LOS Angeles County

Recommendations 6

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  Who: Your Name: _______________________________________________________________________ Address: ________________________________________________________________________ City, State, Zip, Code: _______________________________________________________________ Telephone: ( ) Extension: ______________
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  5 below; as a result, the Utilization Review Units in the hospitals have been able to timely review accounts to enable timely billing. Also, DHS has developed an inventory status report to identify and prioritize accounts that need a TAR in order to be billed for stronger control. DHS does not bill any accounts that do not have a TAR. RECOMMENDATION No. 2.5 Formalize the point at which Medi-Cal fee-for-service accounts are retrospectively reviewed for patients still in the Department hospitals. 7/18/14 RESPONSE DHS agrees with this recommendation. An assessment will be conducted to determine the staffing needs to perform the concurrent reviews recommended. If necessary, DHS will submit a budget request for additional staffing needed to fully implement this recommendation. Completion of the assessment is anticipated by December 31, 2014. CGJ QUESTION 2.5 Has DHS determined the staffing required to review Medi-Cal fee-for-service accounts for patients still in DHS hospitals? 89 LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT 1/30/15 RESPONSE Implemented - Currently Medi-Cal Fee-for-Service patients are reviewed on a daily basis when receiving acute care. DHS utilizes a State approved evidence based proprietary software program (InterQual) for determination of medical necessity. A second level review of the account is completed by a physician to evaluate the medical necessity if InterQual criteria are not met. DHS Utilization Review (UR) Committee has implemented an action plan; where UR nurses are reassigned from other County hospitals should a backlog develop at a DHS facility, to assist in the reviews using approved overtime. Also, additional Physician Advisors are recruited to complete second level reviews. Based on this strategy and assessment, DHS has been able to mitigate the effect of staff shortage at its facilities. RECOMMENDATION No. 2.6 Conduct a Utilization Review staffing analysis at county hospitals as an increase in staff may substantially increase Department cash flow by decreasing backlogs and increasing the timeliness of billings. 7/18/14 RESPONSE DHS agrees with this recommendation. DHS will conduct a staffing analysis to determine if additional staffing will decrease backlogs and increase billing timeliness. If necessary, DHS will submit a budget request for additional staffing needed to fully implement this recommendation. Completion of the evaluation is anticipated by December 31, 2014. CGJ QUESTION 2.6 Has DHS conducted a staffing analysis to determine if additional staffing will reduce backlogs and reduce billing time? 1/30/15 RESPONSE Implemented - In the spring of 2014, DHS performed a comprehensive assessment of staffing needs within inpatient Utilization Review departments with the goal of ensuring sufficient staff are available to complete all inpatient UR related duties which would decrease backlogs and increase billing timeliness. DHS calculated the additional staff needed for each hospital to achieve full staffing levels. These items were included in DHS’ 2014-15 supplemental budget request, approved by the Board of Supervisors on September 30, 2014. Approximately half of the newly added items have been filled to date, with interviews ongoing. RECOMMENDATION No. 2.7 Utilize available systems and tools, and require DHS physicians to report their National Provider Identifier (NPI) number and complete the 855R form linking the NPI number to DHS, as required for Medicare billing purposes, prior to commencing work at a DHS facility. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT 7/18/14 RESPONSE DHS agrees with this recommendation. DHS will assess available systems, tools, and processes to determine how best to implement this recommendation. Completion of the assessment is anticipated by December 31, 2014. CGJ QUESTION 2.7 Does DHS require physicians to report their National Provider Identifier (NPI) number and enter it into the system prior to commencing work at a DHS site? 1/30/15 RESPONSE Partially Implemented - DHS is evaluating the licensed practitioner credentialing process and the utilization of the new Cactus credentialing software to enable improved accountability and control. In the interim, Medical Administration and Finance are working together to initiate enrollment applications for practitioners who provide care to Medicare members. CGJ Question 2.7 as of 02/19/2015 What is the projected date by which DHS expects to fully implement the original recommendation to require DHS physicians to report their NPI number and complete the 855R form linking the NPI number to DHS prior to commencing work at a DHS facility? 3/20/2015 Response The target date is July 1, 2015. On this date, the credentialing process will include initiation of NPIs and enrollment of physicians into the Medicare program for the facilities where it is a requirement (Comprehensive Health Centers and Health Centers). RECOMMENDATION No. 2.8 Monitor the processing of Medicare claims to ensure that the implementation of ORCHID, the Department's new electronic health record system is aiding and providing Medicare itemized claims. 7/18/14 RESPONSE DHS agrees with this recommendation. DHS will monitor the processing of Medicare claims and ensure itemized billing is accommodated within the Online Real-Time Centralized Health Information Database (ORCHID), Affinity Patient Accounting, Billing Clearinghouse, etc., as each DHS facility implements ORCHID. ORCHID implementation and associated interfaces for billing is anticipated to be completed prior to December 31, 2014. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT
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  When: Date(s) of incident: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 165 LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT
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  Where: Names and addresses of other departments, agencies or officials involved in this complaint. Include dates and types of contact, i.e. phone, letter, personal. Use additional sheets if necessary. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________
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  Why/How: Attach pertinent documents and correspondence with dates. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 166 LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT Complaint Guidelines Communications from the public can provide valuable information to the Civil Grand Jury. Any private citizen, government employee, or officer may submit a completed complaint form to request that the Civil Grand Jury conduct an investigation. This complaint must be in writing and is treated as confidential. Prior to submitting the Complaint Form to the Grand Jury office, please retain a copy for your records if needed. Receipt of all complaints will be acknowledged. If the Civil Grand Jury determines that a matter is within the legally permissible scope of its investigative powers and would warrant further inquiry, additional information may be requested. If a matter does not fall within the Civil Grand Jury's investigative authority, or the jury determines not to investigate a complaint, no action will be taken and there will be no further contact from the Civil Grand Jury. The findings of any investigation conducted by the Civil Grand Jury can be communicated only in a formal final report published at the conclusion of the Grand Jury's term, June 30th. Some complaints are not suitable for civil grand jury action. For example, the Civil Grand Jury has no jurisdiction over judicial performance, actions of the court, or cases that are pending in the courts. Grievances of this nature must be resolved through the established judicial appeal system. The Civil Grand Jury has no jurisdiction or authority to investigate federal or state agencies. Only causes of action occurring within the County of Los Angeles are eligible for review. The jurisdiction of the Civil Grand Jury includes the following: • Consideration of evidence of misconduct against public officials within Los Angeles County. • Inquiry into the condition and management of the jails within the county. • Investigation and report on the operations, accounts, and records of the officers, departments or functions of the county including those operations, accounts, and records of any special legislative district or other district in the county created pursuant to state law for which the officers of the county are serving in their ex officio capacity as officers of the districts. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT • Investigation of the books and records of any incorporated city or joint powers agency located in the county. Mail complaint form to: Los Angeles County Civil Grand Jury Clara Shortridge Foltz Criminal Justice Center 210 W. Temple Street, 11th Floor, Room 11-506 Los Angeles, CA 90012 168 LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT CONTINUITY COMMITTEE Ken Star, chair Jim Contreras, vice chair Simeon Zano, secretary Shari E. Pearce John A. Rangel Wesley C. Thompson Margaret M. Yasuda CONTINUITY COMMITTEE The Continuity Committee serves a statutory function of the Los Angeles County Civil Grand Jury: to archive and organize responses to the previous year’s Final Report. The Los Angeles County 2014–2015 Civil Grand Jury (CGJ) also ensured continued retention of CGJ materials and changed the method of indexing that information. California Penal Code Section 933(c) mandates responses, , to the previous year’s reports by the public agencies to whom recommendations were made by the Final Report. The CGJ followed up to ensure reasonably timely compliance by the agencies addressed in the 2013–2014 Final Report. Penal Code Section 933.05 requires that agency responses be specific to each individual finding and recommendation. The committee reviewed the responses and found they substantially complied with the legal requirements. Please take note that the responses filed by the agencies are much more extensive than indicated in the following pages and were placed with the custodians set forth in Penal Code Section 933(c) and also on the CGJ website at http://grandjury.co.la.ca.us/gjreports.html. ARCHIVAL/ORGANIZATIONAL ROLE The committee has continued the actions of its predecessors in maintaining copies of previous reports and responses, both hard copy and electronic. Past Continuity committees have also prepared tables of reports and recommendations for the following year’s jury to use as a
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  1 Los Angeles Department of Water and Power’s research and development lab at the La Kretz Innovation Campus should work with the UCLA La Kretz Center for California Conservation Science to request academic research into groundwater remediation in the San Fernando Basin to help speed the cleanup of the San Fernando Basin Aquifer. As described in the committee’s interview report with LADWP’s Chief Sustainability and Economic Development Officer. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT