Closing the Loop: From Data Entry to

Payment Reconciliation

Topics in Contracting Web-Conference

October 21, 2015

Web-Conference Logistics

• Please remember to dial in 866-740-1260 – Access Code

6196625.

• Your phones will be muted during the presentation.

• Please type your questions in the chat box on the lower

left corner of your screen during the presentation and we’ll

address them during the Q & A section.

• During the question/answer period only, if you’d like to

further clarify your question, press *7 to unmute your

phone to speak and *7 again to re-mute.

• Slides will be sent to all participants.

Agenda

• Introductions

• Data Cycle Review

• Data Entry

• Data Transfer to Public Health Solutions

– Payability Guide

• Data Recognition

• Automatic Data Flagging

• Manual Flagging of Services Based on Site Visit Findings

• Feedback to Service Providers

• Handling Data Discrepancies

• Payment Processing

• Closeout

• Best Practices

• Resources

• Q&A

Data Cycle

Data Entry Data

Transfer to PHS

Data Recognition

Automatic Flagging

Feedback to Service

Providers

Payment

Manual Data

Flagging

Data Entry

Data Transfer to

PHS

Data Recognition

Automatic Flagging

Feedback to Service

Providers

Payment

Manual Data

Flagging

Data Entry

• Contractors in all performance-based service categories use eSHARE (web-based data system developed and operated by New York City Department of Health and Mental Hygiene-NYCDOHMH) to enter data.

• Services reported must be entered by COB on the 15th of the following month (or the next business day, if a weekend or holiday).

Example: September’s services need to be entered into eSHARE no later than October 15th.

Exceptions during Closeout

• NYCDOHMH’s policy on data entry: Contractors should report all services provided under a contract even if the reported services are above projected targets for the contract period and/or even if the reported services are not payable because they exceed client-level limitations.

Data Entry Data

Transfer to PHS

Data Recognition

Automatic Flagging

Feedback to Service

Providers

Payment

Manual Data

Flagging

Data Transfer to Public Health Solutions

• Data are transferred monthly to PHS in an extract file

(meaning there is no ‘submit data’ process per se).

• Service data is uploaded to PHS’ payment system, where it is

automatically quality-reviewed for payability standards.

Payability Guide

• Developed by Public Health Solutions (PHS) and NYCDOHMH to provide

guidance on submitting data for all performance-based contracts (Ryan White

and HIV Prevention)

• Emphasizes requirements for payment, certain requirements for contract

compliance, and information on other data reporting and evaluation requirements. • Updated generally quarterly (PHS sends a Contractor Newsflash when the Guide

is updated)

• Available on the PHS/CAMS website:

www.healthsolutions.org/hivcare/documents/requirementsguide.pdf

healthsolutions.org/hivcare

Forms, Resources &

Procedures

Manuals and Guides

Data Entry

Data Transfer to

PHS

Data Recognition

Automatic Flagging

Feedback to Service

Providers

Payment

Manual Data

Flagging

Data Recognition

• First stage of automatic data processing: records from eSHARE are assessed against minimum data standards.

– DOHMH distributes mapping documents that articulate which eSHARE record types correspond to which PHS payment points.

– The Payability Guide specifies certain ‘Payment Processing Rules’ which are prerequisites for recognition. (Example: ‘A confirmatory test that does not have an earlier HIV antibody test entered in eSHARE under the same Form ID will not be processed for payment.’)

• Data processing at this point also creates certain payment points that are based on sets of eSHARE records. (Examples: Care Coordination PMPD; TCC client graduation; Condom monthly distribution fee.)

• Those records which pass, and those which are created, are given a Service Type Code, appear on the MIR, and are counted in monthly payment vouchers.

Data Entry

Data Transfer to

PHS

Data Recognition

Automatic Data

Flagging

Feedback to Service

Providers

Payment

Manual Data

Flagging

Automatic Data Flagging

Recognition of Services Automatically by Software Routines

• Duplicate items (services) (or possible duplicates) are marked, as are items requiring

data corrections or violate programmatic rules. For each service category, the kinds of

issues reviewed automatically are different.

