[PDF] - Uniform Data System Calendar Year 2013 Bureau of Primary Health Care PDF Document

SLIDE 1

10/7/2013 1

Uniform Data System Calendar Year 2013

Bureau of Primary Health Care

Agenda

Brief Introduction to UDS
Available Assistance
Definitions used in the UDS report
Step‐by‐Step Instructions for Completing UDS

Tables

2013 Changes; 2014 Proposed Changes

2

SLIDE 2

10/7/2013 2

Questions – Do you know?

How many patients are served by the health center

program?

How many visits?
What % of patients are uninsured? % having Medicaid?
What is the average cost per medical visit?
What is the average charge for a visit?
What percentage of women age 24‐64 get a pap test?
What percentage of adult received colorectal screening
Where can you get this information?
How is this information used?
Why are we here today?

3

Health Center Impact

Source: http://bphc.hrsa.gov/healthcenterdatastatistics/index.html Accessed 8/29/13

4

21.1 Million Total

Patients served (85% are medical patients)

Total Visits include:

medical, dental, MH, SA, Vision, Other Professional, and Enabling services

Employees represent

FTE – those employed are far greater

SLIDE 3

10/7/2013 3

UDS: The Who, What, When, Why, and How

WHO: 330 Grantees, LALs, and NMHCs who

were “funded” prior to October 2013

WHAT: “Scope of Project” for the period

January 1, 2013 ‐ December 31, 2013

WHEN: February 15, 2014 report due;

finalized by March 31 with reviewer

WHY: Program evaluation, public data and

reports to Congress and the Administration

HOW: Through “Electronic Handbook” (EHB)

5

12 Tables Provide a Snapshot

f Patients and Performance
Patients you serve

– Tables 3A, 3B, 4 and Zip

Types and quantities of services you provide

– Tables 5 and 6B

Staffing mix and tenure

– Tables 5 and 5A

The care you deliver / quality of care

– Tables 6A, 6B, 7

Costs of providing services

– Table 8A

Revenue sources

– Tables 9D, 9E

6

SLIDE 4

10/7/2013 4

5

Who Reports Which Tables

Table 1 BPHC 330‐Funded Program and NMHCs: Universal Report More than 1 BPHC 330‐ Funded Program: Universal + Special Pop. Grant Reports Look‐Alike Health Center: Universal Report

Zip Codes

Yes n/a Yes

3A, 3B, 4

Yes Yes No Agricultural Worker or Health Care for the Homeless detail

5

Yes Visits & Patients, only Yes

5A

Yes n/a Yes

6A

Yes Yes n/a

6B

Yes n/a Yes

7

Yes n/a Yes

8A

Yes n/a Yes

9D

Yes n/a No Managed Care or Retroactive details

9E

Yes n/a No 330 or ARRA grants

Available Assistance

Regional trainings
On‐line training modules, manual, fact sheets, webinars, and
ther TA materials available:
www.bphcdata.net
http://bphc.hrsa.gov/healthcenterdatastatistics/ reporting/index.html
PALs
CY 2013: http://bphc.hrsa.gov/policiesregulations/policies/pal201302.html
CY 2014: http://bphc.hrsa.gov/policiesregulations/policies/pal201307.html
Telephone and email helpline: 866‐UDS‐HELP or

udshelp330@bphcdata.net

Technical support to review submission
Primary Care Associations/Primary Care Offices
EHB Support (see handout)
HRSA Call Center: 877‐464‐4772 ●

BPHC Help Desk: 301‐443‐7356

8

SLIDE 5

10/7/2013 5

Strategies for Success Submission

Work as a team
Refer to the manual, fact sheets, and other

resources

Check your data before submitting
Refer to last years reviewer’s letter
Address all edits
Check data trends
Compare data to benchmarks

9

2013 Changes

Zip code table will ADD patients by primary

third party payor or uninsured.

Table 4: CHANGE age breaks for insurance.
Table 6B: Immunizations and Cervical Cancer

measures have been CHANGED.

Look‐alikes: ADD managed care to table 4 and

race/ethnicity to table 7.

10

SLIDE 6

10/7/2013 6

2014 Proposed Changes

Table 4: A line will be added to identify Residents
f Public Housing
Table 6A: ADD “first time ever” HIV diagnosis
Table 6B:
ADD to universe women referred for perinatal care even

when no care was provided

CHANGE tobacco to one measure
DELETE CAD process measure
ADD follow‐up for first time ever HIV diagnosed patients
ADD depression screening
Table 7:
ADD referrals to perinatal outcomes (delivery. birth wt.)
ADD lipid control for CAD patients
Simplify HbA1c reporting for diabetic patients

11 11

THE TABLES:

Key Definitions and Step by Step Instructions

SLIDE 7

10/7/2013 7

Patient Profile Tables

Number and socio‐demographic

characteristics of patients served:

– Zip Code Table: by insurance status – Table 3A: by age and gender – Table 3B: by race/ethnicity /language – Table 4: by income, insurance, special populations

Tables 3A, 3B and 4 are completed for each

additional funding stream.

13

Who Counts: Patient Defined

An individual who has one or more visits

reported on Table 5 during the calendar year is considered a “patient.”

– Medical, dental, behavioral health, vision, other professional and selected enabling services

Whenever “patients” are counted, it is an

unduplicated count. Each patient is counted

nce and only once regardless of the number
r scope of visits.

14

SLIDE 8

10/7/2013 8

Patient Types: What are the Differences?

Patient counts are unduplicated counts of

individuals who have one or more visits during the reporting year.

On Grant Report (only relevant if you receive multiple

330 funding streams) a patient is an individual who receives one or more visits supported by a special population grant.

Patients reported by Service Category are individuals

who receive one or more documented “visits” of each specific service type: medical, dental, vision, mental health, substance abuse, enabling, other professional.

15

ZIP CODE TABLE:

Patients by Zip Code and Insurance

16

SLIDE 9

10/7/2013 9

Patients by Zip Code

Report all zip codes with 11 or more patients

– Combine the rest as “other zip codes”

2013 CHANGE: Patients from each zip code are reported by

their primary medical insurance

– This is the third party MEDICAL insurance that would be billed first if the patient had a medical visit – Must be reported for ALL patients including those patients who are not being seen for medical services – There is no unknown insurance category – Totals must tie to totals patients on Table 3A and insured patients on table 4

17

Patients by Zip Code (continued)

Additional instructions for Special Populations

– Homeless: Use zip code of location where patient receives services if no better data exist. – Agricultural: Use zip code of the temporary housing they

ccupy when patient is in the area.

