into ancillary packages (CPRS, QuadraMed, etc.). Today�s presentation will highlight 3 facilities� workflow process to use ASCD to identify additional billing opportunities and to correctly assign SC/NSC to an encounter Karla: Purpose: The purpose of the software is to assist with the review of SC encounters prior to doing the Code Me report from QMED. Class III SCAM was upgraded to Class I with added functionality. This was phase one of the project and only affected PCE and Scheduling. The point is to assure that encounters marked SC are reviewed to assure the right designation has been made. Benefits of use may include: Software focuses on those cases needing up front evaluation; It removes encounter where there is a positive match with the VBA code�therefore decreasing the # of cases requiring an initial (eyeball) review. �For those facilities who contract out outpatient coding, it would provide a vendor worklist of insured cases needing coding. Released Oct 2007 FAQ includes link to training and is posted on the HIM website Future: QMED Interface Ancillary Packages � FY09 Review map/continue to refineKarla: Purpose: The purpose of the software is to assist with the review of SC encounters prior to doing the Code Me report from QMED. Class III SCAM was upgraded to Class I with added functionality. This was phase one of the project and only affected PCE and Scheduling. The point is to assure that encounters marked SC are reviewed to assure the right designation has been made. Benefits of use may include: Software focuses on those cases needing up front evaluation; It removes encounter where there is a positive match with the VBA code�therefore decreasing the # of cases requiring an initial (eyeball) review. �For those facilities who contract out outpatient coding, it would provide a vendor worklist of insured cases needing coding. Released Oct 2007 FAQ includes link to training and is posted on the HIM website Future: QMED Interface Ancillary Packages � FY09 Review map/continue to refine

4. 4 The MAPICD-9 to VBA Rating Codes Rules were established prior to mapping ICD codes to VBA codes Rules concluded with the following: True match, Partial Match, No Match Matching is to the primary Dx code only All Partials and No Match go for review Map is updated at least annually Issues with the map are reviewed as they are reported via remedy tickets Karla Worked with VBA physician to develop the rules. I will now turn it over to Elena to get in to the meat of the presentation and allow she and Mary to share their experiences.Karla Worked with VBA physician to develop the rules. I will now turn it over to Elena to get in to the meat of the presentation and allow she and Mary to share their experiences.

5. 5 What Is ASCD? ASCD is an automated monitoring system designed to flag encounters that are inappropriately marked as �SC� It uses a mapping system with rated disabilities and diagnosis codes that is on the veterans encounter This software recognizes potentially billable encounters for SC veterans that cannot be automatically matched to rated disability codes Elena: The SC Status is automatically determined when the dx code is entered during the checkout process based on the mapping that Linda was talking about earlier. This automation only happens within PCE & Scheduling Certain encounters will be sent to the ASCD application for review based on the mapping criteria as well. These encounters are automatically set into the review file as soon as the checkout process is complete. Even though the encounter is set for review existing billing processes will still take place after the checkout is complete.Elena: The SC Status is automatically determined when the dx code is entered during the checkout process based on the mapping that Linda was talking about earlier. This automation only happens within PCE & Scheduling Certain encounters will be sent to the ASCD application for review based on the mapping criteria as well. These encounters are automatically set into the review file as soon as the checkout process is complete. Even though the encounter is set for review existing billing processes will still take place after the checkout is complete.