Note that the automatic review identifies both definite duplicates and possible duplicates.

• Definite Duplicate - More than one item of the same PHS service type for the same

client on the same day, and that service type is such that no programmatic or clinical

scenario could make it valid to provide more than one service. (Permanent Housing

Placement would be an example.)

• Possible Duplicate - More than one item of the same PHS service type for the same

client on the same day, but it is programmatically possible that the second service is a

valid separate service. (For example, some individual counseling service types could

occur more than once on the same day.) Possible duplicates which are really separate

services must be “attested” during closeout in order to avoid recoupment.

Data Entry

Data Transfer to

PHS

Data Recognition

Automatic Flagging

Feedback to Service

Providers

Payment

Manual Data

Flagging

Manual Data Flagging of Services Based on Site Visit Findings

Prior to Site Visit Contract Managers/Contract Coordinators select records

from a recent MIR for review

During Site Visit PHS staff note any issues (recoupable or non-recoupable

discovered with service tracking & documentation)

During Exit Interview PHS staff review any necessary recoupment and/or

corrective actions

After Site Visit

PHS staff enter issues (if applicable) into the PHS payment

system, attached to each specific item’s record.

PHS sends a Site Visit Report including a recoupment

summary (if applicable) detailing the number of units and

dollar value to be recouped, which matches services in the

Summary of Issues Noted section in the next MIR.

Correction/Recoupment/Validation Reasons Resulting From Site Visit Findings

Data Entry

Data Transfer to

PHS

Data Recognition

Automatic Flagging

Feedback to Service

Providers

Payment

Manual Data

Flagging

Master Itemization Report (MIR)

• Produced from the monthly eSHARE extract

• Provides an itemized listing, as well as a summary, of services recognized by PHS’

payment system (those which meet minimum threshold for correct data) .

• Compares actual services to projected services.

• Presents information about services recognized by the payment system that have

been found to be problematic.

• Sent monthly to Program Managers with a separate notification to the Senior

Administrator and Fiscal Manager.

MIR Review

Section I: DATA INCLUDED contains information about when the MIR was run and

the most recent data extract file that affected the service count.

MIR

Section I-A: PHS INFORMATION SYSTEM ACCOUNTING DISCREPANCIES

UNDER INVESTIGATION

Notes any discrepancies that may arise in the aggregation of item-level data into PHS

payment system. This section is for informational purposes only and is usually blank.

Any discrepancies are investigated and corrected by PHS..

MIR

Section II: YEAR-TO-DATE TOTALS BY SERVICE shows, for each service type,

the year-to-date total count of services, and their value, recognized by PHS’

payment system, and compares them to year-to-date projections.

MIR

Section III: Summary of Issues Noted (SIN) Report

• Summarizes service records that have been recognized for payment but have

subsequently been marked (automatically or as a result of Site Visit findings).

MIR

Section IV: MONTH TOTALS FOR SERVICES SUBMITTED AND RECOGNIZED

Displays monthly total counts of services and their value recognized by the PHS’

payment system, and compares them to monthly projections. Some of these services

may have already been paid, while others may be in the queue awaiting payment.

Section V: ITEMS RECOGNIZED. Shows item-level data. The client ID, date of service,

service type & units of service are included. Items identified as problematic are shaded in

color & the nature of the problem is noted.

MIR

MIR

Section VI: GROUP ATTENDEES RECOGNIZED shows the Client ID numbers

and Collateral ID numbers associated with each Group Event ID..

Care Coordination

Client Trajectories Monetary Value Report

Lists each client in order of client ID and shows the trajectory periods in

different Care Coordination tracks from the start of the current contract

period.