18

SLIDE 10

10/7/2013 10

TABLES 3A AND 3B:

Patient Demographics

19

Table 3A: Patients by Age & Gender

Report total patients
Age is calculated as of

June 30

Count each patient once

and only once

Total on line 39 is official

total – all other totals must equal this number

20

SLIDE 11

10/7/2013 11

Table 3B: Patients by Hispanic or Latino Ethnicity/Race/Language

Use Column B if patient

does not indicate “Latino” or “Hispanic.”

Use Line 6 only if patient

chooses two or more listed races.

– “More than one” shouldn’t be a choice; don’t use for Latino + a race to be “more than one race”

Use unreported, line 7 if

no race was specified.

Total must equal T3A.

21

Table 3B: Patients by Language

Report all patients who would best be served in a

language other than English including:

– Bilingual persons not fluent in medical English – Persons who are served by a bilingual provider – Persons who receive interpretation services – Persons using sign language – Persons in Puerto Rico or the Pacific where a language

ther than English is used
This is the only UDS cell that may be estimated.

22 22

SLIDE 12

10/7/2013 12

TABLE 4:

Other Demographic Data

23

Table 4: Patients by Income

Use income as of your most recent assessment.

– Income may be self‐reported if permitted by your policy

Income must be from recent patient data (within

the last year) – otherwise count as unknown.

Total on Line 6 must = total on table 3A.

24

SLIDE 13

10/7/2013 13

Table 4: Patients by Medical Insurance

2013 CHANGE: Break between age 17 and 18
Report principal 3rd party insurance for MEDICAL

care (even if patient is not a medical patient)

Insurance is reported as of the last visit

– Even if it did not pay for the visit – Total on Line 12 must = total for ages on Table 3A – Total for each insurance type must equal totals on zip code table

25

Table 4: Medical Insurance Reporting Categories

NONE/UNINSURED – patients with no insurance:

may include patients for whom health center may be reimbursed through grant or uncompensated care funds

MEDICAID – report all Medicaid patients including

those in managed care programs run by for‐ profits

MEDICARE – report all

Medicare patients including Medicare Advantage and Medi‐Medi patients

26

SLIDE 14

10/7/2013 14

Table 4: Reporting Categories Continued

CHIP‐RA is handled differently from state to state:

– If provided through Medicaid it is reported on Line 8b (Medicaid) – If provided through a commercial carrier outside of Medicaid it is reported on Line 10b (Other public – not private)

OTHER PUBLIC – Public coverage for patients for a

broad set of benefits – very uncommon

– Do not include family planning, breast and cervical programs, EPSDT, etc.

PRIVATE INSURANCE
NOTE: Workers Comp is

not medical insurance

27

Test Your Reviewer Skills 1

How would you check the reasonableness of

these numbers?

Do they get your seal of approval?

28

Principle Third Party Medical Insurance Source 0‐17 years old (a) 18 and older (b) 7 None 120 450 8a Regular Medicaid (Title XIX) 632 259 8b CHIP Medicaid 75 8 Total Medicaid (Lines 8a+8B) 707 259 9 Medicare (Title XVIII) 120 8 10a Other Public Insurance Non‐CHIP (Specify: ) 84 37 10b Other Public Insurance CHIP 174 10 Total Public Insurance (Line 10a+10b) 84 211 11 Private Insurance 6 35 12 Total (Sum Lines 7+8+9+10+11) 1037 963

SLIDE 15

10/7/2013 15

Table 4: Managed Care Utilization

Completed ONLY by health centers with capitated and/or FFS

managed care (HMO) contracts.

– Patient is assigned to health center or their provider(s) – Patient MUST go to health center for listed primary care services – Do not count Primary Care Case Management patients.

A member month is 1 member enrolled for 1 month. Report the

sum of the monthly enrollments for 12 months (generally from HMO reports to the health center).

– In some cases, “members” might not be “patients.”

29

Table 4: Target Populations

330(g) MHC Grantees – provide separate totals for migratory

and for seasonal agricultural workers on Lines 14 and 15

330(h) HCH Grantees ‐ report patient’s shelter arrangement

as of first visit in 2013 (where they were housed the prior night)

A veteran is an individual who completed service in the

Uniformed Services of the US

30

All health centers must report total number of targeted patients (if any) on Lines 16, 23, 24 and 25.

SLIDE 16

10/7/2013 16

Table 4: Agricultural Worker Defined

An agricultural worker is an individual whose PRINCIPAL

employment is in agriculture on a SEASONAL BASIS, who has been so employed within the last 24 months, and/or their dependents.

“Migratory” establishes temporary home(s) for such employment
“Seasonal” workers do not
Agriculture means farming, including
Cultivation and tillage of the soil
The production, cultivation, growing, and harvesting of any

commodity grown on, or in the land, or as an adjunct to or part of a commodity grown on or in the land; and

Any practice (including preparation and processing for market and

delivery to storage or to market or to carrier for transportation to market) performed by a farmer or on a farm incident to or in conjunction with the above.

31

Table 4: Homeless Defined

A homeless patient is any person

– known to be homeless at the time of any service or who was housed but eligible because of having been a homeless patient within 12 months of the service date.

Shelter arrangements (at the first visit of the year):

– “Street” includes living outdoors, in a car, in an encampment, in makeshift housing/shelter or in other places generally not deemed “ fit for human occupancy” – Persons who spent the prior night incarcerated, in an institutional treatment, a hospital or in jail should be reported based on where they intend to spend the night after their encounter/release. If they do not know, code as “street” – “Doubled up” must be temporary and unstable

32

SLIDE 17

10/7/2013 17

Table 4: Proposed 2014 Changes

Residents of Public Housing

– A line will be added to identify Residents of Public Housing. – Required of all health centers, not just 330(i) PHPC grantees. – Public housing will be restricted to geographically defined programs – either high rise projects or 221(d)(3) low rise programs, but not scattered site

r Section 8 rent subsidy programs
Use of patient address will be acceptable to identify the

population.

