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Winpms™, PPS and your agency
Winpms's PPS features were designed based on various documents
available from HCFA and the Federal Register as well as from feedback and
input from our PPS project team which is made up of CHS staff and staff
members from some of our clients.
With Winpms vesion 7.0, support for PPS is completely integrated
starting with patient intake all the way through patient discharge and
payment processing. Detailed data analysis for clinical and financial data
is also available at various stages in the patient's care as well as
post-discharge.
- During
the intake and referral process you can define the appropriate MSA
code for the patient as well as the discipline, frequency and duration
of visits, including therapy visits that will be required for proper
calculation of the HHRG.
- If
sufficient data has been collected, Winpms will calculate an estimated
reimbursement and cost of care prior to patient admission and notify
you if it comes within a user-define threshold.
- When
you admit the patient, if you haven't already collected the MSA and
therapy data, you will be asked to provide it.
- Using
our Complete Assessment with OASIS (UFO units of Field Operation and
desktop UFO) you can capture all of the required OASIS data. The built
in support for skip patterns and other data entry logic helps make
sure OASIS data is captured accurately. In addition our UFO is
designed to help you comply with HCFA's Conditions of Participation
requirements (COP's), state and federal regulations and JCAHO
standards. If your agency is JCAHO accredited, you can use the
Complete Assessment with Oasis to meet qualifying performance
indicators.
You can also utilize the Haven
4.0 system which is completely integrated into standard pms5 using
our advanced pms5 Haven Bridge that contains extensive reports and pricer
data.
- Once
the initial visit is completed and the start of care assessment data
is collected, Winpms will use this data along with appropriate therapy
visit data to automatically calculate the proper HIPPS code for the
HHRG and OASIS ID using Winpms's built in grouper.
- Once
the initial HHRG is calculated, Winpms will estimate the cost of the
visits on the plan of care and notify you if the estimated cost will
exceed the estimated reimbursement or comes within a user-defined
threshold.
- If
the patient is admitted this information will be used to automatically
generate an initial bill ("RAP") to trigger your initial
payment of the estimated case mix adjusted episode payment based on
that HHRG.
- The
second bill will be for the remaining episode payment or it will be a
bill with appropriate adjustments if there is an intervening event
requiring an adjustment. The second bill will also contain the
appropriate visit and supply data.
- As
you provide care, Winpms will automatically trigger events as
necessary to appropriately handle your billing.
- When
the patient is discharged, Winpms will determine if a Low
Utilization Payment Adjustment (LUPA) needs to be performed. If so,
Winpms will bill by the visit and prepare a second bill with the
appropriate adjustments.
- At
the end of an episode Winpms will determine if you did not meet the
minimum number of therapy visits/hours if the original HHRG
accounted for them. If necessary it will recalculate the HHRG and
produce the appropriate adjustments to the second bill.
- If
you exceed the cost for the billed HHRG, the system will
automatically calculate the necessary adjustment and bill for them
as an Outlier.
- If
there is a discharge and readmit or transfer to a non-owned agency
then Winpms will trigger a Partial Episode Payment (PEP) by
calculating the partial payment and producing a bill.
- If
there is a Significant Change in Condition and a new assessment is
performed and there are new physician's orders, Winpms will use this
data to produce an adjustment that will reflect the prorated portion
of the original HHRG plus the prorated portion of the new HHRG.
- If
you fall below the therapy threshold, Winpms will recalculate the
HHRG and calculate the necessary adjustments on the second bill.
- When
you discharge a patient, Winpms verifies the last billable visit day
for proper determination of the discharge date for PPS.
Then once the standard billing steps are followed the final
bill can be sent using the ECS version 6 with increased line
items.
- Winpms
stores information such as the fixed dollar loss amount and loss share
ratio, base rate, labor and non-labor portions, visit rate, therapy
threshold and LUPA threshold in its database with starting and ending
dates so it can be updated annually.
- PPS
related data such as MSA code wage index and HHRG case mix data can be
updated as necessary from our web site. In order to make collecting
the point of care data necessary for PPS, Winpms offers you a wide
range of collection options including paper forms, UFO units, laptops
or scanning or internet link up from the field to the office.
- Our
Electronic Remittance Advice application will handle both per visit
and per episode payments.
- For
manually keyed payments, you may enter them per visit or per episode.
The semi-automatic payment method will also help speed entry of
payment information under PPS.
- Statistics
reports include:
- Days
left in episode
- LUPA
threshold
- Therapy
Visit threshold
- Percentage
report showing percentage of full episodes, PEP, LUPA, SCIC,
Outlier, and therapy threshold
- Reimbursement
vs. Cost
- Our
upcoming Decision Assistant Clinical Edition will make detailed
analysis of data over any time span fast and easy with our graphical
drag and drop interface. Pick the level of summary or detail that you
want and sort and group in a variety of ways.
- Our
online application service, iWinpms, also supports all of these
advanced PPS features.
-
Our UFO
point-of-care field solution, also supports all of these advanced
PPS features.
For more information
Winpms Prospective Payment System features are an integrated part of
the Winpms family of products. For more information on any member of the
Winpms family of applications call us at 305-971-5529, email us at imm@pms5.com
or to access information on the World Wide Web, go to http://www.pms5.com
The final bill:
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