Care Coordination

Income Predictor Tool

Care coordination contractors are paid for Per-Member-Per-Day enrollment

and for meeting minimum thresholds of service. Income Predictor Tools

helps agencies predict monthly and annual program income .

Handling Data Discrepancies

In instances where you believe that items (services) submitted for payment have not

been recognized by PHS, please follow these steps:

1. Find specific examples that DO NOT appear on the MIR.

2. Verify that the examples have been properly entered in eSHARE. Please consult

the Payability Guide sections on Requirements and Special Issues for that service

type, with special attention to “Payment Processing” rules; these rules articulate the

minimum threshold of data quality without which an item will not be processed for

payment.

3. If the examples appear to be properly entered, send them with the client ID number,

date, and service type via email to your PHS Contract Manager.

Handling Data Discrepancies

Note: eSHARE data is the basis of payment; however, payment logic resides in Public

Health Solutions’ information systems, not in eSHARE.

Please contact your PHS Contract Manager (not NYCDOHMH) about apparent payment

discrepancies. If necessary, PHS staff will reroute questions to NYCDOHMH eSHARE staff.

Data Entry

Data Transfer to

PHS

PHS Data Recognition

Automatic Flagging

Feedback to Service

Providers

Payment

Manual Data

Flagging

Once the PHS payment system receives data:

– Your PHS Contract Manager reviews the data and contract status.

– If all prerequisites are present, payment is approved, entered into the PHS payment system and forwarded to PHS’ fiscal department

Factors that can prevent a payment from being approved include, among others:

Non-executed contract or renewal Lapsed insurance Non-submission of required monthly reports Audit report

PHS aims to pay contractors within 30 days of receipt of data and all required reports

Note: PHS processes payment for services that meet a basic threshold of data correctness. However, services included in payment may subsequently be assessed as non-payable, as previously described

Payment Processing

Closeout

Closeout

• Occurs towards the end of the contract year to reconcile services reported and

determine a final payment.

• Final opportunity for contractors to reconcile and submit additional services or correct

services reported.

• Two data entry deadlines – around the 7th of the month and around the 20th of the

month (as opposed to the 15th).

• Additional MIR is sent between the two dates to review data and make corrections

• Closeout Reports:

– Initial closeout MIR

– Potentially Payable Services (PPS) Report

– Attestables Report

– Final MIR

Potentially Payable Services Report (PPS)

• Service records that initially fail to meet requirements needed for payment (not

recognized and not on MIR) are included in the end-of-year Potentially Payable

Services (PPS) report.

• Generated before closeout & lists all services that could have been recognized for

payment.

• Contractors receive this report a month or so before closeout and are given time to

make adjustments in eSHARE which might render a service payable.

Example of PPS Report

Attestables Report

• Possible duplicate reported services (and other issues)

• Require contractor feedback

Best Practices

• When your organization receives the monthly MIR, Program and Fiscal staff should meet and discuss each contract’s spending (drawdown), performance and data quality.

• Be in frequent contact with your PHS Contract Manager for contract-related concerns, and your NYCDOHMH Project Officer for technical assistance about the service model.

• Understand your service category’s payment rules! Review the Payability Guide if you are unsure.

– PHS notifies you with a Contractor Newsflash communication when updates are made to the Payability Guide.

Best Practices

Resources

Resource Contacts

Problem Resource

Alleged discrepancies between client-

level data from eSHARE and MIR or

Care Coordination Trajectory Report

PHS Manager of Data Systems:

Nagla Bayoumi (646) 619-6628 or

nbayoumi@healthsolutions.org

Need for an MIR outside of the

regularly scheduled mailing from PHS Your PHS Contract Manager

General MIR questions Your PHS Contract Manager

eSHARE questions/problems eSHARE Service Desk: 212-766-4357 (Monday-Friday 8am-6pm, Saturday 10am-2pm)

Questions?

**Please complete the brief survey about this web-conference, which

will be automatically sent to you via email after you log off. Thank You.