33

TABLES 5 AND 5A:

Staffing, Tenure, and Utilization

34

SLIDE 18

10/7/2013 18

Staffing and Utilization Profile Tables

Types and quantities of services provided and

staff who provide these services

– Table 5: Staffing and utilization

FTEs, visits, and patients
Columns B and C (only) are completed for each non‐

CHC funding stream for grantees with multiple funding

streams. (Grant report includes all activity for patients

reported on Grant Tables 3A,3B and 4)

– Table 5A: Tenure for health center staff

35

Table 5: Staffing & Utilization

Col (a) – Staff full‐time

equivalents (FTEs) reported by position

Col (b) – Clinic visits

reported by provider type

Col (c) – Patients

reported by service type

36

SLIDE 19

10/7/2013 19

Full‐time Equivalent (FTE) Defined

WHO: All staff providing services at approved

locations

– Employees, contracted staff, residents, and volunteers – Do not count paid referral provider FTEs

WHERE: Report based on work performed

– FTEs can be allocated across multiple categories

NOTE: Medical director’s corporate time can be allocated to non‐

clinical; do not allocate administrative time of other providers

– Line 22 Other Professional includes Chiropractic, acupuncture, PT, OT, nutrition, podiatry, etc. – Line 29a Other Related include non‐health care staff (e.g., WIC, childcare, housing, fitness, job training, etc.)

37

Calculating FTEs

HOW: FTE is actual for the year, not as of last

day

– 1.0 FTE is equivalent to one person working full‐ time (as defined by health center) for one year

Providers: Based on employment contracts
Based on hours paid including vacation, sick, continuing

education, etc.

– Calculate FTE for persons working part‐time or part‐year (e.g, 6 months full‐time = 0.50 FTE, 9 months half‐time = 0.375 FTE )

38

SLIDE 20

10/7/2013 20

39

Calculating FTEs for Hourly Work

WHO: Volunteers, locums, residents, on‐call

providers, etc. who do not receive PTO benefits.

HOW:

– Calculate the number of hours the comparable position works

E.g., Provider receives 160 hours vacation, 96 hours sick, 40

hours continuing education, 80 hours holidays = 1704 hours worked

– Calculate number of hours person being evaluated actually works

E.g., Volunteer worked 30 days @ 8 hours = 240

– Calculate and report FTE

hours worked (240) divided by FTE work hours (1704) = .14 FTE

(240/1704 = 0.1408)

Visit Defined

WHAT: Face to face, one to one between

patient and provider

For behavioral health ONLY group and telemedicine

may be counted in billed

No group health education, or group medical visits.

– Licensed provider for medical, dental, vision, etc.

Include volunteer and contracted provider

– The service must be charted – The provider must be acting independently – The provider must be using professional judgment unique to their training and education

40

SLIDE 21

10/7/2013 21

Visit Defined ‐ continued

Only 1 visit/patient/provider type/day

– Unless 2 different providers at 2 different sites

Only 1 visit/provider/patient/day regardless of the

number of services provided

COUNT paid referrals; visits when following current

patients in a nursing home, hospital or at home

DO NOT COUNT immunization only, lab only, dental

varnishing, mass screenings, health fairs, outreach or pharmacy visits

Count visits provided by both paid and volunteer staff

41

Patients by Service Category Defined

Total number of patients of that type of

service seen in the program year

A patient may be counted ONLY ONCE in EACH

category regardless of the number of visits.

Patients provided with multiple types of

service MUST be counted in each category.

– E.g. A patient may counted as both a medical and a dental patient.

42

SLIDE 22

10/7/2013 22

43

Table 5A: Tenure for Selected Health Center Staff

Data reported are generally available in health

center Personnel or Human Resource (HR) employment records.

– Starting point will be last year’s work sheet.

Deleting staff who have left and adding new staff

– No new data over and above that needed for HR management should be necessary. – TENURE may be measured in a form differently than the way SENIORITY information is stated. – Virtually all of the work for this can be done well in advance of the submission date.

36

Table 5A: Tenure

WHO: Individuals working

at the health center

– Full‐ and part‐time, part‐ year, contract, NHSC – Locums, volunteers, on‐ call, residents

WHAT: Combined tenure

– In months (not FTE) – As of last work day of year – By job title (consistent with T5)

NOTE: Col b may not = a

SLIDE 23

10/7/2013 23

Who to include in Census

WHAT: Snap shot of selected clinical and key

management staff who worked at the health center

n December 31.
WHO:
Clinical staff:

– Physicians – NP, PA, CNM providers – Dental providers – Mental Health providers – Vision providers

45

Note: Line numbers remain the same as those used for Table 5

for all clinical and non‐clinical staff.

Key Non‐clinical staff:

– CEO / Executive Director – CFO / Fiscal Officer – CIO / IT Director – CMO / Medical Director

46

Tenure for Full and Part Time Staff

Regular employees and persons on regular

contracts, who are employed at the time of the census are each counted as 1 in column A.

– Regardless of when they first started working – Those who are not working that day but who are scheduled to work before and after that day are counted as 1 – Those who are no longer employed on that day are not counted on this table – Those with two jobs (e.g., ObGyn + CMO) are counted as 1 in each category

SLIDE 24

10/7/2013 24

47

Tenure for Other Service Provider Arrangements

Volunteers, locums, on‐call providers,

residents, etc. who are scheduled to work before and after 12/31 are each counted as 1 in column C.

– Regardless of how much time they work if they are considered to be a part of the regular staff they are counted. Some examples include:

Specialists who are usually present at least once each

month or quarter

Primary care providers present during a specific season

48

Tenure Months

Months are calculated from the date person was most

recently hired into that position.

– Continuous months from the start date through December

f the reporting year

– Rounded up to the closest whole number

E.g., Pediatrician hired 8/1/02, promoted to CMO on 9/15/10, and

serves in both roles ‐ Count 137 months as pediatrician and 40 months as CMO

E.g., COO is hired 11/10/88, promoted to Deputy Director 7/12/97

and then promoted to CEO 6/22/13, retaining the obligations of the Deputy Director ‐ Count 7 months as CEO only

E.g., CEO hired 5/15/10 to fill the role of CIO, CFO, and CEO –Count

44 months as CEO, 44 months as CFO, 44 as CIO

SLIDE 25

10/7/2013 25

49

Test Your Reviewer Skills 2

How would you check the reasonableness of

these numbers?

Indicator Prior Year Current Year Total Patients 3,599 3,404 Total Visits 15,396 8,342 Medical Patients 2,403 2,789 Medical Visits 6,899 3,418

TABLES 6A, 6B, AND 7:

Diagnoses, Services and Care Provided, and Quality of Care Indicators

50

SLIDE 26

10/7/2013 26

Clinical Profile Tables

Clinical care

– Table 6A: Selected diagnoses and services

Also completed for each additional non‐CHC funding stream

– Table 6B: “Quality of care” indicators – Table 7: Health outcomes and disparities

EHR Capabilities and Quality Recognition

– Series of questions on the implementation of EHR, national and/or state quality recognition (accreditation or PCMH) certification of systems, and how widely adopted the system is throughout the health center’s and its providers – (Not a numbered table – at end of the EHB entry)

51

The ICD‐10 Transition

CMS mandates that ICD‐9 codes are to be

used through 9/30/14, and that ICD‐10 codes will be used after that date.

