Inpatient Hospital Outlier Monitoring and Hospital-Specific Reporting

FATHOM/PEPPER

MAC/RA Conference Call/WebEx

Thursday, March 26, 2015

9:00 a.m. PDT/10:00 a.m. MDT/11:00 a.m. CDT/12:00 p.m. EDT

Conference Number: Toll-free: 855-282-6330; Toll: 415-655-0003
Access code: 929 076 456

To join the WebEx, click on this link about 5 minutes prior to the start time:
https://tmfpepper.webex.com/tmfpepper/onstage/g.php?d=929076456&t=a
Event password: spring

I. Welcome/Roll Call

Inpatient Hospital Outlier Monitoring and Hospital-Specific Reporting

Palmetto

Noridian

Wisconsin Physician Services

National Government Services

First Coast Service Options

Cahaba GBA

CGS

Novitas

Performant

CGI

Connolly

HDI

CMS

Inpatient Hospital Outlier Monitoring and Hospital-Specific Reporting

II. Q4FY14 Other Hospital (OH) FATHOM Release

A. Available March 19, 2015

B. Revisions:

1. OH FATHOM Target Area Graphs for all provider types: The “mean + 2 standard deviations from the mean” has been added to all target area graphs.

2. LT reports: The “STACH Admissions following LT Discharge” target area has been revised as follows:

Numerator – the method of determining transfer to ST has been changed from patient discharge status code to subsequent claim within one day of LT discharge; now excludes patient discharge status codes 07 (left against medical advice), 20 (expired) and transfers to LT within one day as evidenced by subsequent claim.

Denominator – now excludes patient discharge status code 07 and transfers to LT or short-term (ST) within one day as evidenced by subsequent claim.

3. CAH reports:

a. The prior 1- and 2- day stay target areas have been discontinued and replaced with these five target areas:

· 2-day stays for Medical DRGs

· 2-day stays for Surgical DRGs

· 1-day stays for Medical DRGs

· 1-day stays for Surgical DRGs

· Same-day stays for Medical DRGs

b. The “Single CC/MCC” target area now only considers those DRGs that are affected by the addition of a CC or MCC.

c. The “30-day Readmission to Same” and “30-day Readmission to Same or Elsewhere” target areas now exclude transfers from the denominator (previously they were only excluded from the numerator).

4. IPF reports: The “30-day Readmission” target area excludes transfers to IPFs from the denominator (formerly they were only excluded from the numerator).

5. IRF reports: The “STACH admissions following IRF discharge” target area has been revised as follows:

Numerator – the method of determining transfer to ST has been changed from patient discharge status code to subsequent claim within one day of IRF discharge; now excludes patient discharge status codes of 07, 20 and transfers to IRF or LT within one day as evidenced by subsequent claim.

Denominator – now excludes patient discharge status code 07 and transfers to IRF, LT or ST within one day as evidenced by subsequent claim.

6. Hospice reports: There are 4 new target areas:

a. Continuous Home Care provided in an Assisted Living Facility

b. Routine Home Care provided in an Assisted Living Facility

c. Routine Home Care provided in a Nursing Facility

d. Routine Home Care provided in a Skilled Nursing Facility

III. Reports for Home Health Agencies

A. Target areas:

TARGET AREA / TARGET AREA DEFINITION
Average Case Mix / N: sum of case mix weight for all episodes paid to the HHA during the report period, excluding LUPAs and PEPs
D: count of episodes paid to the HHA during the report period, excluding LUPAs and PEPs
Average Number of Episodes / N: count of episodes paid to the HHA during the report period
D: count of beneficiaries served by the HHA during the report period
Episodes with 5 or 6 Visits / N: count of episodes with 5 or 6 visits paid to the HHA during the report period
D: count of episodes paid to the HHA during the report period
Non-LUPA Payments / N: count of episodes paid to the HHA that did not have a LUPA payment during the report period
D: count of episodes paid to the HHA during the report period
High Therapy Utilization Episodes / N: count of episodes with 20+ therapy visits paid to the HHA during the report period (first digit of HHRG equal to ‘5’)
D: count of episodes paid to the HHA during the report period
Outlier Payments / N: dollar amount of outlier payments received by the HHA during the report period
D: dollar amount of total payments received by the HHA during the report period

B. FATHOM – distributed in June

C. PEPPER – distributed in July

IV. Secure FATHOM Access

A. Secure “CMS/MAC” page of PEPPERresources.org

B. Use organizational account to log in

C. Encryption passcode sent to organization point of contact

Current MAC Points of Contact:

Dena Johnson - Noridian Healthcare Solutions

Stephanie Coffman - Palmetto GBA

Tracy Wang - Novitas Solutions Inc.

Donna Bogart - First Coast Service Options, Inc.

David Bernard - National Government Services, Inc.

Patti Radke-Connell - WPS

Lois Duran - Cahaba GBA

Thaya Morant - CGS

Current RA Points of Contact:

Rob Rolf - CGI

Alison Rice - Connolly

Mary Woon - HealthDataInsights

Jeri Bennett - Performant/DCS

V. Questions/Discussion