6. 6 How Does ASCD Work? Encounters are checked for the following criteria: Is the encounter SC Is the clinic stop code a billable or non-billable Does the diagnosis fully match the related disability Does the diagnosis partially match the rated disability Does VBA code for any of the rated disabilities match at least one of the diagnosis Does the patient have any related disabilities Eligibility Discuss contacting VBA for clarification of ratingDiscuss contacting VBA for clarification of rating

7. 7 Encounters from Ancillary Packages Same review criteria will be used when encounter is sent to PCE If the ancillary package originating SC/NSC value differs from the ASCD SC/NSC value, the encounter will be set for review The ancillary package originating SC/NSC value will not be changed when the encounter is sent to PCE Only CPRS will be updated if SC value is changed via the ASCD application Other ancillary packages will NOT be updated if SC value is changed via the ASCD application

8. 8 ASCD Users General User - can only see encounters at NEW status - no Key Assigned Clinical Reviewers - can only see encounters at a REVIEW status CANNOT undo a SC status SDSC CLINICAL Key Supervisor - can see encounters at NEW, REVIEW or COMPLETED status They can undo a SC status and set an encounter to status or Review. SDSC SUPER Key The same review criteria listed in the previous slide will be used for encounters sent to PCE from ancillary packages. Originating ancillary packages will NOT be updated� This is how PCE currently works. Elena will talk about who has these menus at her site (Mary will cover for St. Cloud when get to reports) The same review criteria listed in the previous slide will be used for encounters sent to PCE from ancillary packages. Originating ancillary packages will NOT be updated� This is how PCE currently works. Elena will talk about who has these menus at her site (Mary will cover for St. Cloud when get to reports)

9. 9 Daily VistA Email Subj: ASCD Compile Numbers [#5026] 04/22/08@21:01 16 lines From: ASCD COMPILE In 'IN' basket. Page 1 ------------------------------------------------------------------------------- Date Range (Compile) - From: Apr 21, 2008 Thru: Apr 21, 2008 Date Range (Late Ins.) - From: Apr 22, 2006 Thru: Apr 22, 2008 Number of encounters Service Connected (Compile) : 33 Number of encounters Service Connected (Late Ins.) : 217 (Number SvcConn with a True Map) : 65 (Number SvcConn with a Partial Map) : 16 (Number SvcConn that don't Map to VBA) : 169 Number of encounters Not Service Connected : 1742 Number of encounters that are Non-billable : 3194 Number of encounters with Non-count Clinics : 0 Number of encounters with no diagnoses : 0 Number of encounters with other errors : 0 Number of encounters already evaluated : 791 --------------------------------------------------------------------------- Total Encounters Checked: 5808

10. 10 VistA eMail Notification Subj: ASCD PURGE REPORT [#0000001] 04/09/08@20:15 5 lines From: ASCD PURGE CHECK In 'IN' basket. Page 1 ------------------------------------------------------------------------------- Encounters with No Action Taken: 2 APR 02, 2008@10:45-CPRS PATIENT A-NEW-Enc #: 0000001 APR 02, 2008@10:45-CPRS PATIENT B-NEW-Enc #: 0000001 Encounters with Actions Taken: 0

11. 11 Tampa Process 3 Different options to review encounters: Edit ASCD Encounters by Date Range Edit ASCD Encounters by ListMan Edit Single ASCD Encounter

12. 12 Edit ASCD Encounters by Date Range Select one of the following: S Service Connected N Non-Service Connected A All Which type do you want to review?: S//ervice Connected Please enter START date: T-60 (APR 22, 2008) Please enter END date: Apr 23, 2008// T-1 (APR 23, 2008) 1 VAMC ST. CLOUD, MN 2 COPE VIRGINIA 3 COPE DULUTH 4 COPE HIBBING 5 STC-PRRTP 6 BRAINERD CBOC 7 WEST CENTRAL CBOC 8 ALL Select DIVISION: (1-8): 8// EX 1: 309.29 is primary DX code and it is mapped as a partial match for RD Code: 9440-CHRONIC ADJUSTMENT DISORDER (SC=Y) 003.24 is secondary DX code and it is mapped as a true match for RD Code: 5000-OSTEOMYELITIS (SC=Y) 780.6 is not mapped to either of the RD codes for this patient (SC=N) EX 2: Patient has RD 7530 - CHRONIC RENAL DISEASE and 309.29 is not mapped to that RD therefore SC is set to NO. 003.24 is not mapped to 7530 either, therefore SC is set to NO 780.6 is not mapped to 7530 either, therefore SC is set to NO EX 1: 309.29 is primary DX code and it is mapped as a partial match for RD Code: 9440-CHRONIC ADJUSTMENT DISORDER (SC=Y) 003.24 is secondary DX code and it is mapped as a true match for RD Code: 5000-OSTEOMYELITIS (SC=Y) 780.6 is not mapped to either of the RD codes for this patient (SC=N) EX 2: Patient has RD 7530 - CHRONIC RENAL DISEASE and 309.29 is not mapped to that RD therefore SC is set to NO. 003.24 is not mapped to 7530 either, therefore SC is set to NO 780.6 is not mapped to 7530 either, therefore SC is set to NO