ICD‐10 codes (only) must be used for the CY

2015 UDS report to be submitted in 2016.

BPHC is reviewing options for working through

the transition.

– BPHC encourages timely transition in accordance with CMS requirements. – BPHC will release UDS reporting guidance shortly.

52

SLIDE 27

10/7/2013 27

TABLE 6A:

Diagnoses and Services

53

Table 6A: Diagnoses and Services

Lines 1‐20d: Selected

diagnoses

– NOTE: Report any appearance not just primary

Lines 21‐34: Selected

services

Uses ICD‐9 or CPT

codes

54

SLIDE 28

10/7/2013 28

Visits by Diagnosis and Service: Column A

Column A – All visits with the diagnosis or service

– Any given patient may have multiple visits for the specified diagnosis or service during the year and ALL ARE COUNTED HERE – A given visit may have more than one of the reportable diagnoses (e.g., hypertension and diabetes) and EACH is counted. – A given visit may have multiple services or diagnoses that are on the same line and ONLY ONE IS COUNTED. (E.g., with five vaccines or two fillings in a single visit

nly one visit is counted)

55

Patients by Diagnosis and Service: Column B

Column B – Unduplicated number of patients

with diagnosis or having received service

– Count a patient ONCE AND ONLY ONCE ON EACH LINE where a visit was counted.

E.g. – a patient who is seen five times for hypertension

will be counted as one patient in column B

– A patient may have a diagnosis and a service on the same day

E.g. – a patient seen for their diabetes and provided

with a flu shot – both are counted.

56

SLIDE 29

10/7/2013 29

Table 6A: 2014 Proposed Change

Persons first diagnosed with HIV during the

reporting year.

– Count only individuals who did not know they had HIV / AIDS or who had never been formally diagnosed with HIV / AIDS prior to a visit with your provider – Do not count persons who knew they had HIV / AIDS but who were being seen for the first time at your health center – There are no codes for this measure

57

TABLE 6B AND 7:

Reporting Methods

58

SLIDE 30

10/7/2013 30

59

Options for Reporting

Report Universe – All patients who meet the

reporting criteria

– Must report universe when:

Universe has fewer than 70 patients who meet the criteria;
Reporting Prenatal Care and Delivery Outcome variables
Report Sample – A sample of 70 charts from the

Universe

Note: You may choose differently for each measure

TABLE 6B:

Quality of Care Indicators

60

SLIDE 31

10/7/2013 31

Process Measures

“Process

measures”: IF patients receive timely routine and preventive care, THEN we can expect improved health

61

Access to prenatal care (first prenatal

visit in 1st trimester)

Childhood immunizations
Cervical cancer screening
Adolescent weight screening & follow

up

Adult weight screening & follow‐up
Tobacco use screening
Tobacco cessation counseling for

tobacco users

Asthma drug therapy
Cholesterol treatment (lipid therapy for

coronary artery disease patients)

Heart attack/stroke treatment (aspirin

therapy for ischemic vascular disease patients)

Colorectal cancer screening

Section A: Prenatal Patients by Age

Report all patients who received prenatal care

during the year by age category.

– Section A is ONLY completed by health centers with Prenatal Programs – Report all women served regardless of whether they delivered, including women whose only service in 2013 was their delivery – Include women who transferred or were “risked out”, as well as women who were delivered by another provider – Do not include patients who may have had tests, vitamins, assessments or education, but did not have their initial clinical visit with the clinic’s obstetrical provider

62

SLIDE 32

10/7/2013 32

Section B: Access to Prenatal Care

Trimester of entry into prenatal care

– Section B is ONLY completed by health centers with Prenatal Programs – For all prenatal patients reported in Section A, indicate what trimester they began care and whether it was with the health center or another provider – “Entry into prenatal care” occurs when the patient has had a visit with a physician or midlevel provider who initiates prenatal care with a complete physical exam (i.e., not a pregnancy test, nurse assessment, etc.)

63

Prenatal Care Count: 2014 Proposed Changes

All Health Centers will report on all pregnant

MEDICAL patients who were provided any of the following required services:

– (2014 Change) no prenatal care BUT REFERRED FOR PRENATAL CARE and delivery, as well as previously reported: – full perinatal services through delivery – some or all prenatal care and then referred for delivery – some prenatal care and then referred out for late prenatal care and delivery – some prenatal care and then transferred because of risk status

64

SLIDE 33

10/7/2013 33

Prenatal Care Don’t Count: 2014 Proposed Changes

Health Centers will NOT report on pregnant

patients who:

– Were not counted as medical patients during the calendar year (e.g., dental only, health education

nly, nutrition only.)

– Were known to be pregnant, but who never sought care or referral for pregnancy including those who had their own obstetrical provider and those who choose to terminate their pregnancy – Those who only requested a pregnancy test and did not return for followup

65

Section C: Childhood Immunizations

Col (a) Universe: All children who

– turned 2 years and 364 days in 2013 (born between 1/2/10 and 1/1/11) AND – who had at least one medical visit in 2013 AND – were first ever seen prior to their 3rd birthday.

This is the “catch‐up” schedule. Technically –

asks about children who were immunized before they turned 3.

– CDC / AAP still recommends immunization by age 2

(no exclusions)

66

SLIDE 34

10/7/2013 34

Childhood Immunizations

Col (b): Universe or sample of 70 patients
Col (c) Compliance: Number of children in Col(b)

who, before their 3rd birthday are fully co mpliant , i.e., for each disease listed on the next slide they (1) received vaccine*, or (2) had evidence of the disease or (3) have a contraindication for vaccine

67 * Hepatitis A, Rotavirus, and Influenza immunizations not measured for compliance beginning CY 2013.

Required Vaccines

Fully compliant means compliant for each of 11

diseases normally vaccinated against with:

– 4 DTP/DTaP, – 3 IPV, – 1 MMR, – 2 HIb, – 3 HepB, – 1 VZV (Varicella) – 4 Pneumococcal conjugate

2013 CHANGE: Removed HepA, rotavirus and

influenza

– CDC / AAP still recommends these vaccines

68

SLIDE 35

10/7/2013 35

Assessing Immunization Compliance

Notes in the medical record indicating that the patient

received the immunization “at delivery” or “in the hospital” may be counted as evidence of compliance.

