Provider Acknowledgement Monitoring Guide · The purpose of the Provider Acknowledgement Monitoring (PAM) application is to track and monitor the physicians signed attestation letters

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Provider Acknowledgement Monitoring Guide

Version 1.0

April 15, 2016

Livanta LLC

240-712-4500 10820 Guilford Road, Suite 205 www.livanta.com Annapolis Junction, MD 20701

http://www.livanta.com/

Provider Acknowledgement Monitoring (PAM)

PAM User Guide i Version 1.0 Draft April 15, 2016

Version History

Version Date Owner/Author Description

0.1 12/01/2015 K Roberts-Murphy Initial Draft

0.2 01/15/2016 G Cummings Updated formatting and layout to PMBOK and Best Practices standards

0.3 04/15/2016 G Cummings Added Error Messages to Appendix B.

Provider Acknowledgement Monitoring

PAM User Guide ii Version 1.0 Draft April 15, 2016

Table of Contents

1 Purpose .................................................................................................................... 1

2 Getting Started.......................................................................................................... 2

3 Upload Individual Physicians Attestation Letters ...................................................... 3

4 Upload Multiple Signed Attestation Letters ............................................................. 12

Appendix A: Acronyms .................................................................................................. 20

Appendix B: Error Messages ......................................................................................... 21

List of Figures

Figure 1: Provider Information ......................................................................................... 2

Figure 2: Upload Physicians Acknowledgement List ....................................................... 3

Figure 3: Upload Physicians ............................................................................................ 4

Figure 4: Warning Message ............................................................................................ 4

Figure 5: Selecting Folder ............................................................................................... 5

Figure 6: Opening File ..................................................................................................... 5

Figure 7: Select Save ...................................................................................................... 6

Figure 8: Monitored Physicians ....................................................................................... 6

Figure 9: Provider Information ......................................................................................... 7

Figure 10: Column Uploaded? ........................................................................................ 8

Figure 11: Column View .................................................................................................. 8

Figure 12: Column Upload .............................................................................................. 9

Figure 13: Upload Letter .................................................................................................. 9

Figure 14: Upload Signed Letter ..................................................................................... 9

Figure 15: Upload Single Physician Letter .................................................................... 10

Figure 16: Warning Message ........................................................................................ 10

Figure 17: Uploaded Confirmation ................................................................................ 10

Figure 18: Status Change ............................................................................................. 11

Figure 19: Physicians List ............................................................................................. 12

Figure 20: Upload Signed Letters .................................................................................. 13


PAM User Guide iii Version 1.0 Draft April 15, 2016

Figure 21: Letter Listing Warning .................................................................................. 13

Figure 22: Saving the Letter Listing ............................................................................... 14

Figure 23: Listing Warning Message ............................................................................. 14

Figure 24: Saved Listing ................................................................................................ 15

Figure 25: Manually Acknowledged Physicians ............................................................ 16

Figure 26: Updated Status ............................................................................................ 17

Figure 27: View Provider Letters ................................................................................... 17

Figure 28: Begin Submitting Letters .............................................................................. 17

Figure 29: Submitting on the Dashboard ....................................................................... 18

Figure 30: Attesting All Letters Have Been Submitted................................................... 18

Figure 31: View Provider Letters ................................................................................... 19

List of Tables

Table 1: Physicians List ................................................................................................... 3


PAM User Guide 1 Version 1.0 Draft April 15, 2016

1 Purpose

The purpose of the Provider Acknowledgement Monitoring (PAM) application is to track and monitor the physicians signed attestation letters that are requesting payment for approved of medical services.

There are two explanations for the PAM application.

1. Per QIO TOPS Control Number: QIO 2006-02.

“Policy Regarding the New Quality Improvement Organization (QIO) Physician Acknowledgment Statements”.

Regulations at 42 CFR 412.46 (one of the conditions at 42 CFR 412, Subpart C) require hospitals to obtain only one signed acknowledgment from physicians who are being granted admitting privileges at a particular hospital. The physician must complete the acknowledgment at the time that he/she is granted admitting privileges at the hospital or before, or at the time the physician admits his/her first patient to the hospital. When the hospital submits a claim, it must have on file a signed and dated acknowledgment from the attending physician that the physician has received the notice specified in 42 CFR 412.46(b).

The QIOs are responsible for monitoring and reporting on the compliance of hospitals that fall under this Policy’s jurisdiction.

2. Rationale/need for protocol

For the purpose of completing Task 10: General Task’s D. Monitoring of Physician Acknowledgement Statements as outlined in the BFCC-QIO contract and CFR.

This process requires continuous, annual monitoring of every hospital and long term acute facility to ensure they have on file a physician acknowledgement statement for physicians billing for services provided in that facility. This is achieved by requesting that each one of these facilities submits copies of their physician statements as well as a spreadsheet of all physicians granted admitting privileges within the last year. Their submissions are then compared to the dates the physicians began billing Medicare for services provided by them in the facility.



2 Getting Started

You are able to upload the Physicians List Physicians Acknowledgement Monitoring – Provider Page from these websites:

bfccqioarea1.com

bfccqioarea5.com

NOTE: As a security measure, the application will time-out after 20 minutes of inactivity.

The dashboard contains interactive information that provides various data that relates to the monitoring of the upload of the signed physician attestation letters.

Figure 1: Provider Information

The Logout button is always available in the upper right corner of the window.

1. Status: the status can change based upon actions of the user.

Comment: The initial Status is Pending Physicians List Upload

2. CCN: CMS Certification Number, remains constant

3. Provider Name: Name of medical facility and remains constant

4. Provider File Uploaded: Either YES or NO

5. Result: Pass or Failed. To be displayed once the review has been completed.



3 Upload Individual Physicians Attestation Letters

Figure 2: Upload Physicians Acknowledgement List

Once accessing the website for the first time and thereafter, yearly, upload the Physicians Acknowledgement list.

1. Select OK and then select Upload Physicians to upload the Physicians Acknowledgements.

NOTE: The Physicians Acknowledgements will be in an Excel spreadsheet format. The user will have to download the template and populate the spreadsheet.

Table 1: Physicians List

CMS Certified Number (CCN), Previously MPN: 330189

Facility Name: City of Angels Medical Center

Contact Name: Marry Lee

Email Address: [email protected]

NPI Physician First

Name Physician Last

Name State

Date Physician Acknowledgment

Statement Signed

Date Admitting Privileges

Were Granted

1340125755 Jason Physician55 CA 5/14/2014 11/21/14

1878665806 Alex Physician06 CA 4/21/2014 7/2/14

1471593926 Mohan Physician26 CA 5/10/2014 12/1/14

1815971288 Pranjal Physician88 CA 9/11/2014 12/10/14

mailto:[email protected]



2. Select Upload Physicians.

Figure 3: Upload Physicians

NOTE: A warning message indicates that a newly uploaded list replaces any prior list.

Figure 4: Warning Message

3. Select Choose File where the physician’s list spreadsheet is located.



Figure 5: Selecting Folder

4. Select Open.

Figure 6: Opening File



5. Select Save.

Figure 7: Select Save

The Physician Acknowledge Monitoring – Provider page displays the list of monitored physicians for a specific provider.

Figure 8: Monitored Physicians



The Provider Information page is displayed:

Figure 9: Provider Information

NOTE: The Status has been updated: Physician List Uploaded – 129 Physicians Uploaded.

Important: The X ( ) in the Uploaded? column indicates that the Attestation Letter has not been uploaded

Within the Physicians section of the form are column headings, the non-instructional headings are:

National Provider Identifier (NPI) - Clicking once on the column heading, sorts by ascending order and clicking twice sorts by descending order.

Physician First Name - Clicking once on the column heading, sorts by ascending order and clicking twice sorts by descending order.

Physician Last Name - Clicking once on the column heading, sorts by ascending order and clicking twice sorts by descending order.

State - Clicking once on the column heading, sorts by ascending order and clicking twice sorts by descending order.

Signed Date - Clicking once on the column heading, sorts by ascending order and clicking twice sorts by descending order.

Year – This column is always the current year.

The added plus information column headings describe the function of the column.



The instructional column headings are:

Uploaded?-Hover the mouse pointer over this column heading to obtain an explanation of the link.

Figure 10: Column Uploaded?

View - Select this link to see the applicable attestation letter.

Figure 11: Column View

Upload - Hover the mouse pointer over column heading to obtain the next step to upload the attestation letters.

A green checkmark ( ) indicates that the attestation letter has been uploaded or

acknowledged. A red X ( ) indicates that a letter has not been uploaded or acknowledged. If a provider attestation file has been uploaded, a button is displayed to manually acknowledge a physician.



Figure 12: Column Upload

6. Upload signed letter –uploads the attestation letter in PDF format for each of the individual physicians.

NOTE: During the initial upload, an instructional pop-up displays with a Next button.

Figure 13: Upload Letter

7. Select Upload signed letter to upload a single file.

Figure 14: Upload Signed Letter



Figure 15: Upload Single Physician Letter

NOTE: The file has been uploaded and the Warning message indicates that a new upload will replace the current upload.

Figure 16: Warning Message

There is now a checkmark ( ) in the Uploaded? column for the corresponding

physician.

Figure 17: Uploaded Confirmation



Figure 18: Status Change

Comment: The Status has changed to Letters Pending Submission indicating that one (1) of the 129 attestation letters has been uploaded and you can View the uploaded signed letter.

