HFS Update for HFMA MN November 7, 2019 Luke DiSabato & Becky - - PowerPoint PPT Presentation

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HFS Update for HFMA MN November 7, 2019 Luke DiSabato & Becky - - PowerPoint PPT Presentation

HFS Update for HFMA MN November 7, 2019 Luke DiSabato & Becky Dolin About HFS Small Company in Elk Grove, CA. 35 years experience making MCR software. HFS makes Medicare Cost Reporting software for Hospitals, Skilled Nursing


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HFS Update for HFMA MN November 7, 2019

Luke DiSabato & Becky Dolin

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About HFS

  • Small Company in Elk Grove, CA.
  • 35 years experience making MCR software.
  • HFS makes Medicare Cost Reporting software for

Hospitals, Skilled Nursing Facilities, Home Health Agencies, CMHC, RHC, FQHC, ESRD, Hospice, Home Office and OPO.

  • SaFE Website, HCRIS Website and IRIS Database

software

  • Specialized Reporting for – CA, MA and VA

11/6/2019 2

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Overview

Agenda

  • MCR Update
  • PS&R Changes
  • IRIS Changes
  • HFS News and Improvements
  • New System Development
  • Feature Updates
  • Training & Support
  • Questions

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Transmittal Updates

11/6/2019 4

Form Type Latest Transmittal CMS Issued HFS Approved HFS Released Effective Date

2552-10 Hospital 15

3/16/2018 4/6/2018 4/13/2018 Ending O/A 9/30/2018

2540-10 SNF 8

3/9/2018 3/29/2018 4/6/2018 Ending O/A 12/31/2017

216-94 OPO 7

10/6/2017 3/29/2018 4/16/2018 Ending O/A 12/31/2017

1728-94 HHA 18

3/16/2018 4/6/2018 4/13/2018 Ending O/A 12/31/2017

265-11 ESRD 5

3/8/2019 4/3/2019 4/12/2019 Ending O/A 1/31/2019

224-14 FQHC 3

5/3/2019 5/31/2019 5/31/2019 Ending O/A 4/30/2019

1984-14 Hospice 3

4/13/2018 4/20/2018 4/26/2018 Ending O/A 12/31/2017

222-17 RHC 1

5/18/2018 9/7/2018 10/26/2018 Ending on or after 9/30/2018

2088-17 CMHC 1

5/18/2018 8/24/2018 10/26/2018 Ending on or after 9/30/2018

No Recent Changes 287-05 HO

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Transmittal Updates

  • Please see our website for additional transmittal information

11/6/2019 5

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2552-10 T-15

  • 2552-10 T-15
  • Published October 19, 2018
  • Effective for cost reporting periods ending on or after 9/30/2018
  • Worksheet S-2 added 2 provider types
  • 10 = Extended Neoplastic Disease Care (previous subclause (II) LTCHs)
  • 11 = Indian Health Services
  • Implement FY 2019 LVA changes
  • 42 CFR 412.101(c)(3) provides for a temporary change in the low-volume

adjustment for qualifying hospitals for FFYs 2019 through 2022 as follows:

  • Those hospitals with 500 or fewer total discharges will receive an adjustment of an

additional 25 percent for each Medicare discharge; and,

  • Those with more than 500 and fewer than 3,800 total discharges will receive an

adjustment of an additional percentage for each Medicare discharge. This adjustment is calculated using the formula [(95/330) - (total discharges/13,200)].

  • To qualify as a low-volume hospital, the hospital must meet both of the

following criteria:

  • Be more than 15 road miles from the nearest subsection (d) hospital; and,
  • Have fewer than 3,800 total discharges based on the hospital’s most recently

submitted cost report.

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Adjustment for Low Volume Hospitals

  • Section 50204 of the Bipartisan Budget Act of

2018 Modified LVA

  • CR10869 issued 10-4-18 states the following:

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Adjustment for Low Volume Hospitals

  • No Table of LVA Factors for FFY 2019
  • MACs will compute factor based “using the hospital’s total

discharges in its most recently submitted cost report as of the time of the MAC’s low-volume hospital status determination”.