13. 13 Working The Encounters *P* = primary diagnosis Selecting �N� (no) at the spot where it asks if you want to change the service connected condition for this encounter means that you don�t want to change it and you believe the encounter is SC Selecting �Y� (yes) at the above spot means you do want to change the encounter to NSC

14. 14 Working the Encounters (cont) �Skip� allows the user to move on to the next encounter to be edited. The skipped encounter will still be available for review at a later date. �Review� enables the user to send the encounter back to a clinical reviewer if the decision cannot easily be made as to whether this encounter is truly service connected or not.

15. 15 Case 1 Encounter 0000001 is marked as service connected and may not be. Date of Encounter: 04/22/2008@08:00 Location: CLINIC A Primary Provider: CPRS PROVIDER A Patient: CPRS PATIENT A (XXXX) Patient is not copay eligible. Patient is insured. Outpatient Coverage is covered. ASCD Evaluation: NSC POVs/ICDs: *P* 296.89 BIPOLAR DISORDER NEC Rated Disabilities: 6260 TINNITUS (10%-SC) DO YOU WANT TO CHANGE THE SERVICE CONNECTION FOR THIS ENCOUNTER? YES

16. 16 Case 1 - continued PAT/APPT/CLINIC: CPRS PATIENT A APR 22, 2008@08:00 CPRS CLINIC A ICD CODE: ...There is 1 ICD CODES associated with this encounter. ____________________________________________________________________________________________________________ - - E N C O U N T E R D I A G N O S I S (ICD9 CODES) - - No. ICD DESCRIPTION PROBLEM LISTNo. ICD DESCRIPTION PROBLEM LIST _____________________________________________________________________________________________________________ 1 296.89 BIPOLAR DISORDER NEC PRIMARY YES Enter Diagnosis : 296.89 --BIPOLAR DISORDER NEC PRIMARY Select one of the following: O ORDERING R RESULTING OR BOTH O&R Is this Diagnosis Ordering or Resulting:: // Patient's Service Connection and Rated Disabilities: SC Percent: 10% Rated Disabilities: 6100 IMPAIRED HEARING (0%-SC) --- Classification --- [Required] Was treatment for SC Condition? NO// Enter NEXT Diagnosis :

17. 17 Case 2 Encounter 0000001xx is marked as service connected and may not be. Date of Encounter: 04/22/2008@09:00 Location: CLINIC B Primary Provider: CPRS PROVIDER B Patient: CPRS PATIENT B (XXXX) Patient is not copay eligible. Patient is insured. Outpatient Coverage is covered. ASCD Evaluation: NSC POVs/ICDs: *P* 244.9 HYPOTHYROIDISM NOS 272.4 HYPERLIPIDEMIA NEC/NOS 401.9 HYPERTENSION NOS 593.9 RENAL URETERAL DIS NOS Rated Disabilities: 5054 HIP PROSTHESIS (100%-SC) 6100 IMPAIRED HEARING (0%-SC) 8520 PARALYSIS OF SCIATIC NERVE (20%-SC) DO YOU WANT TO CHANGE THE SERVICE CONNECTION FOR THIS ENCOUNTER? YES