8. Select the View link to see the applicable attestation letter. (The document below is a substitute example of an uploaded letter.)

PHYSICIAN ACKNOWLEDGEMENT STATEMENT

Notice to Physicians:

Medicare payment to hospitals is based on each patient’s Principal and

Secondary Diagnosis and the Major Procedures performed on the patient, as

attested to be the patient’s attending physician by virtue of his or her

signature in the medical record.

Anyone who misrepresents falsifies, or conceals essential information

required for payment of Federal funds, may be subject to fine,

imprisonment, or civil penalty under applicable Federal Laws.

Physician Signature

Physician Name: Date:

Once the attestation letter is viewed, you can be zoom in or out, save, or print.



4 Upload Multiple Signed Attestation Letters

Located at the bottom of the screen are the following buttons:

Page navigation bar

Upload Physicians button

NOTE: The Upload Physicians button should be used only once, however, if the physician’s list needs to be uploaded again, the capability is present.

Upload Signed Attestations

Submit button

Figure 19: Physicians List



To upload multiple attestation letters:

1. Select Upload Signed Attestation to upload multiple physician attestation letters.

Figure 20: Upload Signed Letters

Figure 21: Letter Listing Warning

Navigate to the location of the file containing the multiple attestation letter on your computer.



Figure 22: Saving the Letter Listing

2. Select Open.

Figure 23: Listing Warning Message

NOTE: See the Warning message.

3. Select Save.



Figure 24: Saved Listing



4. Select Manually Acknowledge for each applicable physician.

Figure 25: Manually Acknowledged Physicians

NOTE: A check ( ) appears in the Uploaded? column which indicates that the attestation letter has been uploaded or Manually Acknowledged.



Figure 26: Updated Status

NOTE: The Status has been updated to reflect the number of letters completed or uploaded.

To view the provider file with multiple physician attestation letters, select View Provider Letters.

Figure 27: View Provider Letters

Important: The View column will not display View for multiple letter uploads.

5. Select Submit to submit the physician list and attestation letters for review once the whole physicians list has been uploaded or manually acknowledged.

Figure 28: Begin Submitting Letters



6. Select Submit on the dashboard

Figure 29: Submitting on the Dashboard

NOTE: See the message: By selecting Submit, you are attesting that all attestation letters have submitted.

Figure 30: Attesting All Letters Have Been Submitted

7. Select Submit.

NOTE: The dashboard has been updated to indicate that the number of attestation letters submitted.



8. Select View Provider Letters to see the submitted Provider letters.

Figure 31: View Provider Letters

See the Providers letters.

PHYSICIAN ACKNOWLEDGEMENT STATEMENT

Notice to Physicians:

Medicare payment to hospitals is based on each patient’s Principal and

Secondary Diagnosis and the Major Procedures performed on the patient, as

attested to be the patient’s attending physician by virtue of his or her

signature in the medical record.

Anyone who misrepresents falsifies, or conceals essential information

required for payment of Federal funds, may be subject to fine,

imprisonment, or civil penalty under applicable Federal Laws.

Physician Signature

Physician Name: Date:

Important: The Actions are locked message indicates you are no longer able to alter the submitted information.



Appendix A: Acronyms

Acronym Description

CCN CMS Certification Number

CMS Centers for Medicare and Medicaid Services

NPI National Provider Identifier

PAM Physicians’ Acknowledgment Monitoring



Appendix B: Error Messages

Error Message Description

File Quarantine failed - unsafe file detected.

The file contains malicious code or is from a type not allowed to be uploaded into the system. Only Excel or PDF files can be uploaded into the system.

Error reading Excel Header information.

The system cannot read the header information, or the header information is incorrect. Please verify the header information and try again.

Error reading Excel data

The system cannot read the Excel spreadsheet. Please make sure that it is an Excel .xls or .xlsx spreadsheet.

Error writing Excel Header information to hospital

The system cannot write the provider information to the database. Please report this problem to the Helpdesk Support Team.

Error inserting new physician

The system cannot write the physician information to the database. Please report this problem to the Helpdesk Support Team.

Unable to write file to *path* Error: *file-writing error*

The system cannot write the file to the file system. Please report this problem to the Helpdesk Support Team.

Error reading physicians table for hospital

The system cannot read the physician information. Please verify that you are using the correct template.

Error updating existing physician

The system cannot update the physician information in the database. Please verify that the information in the spreadsheet is correct.

CCN not entered in file

There is no CCN number in the header portion of the spreadsheet. Please enter the CCN number in the spreadsheet.

Successfully uploaded file

File uploaded correctly.

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Provider Acknowledgement Monitoring Guide · The purpose of the Provider Acknowledgement Monitoring (PAM) application is to track and monitor the physicians signed attestation letters