Record Review and calls
What assessments do Recovery Managers complete?
Initials and annuals
What is the deadline for submission of completed assessment
14 days
REASONS FOR DISENROLLMENTS
No monthly contact after 3 attempts to contact:
The individual passed away
The individual has been in an NF or hospital for more than 30 days.
Transition to a different waiver program.
When you have a new enrollee, what are the two in person contacts that are needed
15 day and 180 day
How many steps are in the record review process?
5
How far ahead can an assessment be pulled forward?
90 days
What is needed in order to have a successful monthly contact
Successful contact with individual or AR
3 contact attempts- different days/times, contact provider/AR/Mycare plan, send for disenrollment
What are the two types of incident reports
critical and reportable
What is the first step
run PNM to verify insurance/ on SRS
How long do you have to submit a completed assessment?
14 days
How long do you have to document a call
24 hours
What is the new process for submitting a disenrollment
Use the disenrollment link in your RVU tracker
What is a critical incident?
Abuse; Emotional abuse, Physical abuse, Sexual abuse, Verbal abuse, Unauthorized use of restraint, seclusion, or restrictive intervention. Exploitation Misappropriation (Theft); Involves theft of $500 or more, Involves theft of less than $500, Neglect, Unnatural or Accidental Death, H&W at Risk: Individual lost/missing, Prescribed Medication Issue resulting in EMS, ER, or Hospital, Self-harm or suicide attempt resulting in Hosp/ER, Prescribed Medication Issues- Provider Error
How long should the call last in CSIS to get credit for billing
8 minutes
What is the main thing needed for program approval
Qualified Diagnosis verification
How long to complete a critical incident report once notified
1 business day
What is the process to transition an individual to another waiver?
Coordinate with that waiver program/MyCare case manager, sign a voluntary disenrollment form (agreement/ responsibilities form), send in disenrollment
What is a reportable incident?
behavior resulting in an HSAP, natural death, eviction or housing crisis, health and welfare risk due to loss of caregiver, prescribe medication issues not resulting in EMS/hospital, suicide attempt not resulting in hospitalization
What is the expectation for call completion
completed first two weeks of the month
What are the notes needed for an assessment?
In person visit note
ANSA narrative
Recommendation note
What is the timeline for a reportable incident report submission?
72hrs
Common Disenrollment Types and their Codes
510: Death
410: Transition to waiver
514: UTR
800: LTC
806: loss of Medicaid
What constitutes an EBU being created
Change of residence, hospitalization, nursing home facility admit, 3 incidents in 90days