📋
Extracted from Consolidated Report
This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.
⚠️ Translation Notice: This content has been automatically translated. The original English text is the official version. Translation may contain errors.
⚠️ Este contenido ha sido traducido automáticamente. El texto original en inglés es la versión oficial. La traducción puede contener errores.
Findings 3 findings
F1
Page 99
The Department of Health Services responded to all 16 questions put to it by the committee. Its responding document is reproduced in full as Attachment A to this report. The questions are listed and DHS’s responses are summarized on the following table.
F2
Page 99
The table lists the committee’s questions on the left and categorizes the DHS responses as either implemented, in progress, no progress, or decline to implement. Of the 16 2 Online Real-Time Centralized Health Information Database. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT
F3
Page 100
With 15 out of 16 recommendations either completed or underway, clearly a good faith effort is being made by DHS. The department is to be complimented on its rapid progress. LOS ANGELES COUNTY 2014–2015 CIVIL GRAND JURY FINAL REPORT Summary of Responses to Civil Grand Jury questions by the Department of Health Services In No Questions to DHS Implemented Progress Progress Decline Comments 2.1 Have both the new ORCHID system and the current system incorporated codes on all accounts for classifying and explaining reasons for denial? X 2.2 Has DHS updated the procedure to include new Reason for denial codes? X 2.3 Has the availability of Patient Financial Services worker staff been increased at all hospitals? X 2.4 What method, if any, has DHS Replaced with implemented to replace the new process discontinued method of (see Attachment identifying write-offs for denied or A) late claims that are billed by the DHS Consolidated Business Office? X 2.5 Has DHS determined the staffing required to review Medi- Cal fee-for-service accounts for patients still in DHS hospitals? X 2.6 Has DHS conducted a staffing analysis to determine if additional staffing will reduce backlogs and reduce billing time? X 2.7 What is the projected date by Target date is which DHS expects to fully July 1, 2015 implement the original
Recommendations 1
-
R2Page 1065 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