A note that “patient is up‐to‐date” with immunizations

that does not list the date of each immunization and the name of the provider does not constitute sufficient evidence of compliance.

Good faith efforts to get a child immunized which

nonetheless fail remain “non‐compliant” including

– Parental failure to bring in the patient – Parents who refuse for religious reasons – Parents who refuse because of beliefs about vaccines

69

Section D: Cervical Cancer Screening

Col (a) Universe: All women

– aged 24 – 64 (born 1/1/49 – 12/31/89) AND – with at least one medical visit in a health center clinic during the reporting year AND – who were first seen before age 65. (excluding women with hysterectomy)

Col (b): Universe or sample of 70 patients

70

SLIDE 36

10/7/2013 36

Cervical Cancer Screening (2013 CHANGE)

Col (c) Compliance: Number of women in Col (b)

who received one or more documented Pap tests (regardless of where performed) during the measurement year or during the two years prior to the measurement year OR, for women who received a Pap test accompanied with an HPV test after age 30, the test was done during the measurement year or the four years prior

71

Assessing Cervical Cancer Compliance

Count as “in compliance” a medical record with

– A copy of the test result (your lab or another lab) – An evidence based entry in the patient’s chart which includes the provider, test date and result, which was entered by your provider or clinic staff

A note that “patient was referred” or “patient reported

receiving pap test” does not constitute sufficient evidence

f pap test compliance.
Even if a good faith effort was made to get the patient

tested, she is “non‐compliant,” even if she:

– refused to have test – failed to return for a scheduled test – claims to have had one but cannot document it

72

SLIDE 37

10/7/2013 37

Section E: Adolescent Weight Screening and Follow Up

Col (a) Universe: All children and adolescents

– aged 3 through 17 on December 31st (born 1/1/96 – 12/31/10) AND – with at least one medical visit in a health center clinic during the reporting year AND – were was first seen before age 17 (excluding pregnant adolescents)

73

Adolescent Weight Screening and Follow Up

Col (b): Universe or sample of 70 patients
Col (c) Compliance: Number of patients in Col (b)

who

– had a recorded BMI percentile during 2013 AND – had documented counseling on nutrition (not just diet) AND – had documented counseling on activity (not just exercise)

74

SLIDE 38

10/7/2013 38

Assessing Adolescent Weight Screening Compliance

Just recording that a well child visit was done

does not meet the requirement

All three criteria: BMI percentile, counseling
n nutrition, and counseling on activity must

be documented

75

Section F: Adult Weight Screening and Follow Up

Col (a) Universe: All adults

– aged 18 and over on December 31st (born on or before 12/31/1995) AND – with at least one medical visit in a health center clinic during the reporting year AND – last seen after they turned 18. (excluding pregnant women & terminally ill patients)

Col (b): Universe or sample of 70 patients

76

SLIDE 39

10/7/2013 39

Adult Weight Screening and Follow Up

Col (c) Compliance: Number of patients in Col (b)

who

– had their BMI recorded at their last visit or within 6 months of that visit AND – had a follow‐up plan documented if they were

under age 65 and BMI was ≥ 25 OR < 18.5 or
age 65 or older and BMI was ≥ 30 OR < 22

77

Assessing Adult Weight Compliance

Just recording height and weight is not

adequate – BMI must be visible in chart or on template

78

SLIDE 40

10/7/2013 40

Section G1: Tobacco Use Screening

Col (a) Universe: All adults

– aged 18 and over on December 31st (born on or before 12/31/1995) AND – who have been seen at least twice (ever) in the practice for medical care AND – with at least one medical visit in a health center clinic during the reporting year AND – last seen after they turned 18 (no exclusions)

79

Tobacco Use Screening

Col (b): Universe or sample of 70 patients
Col (c) Compliance: Patients in the sample

who were queried about their tobacco use

ne or more times by any provider (e.g.

dental, vision) during their last visit or within 24 months of their last visit

80

SLIDE 41

10/7/2013 41

Section G2: Tobacco Cessation Counseling for Tobacco Users

Col (a) Universe: All adults

– who used any form of tobacco within 24 months AND – aged 18 and over on December 31st (born on or before 12/31/1995) AND – who have been seen at least twice (ever) in the practice for medical care AND – with at least one medical visit in a health center clinic during the reporting year AND – last seen after they turned 18 (no exclusions)

81

Tobacco Cessation Counseling for Tobacco Users

Col (b): Universe or sample of 70 patients
Col (c) Compliance: Patients in the sample who

– received tobacco use cessation services OR – received an order for cessation medication (Rx or OTC) OR – were on medication

82

SLIDE 42

10/7/2013 42

Tobacco Measure: 2014 Proposed Change

Only one measure will be used, not two
Measure will reflect the adult weight measure

in structure.

Will ask if they were assessed and, if they were

found to be users, were they provided with intervention – all in one question

83

Section H: Asthma Treatment

Col (a) Universe: Patients aged 5 through 40

– initially diagnosed with persistent asthma AND – born between 1/1/73 and 12/31/08 AND – last seen while between ages 5 through 40 AND – seen at least twice (ever) in the practice AND – had at least one medical visit in a health center clinic during the reporting year (excluding patients with allergic reaction to asthma meds and intermittent asthma)

84

SLIDE 43

10/7/2013 43

Asthma Treatment

Col (b): Universe or sample of 70 patients
Col (c) Compliance: Patients in the sample who

– received or had a prescription for inhaled corticosteroids OR – received or had a prescription for an approved alternative medication OR – was on medication

85

Section I: Cholesterol Treatment (Lipid Therapy for CAD patients)

Col (a) Universe: All adults

– with an active diagnosis of CAD during current or prior year or had a myocardial infarction (MI) or had cardiac surgery AND – aged 18 and over on December 31st (born on or before 12/31/1995) AND – last seen after they turned 18 AND – seen at least twice (ever) for medical care AND – had at least one medical visit in a health center clinic during the reporting year (excluding individuals whose last LDL lab test was <130 mg/dL or with an allergy to or a history of adverse outcomes from or intolerance to LDL lowering medications)

86

SLIDE 44

10/7/2013 44

Cholesterol Treatment

Col (b): Universe or sample of 70 patients
Col (c) Compliance: Patients in the sample who

received a prescription for, were provided with, or were taking lipid lowering medications

2014 Proposed Change: This measure will be

eliminated from table 6B. It will be revised and reported on table 7 (the measure will be described

n table 7).

87

Section J: Heart Attack/Stroke Treatment (Aspirin Therapy for IVD Patients)

Col (a) Universe: All adults

– with an active diagnosis of IVD during the current or prior year OR had been discharged after AMI or CABG or PTCA between January 1, 2012 and November 1, 2012 AND – aged 18 and over on December 31st (born on or before 12/31/1995) AND – last seen after they turned 18 AND – had at least one medical visit in a health center clinic during the reporting year (no exclusions)

88 AMI: acute myocardial infarction CABG: coronary artery bypass graft PTCA: percutaneous transluminal coronary angioplasty

SLIDE 45

10/7/2013 45

Heart Attack/Stroke Treatment

Col (b): Universe or sample of 70 patients
Col (c) Compliance: Patients in the sample

who had documentation of aspirin or another anti‐thrombotic medication being prescribed, dispensed, or used

89

Section K: Colorectal Cancer Screening

Col (a) Universe: Patients aged 51 through 74

– born between 1/1/39 and 12/31/62 AND – had at least one medical visit in a health center clinic during the reporting year (excluding patients who have had colorectal cancer)

90

SLIDE 46

10/7/2013 46

Colorectal Cancer Screening

Col (b): Universe or sample of 70 patients
Col (c) Compliance: Patients in the sample who

had documentation of appropriate colorectal cancer screening:

– Colonoscopy conducted during reporting year or previous 9 years OR – Flexible sigmoidoscopy conducted during reporting year or previous 4 years OR – Fecal occult blood test (FOBT), including the fecal immunochemical (FIT) test, during the reporting year

91

2014 Proposed Changes – New Process Measures

HIV Follow‐up

– Patients first ever diagnosed with HIV by clinic staff between October 2, 2013 and September 30, 2014 who received a follow‐up visit within 90 days

NOTE: This means beginning to track in 2013
Depression Screening

– Patients aged 12 and older who were screened for depression using a standardized tool and, if found to be depressed, had a follow‐up plan documented

92

SLIDE 47

10/7/2013 47

Test Your Reviewer Skills 3

How would you check the reasonableness of

these numbers?

Do they get your seal of approval?

93

Section D‐ Cervical Cancer Screening Pap Tests Total Number of Female Patients 24‐64 years of age (a) Number Charts Sampled or EHR total (b) Number of Patients Tested (c) 11 Pap Tests 920 70 63

TABLE 7:

Health Outcomes and Disparities

94

SLIDE 48

10/7/2013 48

Intermediate Outcome Measures

Low birth weight
Blood pressure control

(hypertensive patients with blood pressure < 140/90)

Diabetes control (diabetic

patients with HbA1c <=9%) “Intermediate outcome measures”: IF this measurable intermediate

utcome is improved,

THEN later negative health

utcomes will be less likely.

95

Disparities Format

Hispanic/Latino 1a Asian 1b1 Native Hawaiian 1b2 Pacific Islander 1c Black/African American 1d American Indian/Alaska Native 1e White 1f More than One Race 1g Unreported/Refused to Report Race Subtotal Hispanic/Latino Non‐Hispanic/Latino 2a Asian 2b1 Native Hawaiian 2b2 Pacific Islander 2c Black/African American 2d American Indian/Alaska Native 2e White 2f More than One Race 2g Unreported/Refused to Report Race Subtotal Non‐Hispanic/Latino Unreported/Refused to Report Ethnicity h Unreported/Refused to Report Race and Ethnicity i Total

All outcome data are

reported in a matrix to show ethnicity and race.

Latino patients are

reported in section 1.

Patients who report race

but not ethnicity are assumed non‐Hispanic and reported in section 2.

Patients with neither race

nor ethnicity are reported as Unreported in section 3.

96

SLIDE 49

10/7/2013 49

HIV Pregnancy and Deliveries by Health Center Clinicians

Line “0”: Pregnant HIV patients seen in the clinic,

regardless of whether or not they received prenatal care

– All health centers report, including those with no prenatal care program

Line 2: Total number of deliveries performed by

health center clinicians including deliveries to non‐health center patients

– Only agencies which provide prenatal care report this line

97 HIV Positive Pregnant Women Blank 2 Deliveries Performed by Grantee’s Providers Blank

Section A: Low Birth Weight

Column 1a: All prenatal care patients from Table 6B

who were known to have delivered during the year, even if the delivery was done by another provider

– Column 1a need not / will not / should not equal the sum

f columns 1b + 1c + 1d except by coincidence
Columns 1b – 1d: Live births born to prenatal care

patients during the year by weight, including multiples, regardless of who performed the delivery

98

Prenatal Care Patients Who Delivered During the Year (1a) Live Births: <1500 grams (1b) Live Births: 1500‐ 2499 grams (1c) Live Births: =>2500 grams (1d)

SLIDE 50

10/7/2013 50

Section A: Low Birth Weight 2014 Proposed Change

All Health Centers will report the outcomes for ALL

pregnant MEDICAL patients who were provided any of the following required services:

– no prenatal care BUT REFERRED FOR PRENATAL CARE and delivery, as well as – full perinatal services through delivery – some or all prenatal care and then referred for delivery – some prenatal care and then referred out for late prenatal care and delivery – some prenatal care and then transferred because of risk status

Will require the tracking of patients by programs who

never reported in the past.

99

Section B: Blood Pressure Control

Col (2a) Universe: Patients aged 18 to 85

– diagnosed with hypertension prior to 6/30/13 AND – born between 1/1/29 and 12/31/95 AND – seen at least twice during the reporting year for any medical service (excluding pregnant women and patients with End Stage Renal Disease)

100

Total Hypertensive Patients (2a) Charts Sampled or EHR Total (2b) Patients with HTN Controlled (2c)

SLIDE 51

10/7/2013 51

Blood Pressure Control

Col (2b): Universe or sample of 70 patients
Col (2c) Compliance: Patients in the sample

whose most recent blood pressure is less than 140/90

– No documented blood pressure during the reporting year is out of compliance.

101

Total Hypertensive Patients (2a) Charts Sampled or EHR Total (2b) Patients with HTN Controlled (2c)

Section C: Diabetes Control

Col (3a) Universe: Patients aged 18 to 75

– diagnosed with diabetes AND – born between 1/1/39 and 12/31/95 AND – seen at least twice during the reporting year for any medical service (excluding those with only a diagnosis of gestational diabetes or steroid‐induced diabetes)

102

Total Patients with Diabetes (3a) Charts Sampled or EHR Total (3b) Patients with HbA1c <7% (3c) Patients with 7% <= Hba1C <8% (3e) Patients with 8%<= HbA1c <=9% (3e) Patients with HbA1c >9%

r No Test

during Year (3f)

SLIDE 52

10/7/2013 52

Diabetes Control

Col (3b): Universe or sample of 70 patients
Col (3c‐3f) Test Result: Patients in the sample

whose last HBA1c during the reporting year is in the given range

– No test during the reporting year is out of compliance and reported in Column 3f

103

Total Patients with Diabetes (3a) Charts Sampled or EHR Total (3b) Patients with HbA1c <7% (3c) Patients with 7% <= Hba1C <8% (3e) Patients with 8%<= HbA1c <=9% (3e) Patients with HbA1c >9%

r No Test

during Year (3f)

Diabetes Control: 2014 Proposed Change

HbA1c Result categories will be reduced.

–Instead of four categories, there will be only three:

less than 8%, 8% through 9%, and greater than 9%

–Failure to test will still be lumped with the “greater than 9%” category and considered failure to meet the standard.

104

SLIDE 53

10/7/2013 53

2014 Proposed Change: Add Cholesterol Treatment (Lipid Therapy for CAD Patients)

Universe will be all patients:

– with an active diagnosis of CAD during current or prior year or had a myocardial infarction (MI) or had cardiac surgery AND – Were aged 18 or older on December 31st (born on or before 12/31/1996) AND – last seen after they turned 18 AND – seen at least twice (ever) for medical care AND – had at least one medical visit in a health center clinic during the reporting year

Compliance will be LDL < 100 mg/dl

105

TABLES 8A, 9D, AND 9E:

Financial Profile

106

SLIDE 54

10/7/2013 54

Financial Profile Tables

Cost of delivering services and sources and

amounts of income

– Table 8A: Financial costs – Table 9D: Income from patient services – Table 9E: Other revenues

107

TABLE 8A:

Financial Costs

108

SLIDE 55

10/7/2013 55

Table 8A: Financial Costs

Accrued costs and

allocation of facility and non‐clinical services

Exclude bad debt
Include depreciation
Report donated (“in‐

kind”) costs on line 18, only

109

Table 8A and Table 5 Crosswalk

FTEs Reported on Table 5, Line: Have costs reported

n Table 8A, Line:

1‐12: Medical providers and clinical support staff 1: Medical Staff 13‐14: Lab and X‐Ray 2: Lab and X‐Ray 16‐18: Dental (e.g. dentists, dental hygienists, etc.) 5: Dental 20a‐20c: Mental Health 6: Mental Health 21: Substance Abuse 7: Substance Abuse 22: Other Professional (e.g. nutritionists, podiatrists, etc.) 9: Other Professional 22a‐22c: Vision Services (Ophthalmologist, Optometrist, Optometric Assistant, Other Vision Care) 9a: Vision 23: Pharmacy 8a: Pharmacy 24‐28: Enabling (e.g. case management, outreach, eligibility, etc.) 11a‐11g: Enabling 29a: Other programs/services (e.g. non‐health related services including WIC, job training, housing, child care, etc.) 12: Other related services 30a‐30c and 32: Corporate non‐clinical and Patient Support (e.g. corporate, intake, medical records, billing, fiscal, and IT staff) 15: Non‐clinical 31: Facility (e.g. janitorial staff, etc.) 14: Facility

110

SLIDE 56

10/7/2013 56

Table 8A: Lines 1 ‐ 10

Line 1: Medical care costs

– Medical staff salaries and benefits – Staff dedicated to operation of EHR and QI programs – Staff on contract and contracted visits

Excludes Ophthalmologists and Psychiatrists
Line 2: All medical (not dental) lab and x‐ray costs

including supplies, lab staff, etc.

Line 3: All other direct medical costs including provider

dues, CME, and travel; supplies, depreciation, EHR system, etc.

Lines 5,6,7,9,&9a: Other clinical services costs

– Personnel (hired or contracted) and all “other” direct expenses for (5) dental, (6) mental health, (7) substance abuse, 9 (other professional) and (9a) vision

111

Table 8A: Lines 8a and 8b

Pharmacy Costs

– Line 8b ‐ costs of pharmaceuticals, only – Line 8a ‐ all other pharmacy costs including MIS, staff, equipment, non‐pharmaceutical supplies, etc.

If you cannot separate non‐drug cost from total cost ‐ report all costs on

line 8b

All pharmacy overhead is on Line 8a col b
Note: Do not include donated pharmaceuticals on either line. This is shown on

line 18.

112

SLIDE 57

10/7/2013 57

Table 8A: Lines 11a ‐ 12

Line 11a‐11g: Enabling

― Personnel detail (hired

r contracted) and all

“other” direct enabling expenses

Line 12: Other program

related costs

– Include costs associated with staff reported on Table 5 Line 29a as well as other related direct expenses for non‐health‐ care services such as:

WIC
Housing Corporations
Job training
Head Start /Early Head Start
Child care
Adult Day Health Care
Shelters
Fitness programs

– Include any “pass through” funds here

113

Table 8A: Lines 14 – 15 Non‐Clinical Support and Facility

Line 14: Facility costs include rent or depreciation,

mortgage interest payments, utilities, security, janitorial services, maintenance, etc.

– No CIP or FIP costs, but include appropriate depreciation

Line 15: Non‐clinical support staff costs include costs

for corporate administration, billing and collections, and medical records and intake staff as well as all associated costs including supplies, equipment, depreciation, travel, etc.

114

SLIDE 58

10/7/2013 58

Allocation of Facility

Facility

– Allocate each building separately

Captures differences in costs per building such as

improvements, donated space, etc.

– Allocate based on proportion of square footage utilized by each cost center or better data if available – Include allocation to “non‐clinical support” for administrations facility costs

115

Allocation of Non‐Clinical Support

Non‐clinical support staff and costs

– Allocate based on actual use

E.g. – allocating billing to cost centers that bill, front

desk costs to those services that use the front desk staff for check in, etc.

– Alternative: straight line method, using the proportion of total costs to the service category excluding all Non‐Clinical Support costs and Facility costs – Can use both methods

116

SLIDE 59

10/7/2013 59

Test Your Reviewer Skills 4

How would you check the reasonableness of

costs as they relate to staffing and visits?