18. 18 Case 2 � continued PAT/APPT/CLINIC: CPRS PATIENT B APR 22, 2008@09:00 CPRS CLINIC B ICD CODE: ...There is 4 ICD CODES associated with this encounter. ____________________________________________________________________________________________________________ - - E N C O U N T E R D I A G N O S I S (ICD9 CODES) - - No. ICD DESCRIPTION PROBLEM LISTNo. ICD DESCRIPTION PROBLEM LIST _____________________________________________________________________________________________________________ 1 244.9 HYPOTHYROIDISM NOS 2 272.4 HYPERLIPIDEMIA NEC/NOS 3 401.9 HYPERTENSION NOS 4 593.9 RENAL URETERAL DIS NOS Enter Diagnosis :1 244.9 HYPOTHYROIDISM NOS Select one of the following: O ORDERING R RESULTING OR BOTH O&R Is this Diagnosis Ordering or Resulting:: // Rated Disabilities:Rated Disabilities: 5054 HIP PROSTHESIS (100%-SC) 6100 IMPAIRED HEARING (0%-SC) 8520 PARALYSIS OF SCIATIC NERVE (20%-SC) Was treatment for SC Condition? NO// Enter NEXT Diagnosis : 2 272.4 HYPERLIPIDEMIA NEC/NOS Margie: EX 3: Patient has RD 5099 � BONE CONDITION and it is not mapped to any DX codes. Therefore, 309.29 SC status is set to YES. 003.24 SC status is set to YES. 780.6 SC status is set to YES. Margie: EX 3: Patient has RD 5099 � BONE CONDITION and it is not mapped to any DX codes. Therefore, 309.29 SC status is set to YES. 003.24 SC status is set to YES. 780.6 SC status is set to YES.

19. 19 Case 3 Encounter 0000001x is marked as service connected and may not be. Date of Encounter: 04/22/2008@09:00 Location: CLINIC C Primary Provider: CPRS PROVIDER C Patient: CPRS PATIENT C (XXXX) Patient is not copay eligible. Patient is insured. Outpatient Coverage is covered. ASCD Evaluation: NSC POVs/ICDs: *P* 389.9 HEARING LOSS NOS 272.4 HYPERLIPIDEMIA NEC/NOS 401.9 HYPERTENSION NOS 274.3 GOUT Rated Disabilities: 5054 HIP PROSTHESIS (100%-SC) 6100 IMPAIRED HEARING (0%-SC) 8520 PARALYSIS OF SCIATIC NERVE (20%-SC) DO YOU WANT TO CHANGE THE SERVICE CONNECTION FOR THIS ENCOUNTER? YES

20. 20 Case 3 - continued PAT/APPT/CLINIC: CPRS PATIENT C APR 22, 2008@10:00 CPRS CLINIC C ICD CODE: ...There is 4 ICD CODES associated with this encounter. ____________________________________________________________________________________________________________ - - E N C O U N T E R D I A G N O S I S (ICD9 CODES) - - No. ICD DESCRIPTION PROBLEM LISTNo. ICD DESCRIPTION PROBLEM LIST _____________________________________________________________________________________________________________ 1 401.9 HYPERTENSION NOS 2 272.4 HYPERLIPIDEMIA NEC/NOS 3 274.9 GOUT NOS 4 389.9 HEARING LOSS NOS Enter Diagnosis : @4 (Screen will refresh to remove #4 and continues with questions) Enter Diagnosis 1 Select one of the following: O ORDERING R RESULTING OR BOTH O&R Is this Diagnosis Ordering or Resulting:: // Rated Disabilities: Rated Disabilities: 5054 HIP PROSTHESIS (100%-SC) 6100 IMPAIRED HEARING (0%-SC) 8520 PARALYSIS OF SCIATIC NERVE (20%-SC) Was treatment for SC Condition? NO//

21. 21 Case 4 Encounter 666654333 is marked as service connected and may not be. Date of Encounter: 04/22/2008@011:00 Location: AUDIOLOGY CLINIC Primary Provider: CPRS PROVIDER D Patient: CPRS PATIENT D (XXXX) Patient is not copay eligible. Patient is insured. Outpatient Coverage is covered. ASCD Evaluation: NSC POVs/ICDs: *P*389.9 HEARING LOSS NOS Rated Disabilities: 5054 HIP PROSTHESIS (100%-SC) 6100 IMPAIRED HEARING (0%-SC) 8520 PARALYSIS OF SCIATIC NERVE (20%-SC) DO YOU WANT TO CHANGE THE SERVICE CONNECTION FOR THIS ENCOUNTER? NO

22. 22 Case 5 Encounter 000822345 is marked as service connected and may not be. Date of Encounter: 04/22/2008@011:00 Location: CLINIC E Primary Provider: CPRS PROVIDER E Patient: CPRS PATIENT E (XXXX) Patient is not copay eligible. Patient is insured. Outpatient Coverage is covered. ASCD Evaluation: NSC POVs/ICDs: *P* 244.9 HYPOTHYROIDISM NOS 401.9 HYPERTENSION NOS Rated Disabilities: 6100 IMPAIRED HEARING (0%-SC) WARNING: This encounter came from another package. If it is changed it will not agree with what is in the originating package. Do you want to continue with this encounter? YES// DO YOU WANT TO CHANGE THE SERVICE CONNECTION FOR THIS ENCOUNTER? YES

23. 23 Bedford�s Process Coder completes the initial review by comparing the information in the encounter thru ASCD with the documentation in CPRS If the coder feels confident whether the visit is SC or NSC based on the progress note, the coder will either Retain the original decision or Modify the encounter at that point MaryMary

24. 24 Bedford�s process cont�d. If the coder cannot make the determination based on the documentation, the encounter will be set to Review for a UR nurse�s opinion The UR nurse may consult with the original provider to discuss prior to completing the review Once the encounter has been reviewed it will be Completed. At this point CPRS, PCE, and the Scheduling Packages are updated along with Claims Tracking.

25. 25 The St. Cloud Process Similar to Bedford and Tampa Coder does review UR Nurse provides assistance if needed Supervisor can change encounter if needed

26. 26 Other options Review your site process flow and staffing Coordinate with MCCF and UR Determine who will be assigned ASCD options and keys Coordinate with IT for implementation of software Set date to start based on current Code Me/Bill Me process and encounter checkout dates Monitor reports and make adjustments and do additional training as appropriate

27. 27 ASCD Reports Clinic Service Total Summary Report Compile Results Report Estimated Recovered Costs Report First Party Billable Service Connected Report Manager Summary Report Provider Service Connected Encounters Report Provider Total Summary Report Service Connected Encounters Report Third Party Billable Service Connected Report Unbilled/Billable Amount Report User Service Connected Encounters Report User Total Summary Report MaryMary

28. 28 Compile Results Report (Summary or Detailed Report) Results of the software compile for any date range. This is not the results of the encounter review. Detailed report includes list of encounters reviewed by ASCD or marked for manual review due to diagnosis code Detailed list is useful for audit of encounters and the selection of the appropriate SC diagnosis in checkout compared to documentation

29. 29 Compile Result Report Example Compile Results Report - Summary PAGE: 1 For Encounters Dated 6/1/07 THRU 6/8/07 # Enc Reason ------------------------------------------------------------------------------- 2 A diagnosis fully matched a rated disability condition 1 A diagnosis partially matched a rated disability condition 21 Eligibility is not service connected 1 No Diagnoses identified as service connected 4 Non-billable because patient is not insured ------------------------------------------------------------------------------- 29 TOTAL Encounters * Third Party=TP; Means Test=MT <End of Report>

30. 30 Manager Summary Report Report can be run by division for date range Indicates the overall review status for any date range, including: Number of encounters to be processed Number of encounters sent to clinical review Number of encounters changed or not changed during review process