  • Then factor input on Exhibit 4:

11/6/2019 8

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2552-10 T-15

  • 2552-10 T-15 (Continued)
  • Wage Index Changes
  • Worksheet S-3, Part II, line 18 “Other Wage Related Costs”
  • Not completed for cost reporting periods beginning on or after

9/30/2018.

  • Same With S-3, Part IV, line 25
  • Worksheet E, Part A
  • Outliers to be split by FFY for CR periods beginning on/after

10/1/2018

  • I Series
  • Treatments reported for Acute Kidney Injury

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2552-10 T-15

  • 2552-10 T-15 (Continued)
  • New Edits
  • 13255S The amount on Worksheet S-3, Part II, line 18, column 4, must equal the sum
  • f Worksheet S-3, Part IV, line 25, and subscripts. Effective for cost reporting periods

beginning on or after October 1, 2018, Worksheet S-3, Part II, line 18, column 4; and Worksheet S-3, Part IV, line 25, and subscripts, must equal zero. [09/30/2017]

  • 13260S For cost reporting period beginning on or after October 1, 2015, Worksheet

S-3, Part II, line 14, columns 2, 3, 4, 5, and 6, must equal zero. For cost reporting periods beginning prior to October 1, 2015, Worksheet S-3, Part II, lines 14.01 and 14.02, columns 2, 3, 4, 5, and 6, must equal zero. [09/30/2018]

  • 13267S Worksheet S-3, Part III, line 1, columns 4 and 5, must be greater than zero for

IPPS providers. [09/30/2018]

  • 13270S For cost reporting period beginning on or after October 1, 2015, Worksheet

S-3, Part IV, line 8, must equal zero. For cost reporting periods beginning before October 1, 2015, Worksheet S-3, Part IV, lines 8.01, 8.02, and 8.03, must equal zero. [09/30/2018]

  • 10225E If Worksheet S-2, Part I, line 60, is “N”, then Worksheets E, Part A, line 53; E-

3, Part I, line 1.01; E-3, Part II, line 13; E-3, Part III, line 14; E-3, Part IV, line 4; and E- 3, Part V, line 2; must be zero. [09/30/2018]

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Proposed Form Set 1728-19

  • Notice of Draft published in 4/16/2019 Federal

Register

  • 60-Date comment period ending 6/17/2019
  • Draft available at https://www.cms.gov/Regulations-and-

Guidance/Legislation/PaperworkReductionActof1995/PRA-Listing-Items/CMS-1728- 19.html?DLPage=1&DLEntries=10&DLSort=1&DLSortDir=descending

  • Proposed effective date cost reporting periods beginning
  • n or after January 1, 2019, and ending on or after

December 31, 2019.

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NEW FORM SETS

  • CMS Published 5/18/2018
  • Effective for cost reporting periods ending on or

after 9/30/2018

  • 222-17 Free-Standing RHC
  • Or part of HHA/SNF
  • Hospital-based on 2552-10
  • 2088-17 Free-Standing Community Mental Health

Center (CMHC)

  • BOTH SYSTEMS DEVELOPED/APPROVED/RELEASED

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Amended Cost Report Clarification

  • Amended Cost Report Clarification
  • With the S-10 amended cost reports, we noticed many

users were incorrectly identifying the EC file when it is an amended cost report. When you amend a cost report, you open up W/S S and select the S Part I tab and then on line 5 you change the mcr code to 5- Amended and change line 3 to 1 for 1st amended.

11/6/2019 13

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Amended Cost Report Clarification

  • Amended Cost Report Clarification
  • Then when you do an ECR Export, you keep the EC

Option submission still as 1st, only change this if you have 2 cost reports in the same calendar year (like a 6- 30 and 12-31 due to CHOW). The EC file extension changes, like below to a 17A2.

11/6/2019 14

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Amended Cost Report Clarification

  • Amended Cost Report Clarification
  • As you can see on the prior slide, we made a change to

identify State Medicaid Submissions that users may want to use, in this case it is still an Amended cost report so the 1st XIX is 17E2, 2nd would be 17F2 & we allow for 22nd XIX submission being 17Z2.

11/6/2019 15

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Electronic Filing

  • MCReF
  • The 287-05 (Home Office) form set has not been

updated with the electronic signature language. Providers are able to upload the files to MCReF but the signed Schedule A page must be mailed into the MAC and still meet the original signature criteria that the MAC requires now.

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  • We have received statements from many clients saying
  • ur PS&R Reconciliation is difficult to use when you

have Sub-providers that have different allocation basis than the Hospital. Below is a revision we just released:

PS&R Changes - Hospitals

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  • We have done this for Psych, Rehab, SNF and Swing Bed

SNF units. The Provider is the Hospital and the others will be identified by provider #. When you import the Extract, we will populate the Rev Codes located in the csv file for that particular unit.

PS&R Changes - Hospitals

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  • If you have a rev code that is split to more than 1 cost

center, you want to establish a stat code in the User Define Statistics at left side (see next slide).

  • In the Provider Cross Reference, you zero out the W/S A

line # and enter the stat code. If Pt B % split is different than Pt A, you will set up a 2nd stat code and enter the Pt B in the Override for Pt B Stat Code column.

PS&R Changes - Hospitals

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PS&R Basics - Hospitals

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PS&R Basics - Hospitals

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  • The HFS IRIS program is SQL based that allows for

Check for Updates and Net Sync that we have in the Medicare Cost Report software.

  • We allow for manual entry of data but also import

information that is prepared in excel using a specific template.

HFS IRIS Program

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  • The file has to use a specific format with the headers

that are from the CMS’ M & A structure shown as follows and we have a link on our IRIS page for the csv file https://www.hfssoft.com/doc/Consolidated.csv

IRIS Data Entry

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  • We suggest to open up the PY M.dbf file in Excel, you

need to open Excel first then do a File – Open and change the type of file from Excel Files to All Files:

IRIS Data Entry

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  • Then you would copy the M file data from SSN to

FYEND (see below) to the consolidated csv file opened in excel:

IRIS Data Entry

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  • Please note that the Master’s RESYEAR column is not in

the consolidated file so you will need to delete those records and shift cells left:

IRIS Data Entry

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  • You then need to change the FYB and FYE to the CY.

Then you delete residents that are no longer rotating in the CY. If you have multiple assignments, you insert a line and enter the assignment info and copy the Master info to account for all assignments (ensure the master information is identical – do not change anything):

IRIS Data Entry

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  • You then need to enter any new residents and their
  • assignments. You save the file as a CSV, do not worry

about leading zeroes missing, we account for that. You cannot have any commas in the name fields, this causes a new column in csv, so just remove these or the import will have errors.

IRIS Data Entry

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CMS’ IRIS Changes

  • CMS has been having meetings since April 2015 with all
  • f the IRIS vendors to assist them in creating their own

IRIS system.

  • CMS has tied the IRIS into the PS&R and STAR system to

incorporate a National Database.

  • MACs are now uploading the IRIS files submitted with

the Medicare Cost Reports.

  • CMS issued CR9984 on March 17, 2017 instructing MACs

to load a minimum of 4 years of historical IRIS dbf files to the new STAR IRIS.

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CMS’ IRIS Changes

  • This will enable the IRIS database to accumulate

historical info for each resident to determine the initial residency and number of years the residents have completed.

  • The other major issue is running overlaps,

therefore, it is vital to have discussions between the hospitals if residents rotate to other hospitals.

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CMS’ IRIS Changes

  • CMS is pushing to compare the cost report FTEs to what

they calculate the FTEs from the submitted IRIS files. They are planning to begin holding up the acceptance of cost reports in the near future where they do not trace (at the earliest, we think it could be the 12-31-19 FYEs but unlikely).

  • This was included in the FFY19 IPPS Proposed Rule,

however, based on concerns from many parties, CMS took this out in the Final Rule. Thoughts are that they would include this in the FFY20 Proposed Rule but it was not.

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CMS’ IRIS Changes

  • CMS has finally published the contents with the IRIS revisions in

the Federal Register at the following link and there was a 60- day window for comments: https://www.federalregister.gov/documents/2019/04/08/2019- 06884/agency-information-collection-activities-proposed- collection-comment-request

  • The contents are at the following link for CMS-R-64 dated 4-8-19:

https://www.cms.gov/Regulations-and- Guidance/Legislation/PaperworkReductionActof1995/PRA- Listing-Items/CMS-R- 64.html?DLPage=8&DLEntries=10&DLSort=1&DLSortDir=descendi ng

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CMS’ IRIS Changes

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CMS’ IRIS Changes

  • CMS is moving to get rid of the M & A dbf files

and going to 1 xml file for submission of IRIS with the cost reports.

  • This will get rid of the free DOS based IRIS system

and require providers to submit with the new system – more than likely with an IRIS vendor.

  • We are in the process of making these changes

along with the changes summarized in the following slides.

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CMS’ IRIS Changes

  • CMS is planning on adding the following new

fields to IRIS:

  • Non-IRPS Year One – Simultaneous Match
  • Non-IRPS Year One – Prelim. – Transitional
  • IRF % and IPF % - for time spent at subprovider
  • Non-Provider Site %
  • New Program – True or False
  • Displaced Resident – True or False

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CMS’ IRIS Changes

  • The plan is to then be able to trace FTE amounts from

IRIS files to the cost report for the following fields:

  • E Part A lines 10, 11, 16 (displaced), and 17 (new)
  • S-2 Part I line 66 cols 1 & 2, line 67 cols 3 & 4
  • E-3 Part II (Psych) lines 6 & 7 (new)
  • E-3 Part III (Rehab) lines 7 & 8 (new)
  • E-4 line 6, line 8 & 16 cols 1 & 2, line 10 col 2, and

line 15 cols 1 & 2

  • E-4 lines 10.01, 15.01, and 16.01 (added in T10)

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CMS’ IRIS Changes

  • There are just too many fields for the many

computations to be on 1 Audit Report, we plan the following changes to the Audit Report:

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CMS’ IRIS Changes

  • We also plan the following change to the Audit Report (this is

preliminary, additional lines – New Prog - coming):

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CMS’ IRIS Changes

  • We are planning to add new reports to show

details of the IPF, IRF, New, Displaced and also the Non-Provider Setting.

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CMS’ IRIS Changes

  • TIMELINE?????
  • This is the real unknown.
  • Now that there is a Federal Register notice and

comment period, we believe it is around the corner.

  • We do see that the published contents do not

have the tables showing the Initial Residency Period lengths to be used in calculation of FTEs, the Medical Schools and Residency Codes.

  • We have also asked for the list of Edits to ensure

consistency.

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MCRIF32 Recent Improvements

  • 222-17 & 2088-17 MCRX Released
  • 2088-92 & 287-05 MCRX Released

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MCRIF32 – State Development

  • State of VA
  • Customized Hospital forms (DRG 796)
  • Customized SNF forms (PIRS 1090)

Goals of the project…

  • collect data electronically
  • Make available to other VA state systems
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SaFE April/May 2019 Processing

  • Processed and Stored 9,758 provider submissions.
  • Hospital, SNF, ESRD, RHC, FQHC, HHA, Hospice and

OPO submissions

  • 37 Failed Pre-Acceptance Those files were looked

at and corrected by HFS Support prior to submission so rejection was avoided.

  • 33% of submissions included additional HFS Files
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SaFE Signature Statistics

  • May’s SaFE Volume:

Wet - 44% Self – 7 % CFO – 49%

  • May’s Overall Volume:

Wet - 69% Self – 9 % CFO – 22%

11/6/2019 44

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Common 12/31/2018 Issues

  • Some issues encountered
  • CFO “Blocked” from email
  • Added forward link
  • Some email systems strip zip files
  • Added link to SaFE for download
  • Sent 3 files unzipped
  • Preparer must have SaFE login
  • With valid email
  • Missing PI codes
  • Do not open PI file in Adobe

11/6/2019 45

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PI Encryption Rejections

  • Warning for Users regarding PI Encryptions
  • We see numerous providers being rejected for missing

PI Encryptions. The PI encryption is written outside of the Adobe pdf file and can only be seen by opening the pdf in Notepad or WordPad and scrolling to the bottom:

11/6/2019 46

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Encouraging Login in MCRIF32

HFS is working to integrate our systems. We can do more if we know more about who the user is.

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Net Sync User Regular HFS User

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Encouraging Login in MCRIF32

  • Access to New Report Wizard
  • Automatic Updates Option to Replace Check for

Updates(Coming Soon)

  • HCRIS
  • SaFE – Something to keep in mind for Net Sync Users

11/6/2019 48

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New Report Wizard

  • We have added a New Report Wizard with ability

for you to pull in information from your PY report. The Template feature is still there but we have expanded this for the user, please look through this and we would love to have feedback on possible additional items. Right now we have added this to the 2552-10 and 1728-94 systems.

  • This is under File | New Report Wizard.

11/6/2019 49

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New Report Wizard

11/6/2019 50

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New Report Wizard

With SaFE, you will need to log in.

11/6/2019 51

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New Report Wizard

11/6/2019 52

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New Report Wizard

11/6/2019 53

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New Report Wizard

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FFY 2019 IPPS FINAL RULE

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  • Supporting documents:
  • Teaching hospitals--For teaching hospitals, the Intern and Resident Information

System (IRIS) data.

  • Bad debt--Effective for cost reporting periods beginning on or after October 1, 2018,

for providers claiming Medicare bad debt reimbursement, a detailed bad debt listing that corresponds to the amount of bad debt claimed in the provider’s cost report.

  • DSH eligible hospitals--Effective for cost reporting periods beginning on or after

October 1, 2018, for hospitals claiming a disproportionate share hospital payment adjustment, a detailed listing of the hospital’s Medicaid eligible days that corresponds to the Medicaid eligible days claimed in the hospital’s cost report. If the hospital submits an amended cost report that changes its Medicaid eligible days, the hospital must submit an amended listing or an addendum to the original listing of the hospital’s Medicaid eligible days that corresponds to the Medicaid eligible days claimed in the hospital’s amended cost report.

  • Charity care and uninsured discounts--Effective for cost reporting periods beginning
  • n or after October 1, 2018, for DSH eligible hospitals reporting charity care and/or

uninsured discounts, a detailed listing of charity care and/or uninsured discounts that corresponds to the amounts claimed in the DSH eligible hospital’s cost report.

  • Home Office (Next Slide).
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FFY 2019 IPPS FINAL RULE

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  • Supporting documents:
  • Home office cost allocation.

1. Same fiscal year end. Effective for cost reporting periods beginning on or after October 1, 2018, for providers claiming costs on their cost report that are allocated from a home office

  • r chain organization with the same fiscal year end, a Home

Office Cost Statement completed and submitted by the home

  • ffice or chain organization to its chain provider’s servicing

contractor that corresponds to the amounts allocated from the home office or chain organization to the provider’s cost report. 2. Differing fiscal year end. Effective for cost reporting periods beginning on or after October 1, 2018, for providers claiming costs on their cost report that are allocated from a home office

  • r chain organization with a different fiscal year end, a Home

Office Cost Statement completed and submitted by the home

  • ffice or chain organization to its chain provider’s servicing

contractor that corresponds to some portion of the amounts allocated from the home office or chain organization to the provider’s cost report.

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SaFE

SaFE’s next goals…..

  • Store sensitive data
  • Encourage standard formats to enable

automated checks

  • Live Checking
  • Build Relationships with supplemental

files

  • Batch Submissions

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HITRUST Certification

We decided to pursue a HITRUST certification. The HITRUST Alliance was our choice because:

  • HITRUST is the most widely-adopted security framework in the U.S. healthcare
  • industry. It provides an industry-wide approach for managing Business Associate

compliance.

  • HITRUST is required by some major healthcare organizations.
  • HITRUST is updated regularly. The framework is updated regularly to ensure that

healthcare organizations leveraging the framework are prepared whenever new regulations and security risks are introduced. It is the most frequently updated security framework in use, with quarterly updates and annual audit changes. This means that people who abide by the CSF will actually be actively ensuring that their security is maximized.

  • Organizations are required to be regularly re-assessed and certified.

11/6/2019 58

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HITRUST Certification

HITRUST CSF comprehensive security framework includes:

  • relevant State laws
  • HITRUST CSF inclujdes CMS Acceptable Risk Safeguards and

CMS Minimum Security Requirements (CMSR).

11/6/2019 59

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HITRUST Certification

  • We started the formal assessment process in August 2018.
  • Based on information regarding our client base, our

software products and characteristics of our company, HITRUST assigned almost 200 different security control requirements that HFS needed to demonstrate compliance with.

  • We were certified on March 20, 2019.

11/6/2019 60

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HITRUST Certification

11/6/2019 61

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SLIDE 62

MASS CHIA PROJECT

  • Imports MCRX Files​
  • Instant Calculations​
  • Instant Edits​
  • Exports State of Mass Approved PDF/XML Files​
  • Multi-User Access​
  • Single Sign On​
  • Cross Platform​

What are the Key Features?

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SLIDE 63

MASS CHIA PROJECT

WORKSHEET A

TRIAL BALANCE OF EXPENSES

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Website Development

Single Sign On (SSO) HFSSOFT.com, MassCR, HCRIS & SaFE

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Enhancements since last User Meeting

  • Report Statistics
  • Added more than 87,000 cost reports since last

year.

  • CMS data available including creation of cost report

MCRX/PDF files and snapshot reports for all systems within a week from CMS data published.

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Enhancements since last User Meeting

  • Advanced Search Screen
  • Ability to select a specific CMS published date.
  • icon added to provide help and instructions.
  • NPR filter added (S, I, line 10).
  • NAHE filter added (S-2, I, line 60).

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Enhancements since last User Meeting

  • Advanced Search Screen
  • Ability to extract ALL worksheets

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Enhancements since last User Meeting

  • Preferences | My Settings
  • Added capability to customize CSV headings
  • Added ability to use a “comma.”

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Enhancements since last User Meeting

  • Automatic email notification when pre-selected providers are updated with new data. See

sample screen below:

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Enhancements since last User Meeting

  • My Provider List
  • My Provider list now has a new option to include the Provider name when

extracting.

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Future Enhancements

  • Dashboard (user’s initial screen)

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API - Outline

  • What is the HFS API Excel Spreadsheet
  • Explaining the four tabs and each of their capabilities
  • Results
  • Extract
  • Write
  • Auditor Setup
  • Examples of using the HFS API Excel Spreadsheet
  • Extracting and comparing prior year data to workpaper’s current year data before then writing

data to the cost report

  • Writing data to the cost report and extracting 4 years of data, using Vlookups to compare
  • Applying adjustment
  • Writing over 5,000 lines of data to the cost report

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Training and Support

  • Continued WebEx Training on HFS software

features

  • Transmittal Updates
  • Guest Speakers
  • Certified for Live Internet Training
  • Individual Meetings/Training/Presentations
  • Suggestions

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Training and Support

Save the Date…. HFS Provider User Meeting October 22 – 23, 2020 Disney’s Coronado Springs Resort

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