117

TABLE 9D:

Patient Related Revenue

118

SLIDE 60

10/7/2013 60

Table 9D: Patient Related Revenue

Cash basis
Patient revenues are

reported by payor: Medicaid, Medicare, Other public, private and self‐pay

119

Charges

Full Charges Col(a):

– Undiscounted, unadjusted charges for services based

n fee schedule; charges should cover costs

– Include all charges (i.e., medical, dental, pharmacy, mental health, etc.). – Do not include “charges” where no collection is attempted or expected such as charges for enabling services, donated pharmaceuticals, or free vaccines.

120

SLIDE 61

10/7/2013 61

Collections

Collections Col(b):

– Report all amounts collected as payments for health services including capitation payments, payments from patients and third party insurance, FQHC reconciliation payments and contract payments (e.g., schools, jails, etc.) received during the year. – Report by payor. – Do not include “meaningful use” payments.

121 122

Adjustments

Adjustments Col(c1‐c4):

Note: Adjustments are included in col(b), but do not = col(b). – Columns (c1) and (c2): reconciliation payments for FQHC

r CHIP‐RA settlements

– Col (c3): “Other Retroactive Payments” including risk pools, incentives, PFP, withholds and court ordered payments – Col (c4): amounts which are returned to third party (report as positive number)

SLIDE 62

10/7/2013 62

Allowances

Allowances Col(d):

– Reductions in payment by a third party based on a contract – Allowances do not include:

non‐payment for services that are not covered by the third party
r rejected by the 3rd party
deductibles or co‐payments that are due from the patient and not

paid by a third party

– Reduce allowances by amount of FQHC payments – For capitated plans, col d = col a – col b

123

Sliding Discounts

Sliding Discounts Col(e):

– A reduction in the amount charged (paid or owed) for services rendered which

Is based solely on the patient’s documented income

and family size at the time of service as it relates to the federal poverty level

May be applied to insured patients’ co‐payments,

deductibles and non‐covered services when the charge has been moved to self pay if consistent with how uninsured patients are treated

May not be applied to past due amounts

124

SLIDE 63

10/7/2013 63

Bad Debt

Bad Debt Col(f):

– Amounts considered to be uncollectable and formally written off during the current calendar year, regardless of when the service was provided – Only self‐pay bad debt is reported, not third party bad debt – Do not report as a “cost” on Table 8A – Bad debt can never be changed to a sliding discount

125

Payors: Medicaid and Medicare

Lines 1 ‐ 3: Medicaid

– All routine Medicaid – EPSDT – under any name – Medicaid part of Medi‐Medi or crossovers – CHIP, if paid through Medicaid – May also include fees for other state programs which are paid by the Medicaid intermediary

Lines 4 ‐ 6: Medicare

– All routine Medicare – Medicare Advantage – Medicare portion of Medi‐Medi or crossovers

126

SLIDE 64

10/7/2013 64

127

Payors: Other Public and Private

Lines 7 ‐ 9: Other Public

― State or other public insurance programs ― Non‐Medicaid CHIP programs ― State‐based programs which cover a specific

service or disease (i.e., BCCCP, Title X, Title V, TB)

― Does not include indigent care programs ― NOTE: Patients who benefit from services paid for

by “other public payers” are not necessarily counted as “other public insurance” on Table 4

Lines 10 ‐ 12: Private

― Private and commercial insurance ― Medi‐gap programs, Tricare, Workers Comp. etc. ― Contracts with schools, jails, head start, etc.

NOTE: Patients benefiting from other public
r private may not be insured in these

categories on table 4

128

Payment Types Reported

Each of the four third‐party payor

categories has three payment types:

– Fee‐for‐service = Payment for each charge (or global fee) on the charge slip / encounter form / bill – Managed care capitated = Payments for each month the patient is enrolled in the program + in public programs, reconciliations to some prospective payment rate (PPS) – Managed care fee‐for‐service = Patient is assigned to doctor or clinic, but payment is only made when a charge is reported. Reconciliation to PPS rates occur in some public programs

SLIDE 65

10/7/2013 65

Payors: Self Pay

Line 13: Self Pay

– Charges for which patients are responsible and all associated collections including:

Full fee patients
Patients receiving sliding discounts
“Nominal fee” or “zero‐pay” patients
Co payments and/or deductibles
Services not covered by a patient’s insurance
Services which form or will form the basis for state or

local safety net (uncompensated care) funds

Dental patients who only have medical insurance

129

Reclassify Charges

It is essential to reclassify charges which are

unpaid in whole or in part, not including allowances:

– This includes co‐payments and deductibles as well as charges for non‐covered services which are rejected by third parties

Deduct unpaid charges or portion of charge from original

payor (Medicaid, Medicare, Private, etc.)

Add to charges on line for self pay or the secondary (tertiary,

etc.) payor

Show collections of these amounts on the appropriate line

130

SLIDE 66

10/7/2013 66

Test Your Reviewer Skills 5

How would you check the reasonableness of these

table 4 and table 9D numbers?

131

Do they get your

seal of approval?

TABLE 9E:

Other Revenues

132

SLIDE 67

10/7/2013 67

Table 9E: Other Revenues

Report non‐patient‐service

income.

Cash basis – amount

received/drawn down during the year

Report “last party” to

handle funds before you received them.

Do not include:

– Capital received as loan – Patient‐related revenue – Value of donated services, supplies, or facilities – Donated “community value”

133

Federal Grants

Line 1: BPHC Grant drawdowns

– Report all funds received directly from BPHC regardless of their end use. – Include funds received from BPHC and passed through to another agency.

If you do not report activity for grant, report as cost on Table 8A, Line

12

Line 3: Other Federal Grants

– Report funds received from Federal government grants management system. – Do not report Ryan White – especially part A or part B – here unless you are an entity that receives the funds directly. – Do not include IHS funds for compacted and contracted services received by a tribe and passed through to the clinic.

134

SLIDE 68

10/7/2013 68

Other Government Grants

Line 3a: Medicare and Medicaid EHR Incentive

Payments for Eligible Providers

– Payments made directly to providers and turned

ver to the health center are also recorded here
Line 4a: ARRA – CIP and FIP drawdowns
Line 6: State Grants ‐ and ‐ Line 7: Local Grants

– Do not include grant funds which pay for units of service

135

Other Revenue Sources

Line 6a: Indigent Care Programs

– State and local programs that pay for health care in general and are based on a current or prior level of service, or on a fee per visit, but not fee‐for‐service

– Report full charges on Table 9D as self‐pay charges and everything not due from the patient is written off as a sliding discount – Do not include state insurance plans

Line 8: Foundation / Private Grants
Line 10: Other Revenues

– Contributions, fund raising income, rents, sales, patient record fees, etc.

136

SLIDE 69