31. 31 Managers Summary Report Example Managers Summary Data Report PAGE: 1 For Encounters Dated 1/1/08 THRU 1/31/08 For Division: ALL ------------------------------------------------------------------------------- ASCD Encounters that are potentially billable: 3132 ------- Encounters verified with Rated Disability Codes: 330 Encounters where SC NOT changed: 277 Encounters where SC was changed to NSC: 275 Encounters where NSC was changed to SC: 32 Encounters sent to Clinical Review: 0 Encounters not editable: 0 Encounters not yet processed: 2218 <End of Report>

32. 32 User Total Summary Report Report can be run by division for date range Useful productivity tool for review staff Indicates the overall review status by reviewer including: Number of encounters changed Number of encounters sent to clinical reviewer Number of encounters not changed

33. 33 User Total Summary Report Example User Summary Data Report PAGE: 1 For Encounters Dated 6/1/07 THRU 6/8/07 By Division: ALL REVIEW SC to NSC NSC to SC SC KEPT ---------------------------------------------------------------------------------------------- GARDING,MARY L. 0 1 0 8 MILLER, ELENA 0 2 2 10 PORTER, KARLA 1 1 1 9 ------- ------- ------- ------- TOTAL 1 4 3 27 <End of Report>

34. 34 User Service Connected Encounters Report Report can be run by division for a date range Report is sorted by user who last edited the SC connection information, includes: Encounter date and number Compile determination and user determination Status of review and date edited Total of encounters by user Detailed list useful in a validation audit of reviewed encounters, includes encounter diagnosis codes and rated disability codes

35. 35 User Service Connected Encounters Report Summary Example PAGE: 1 FOR ENCOUNTERS DATED 6/1/07 THRU 6/8/07 By Division: ALL ENCOUNTER DATE ENC # VBA SC USER SC STATUS DATE LAST EDITED GARDING,MARY L. 06/01/2007@09:30 7632586 YES YES COMPLETED JUN 28, 2007 06/01/2007@11:30 7632589 YES YES COMPLETED JUN 26, 2007 06/04/2007@10:30 7632595 NO NO COMPLETED JUN 26, 2007 06/05/2007@08:00 7632601 NO NO COMPLETED JUN 28, 2007 06/05/2007@08:20 7632602 NO YES COMPLETED JUN 28, 2007 06/05/2007@09:30 7632605 YES YES COMPLETED JUN 28, 2007 06/06/2007@13:30 7632618 YES YES COMPLETED JUN 28, 2007 Total: 7

36. 36 Service Connected Encounters Report Report can be run by division for a date range Report is detailed listing of encounters reviewed by ASCD or marked for manual review due to diagnosis code including: Veteran name and last 4 SSN Encounter number SC value (YES or NO) Diagnosis and codes for encounter Rated disabilities and codes for rating Report can be run to just include the Service Connected, Non-Service Connected or All encounters from ASCD compile List is useful in validation audit of NSC encounters compared to documentation to ensure clinical staff note all treated diagnoses in checkout process, especially the SC conditions

37. 37 Provider Service Connected Reports Provider Service Connected Encounters Report Very similar to Service Connected Encounters Report except listed by provider Report is useful in on-going review and education with selected providers Provider Total Summary Report Indicates the overall status of compile and review listed by provider Clinic Service Total Summary Report Indicates the overall status of compile and review listed by clinic with totals by Service

38. 38 Clinic Service Total Summary Report Service Summary Data Report PAGE: 1 For Encounters Dated 6/1/07 THRU 6/4/07 For Service: ALL VBA OK REVIEW SC to NSC NSC to SC SC KEPT NEW ------------------------------------------------------------------------------------------------------------------- MEDICINE CLINIC A 4 0 0 1 3 1 CLINIC B 6 0 0 0 2 0 CLINIC C 8 0 1 0 2 5 CLINIC D 6 0 0 0 2 0 --------- --------- --------- --------- -------- ------- Subtotal MEDICINE 24 0 1 1 9 6 --------- --------- --------- --------- --------- ------- TOTAL 24 0 1 1 9 6 <End of Report>

39. 39 Unbilled/Billable Amount Report Report can be run by division for a date range Report includes reviewed encounters that were changed from SC to NSC or NSC to SC which already were billed Useful to run periodically and communicate information to Revenue Unit

40. 40 Unbilled/Billable Amount Report Example ASCD Billable (NSC to SC) Amounts Report by Division ALL Run Date: Jun 26, 2008@16:31:08 Page 1 *** Report reflects ONLY reviewed encounters *** Name SSN Enc Date/Time Encounter No. Clinic Prim Prov Date Edited Instit $ Profess $ Bill Nos. -------------------------------------------------------------------------------- CPRS PATIENT B xxx-xx-xxxx 01/01/1901@09:00 66633333 CLINIC A CPRS PROVIDER A 01/23/2008 157.85 132.42 CPRS PATIENT B xxx-xx-xxxx 01/10/1901@14:30 0004444 CLINIC B CPRS PROVIDER B 01/18/2008 123.16 85.43 -------------------------------------------------------------------------------- TOTAL: 281.01 217.85 <End of Report>

41. 41 Billable Services Reports � Estimated Costs Estimated Recovered Costs Report First Party Billable Service Connected Report Third Party Billable Service Connected Report

42. 42 Estimated Recovered Costs Report Example Recovered Costs Report by Division: ALL Run Date: Jun 28, 2008@17:40:36 Page 1 Enc # Patient Enc Date Change Date AuthDate Pay Date Prncpl Bill Prncpl Pay --------------------------------------------------------------------------------------------------------------------------------------------------------- 0000001 CPRS PATIENT A (XXXX) 01/08/2008 01/11/2008 12/26/2007 01/16/2008 15.00 45.00 0000001 CPRS PATIENT B (XXXX) 01/10/2008 01/15/2008 03/17/2008 15.00 0.00 TOTAL FIRST PARTY: 30.00 45.00 --------------------------------------------------------------------------------------------------------------------------------------------------------- 0000001 CPRS PATIENT A (XXXX) 01/08/2008 01/11/2008 12/26/2007 01/16/2008 101.72 0.00 0000001 CPRS PATIENT B (XXXX) 01/10/2008 01/15/2008 03/17/2008 75.11 75.11 TOTAL THIRD PARTY: 176.83 75.11 --------------------------------------------------------------------------------------------------------------------------------------------------------- TOTAL FOR BOTH: 206.83 120.11 <End of Report>

43. 43 Benefits Service connected encounters should be reviewed as may be potential billable ASCD has advantage to have one area or person reviewing the SC determinations and making changes. Also provides for an automated secondary review (Supervisor, UR or MD) If review is done in ASCD then SC encounters do not need to be reviewed in CCM. Those encounters can just be purged from code me list. ASCD can streamline the Code Me process since those encounters are already reviewed and not need to review by coding staff or contract coding staff MaryMary

44. 44 Benefits (cont) The number of SC errors has reduced significantly since working and implementing the ASCD software Over $7 million has been recovered since January 2006 Reduction in the action required encounters SC/NSC training is conducted for new providers and incorporated into all provider training ElenaElena

45. 45 Other User Sites Dayton East Orange Fargo Ft. Harrison Black Hills Grand Junction Hines Houston Indianapolis

46. 46 Other User Sites (cont) Lebanon Madison Marion, IN NY Harbor N. Chicago Salem Walla Walla White River Junction

47. 47 ASCD User�s Manual The User�s Manual for ASCD can be found at: http://www.va.gov/vdl/documents/Clinical/Automated_Service_Connected_Designation/sd_53_p495_um.doc

48. 48 Questions