TRC
1. Name all 4 rates that are reported for TRC measure?
NIA: Notice of Inpatient Admission
RDI: Receipt of Discharge Information
MRP: Medication Reconciliation Post Hospital Discharge
PE: Patient Engagement
True or False
The member or family members can notify PCP/OCP of the inpatient admission.
False
What date is acceptable to receive documentation in the outpatient medical record for evidence of receipt of discharge information?
On the day of discharge through 2 days (3 days total)
Two questions:
1. Medication Review Post Discharge should be conducted by who?
2. Is it acceptable for a CMA to perform a medication reconciliation post hospital discharge?
A. Prescribing practitioner
B. Clinical pharmacist
C. Physician assistant (NP, PA, OD, MD)
D. Registered nurse
2. Yes, as long as the provider signs off on the note within the appropriate timeframe.
What timeframe is acceptable for PE notification?
Patient Engagement must be done within 30 days of discharge. (Cannot be on day of discharge)
True or False:
Palliative care is an exclusion for TRC
False:
Exclusions:
1. Members in hospice or using hospice services any time during MY
2. Members who died any time during the MY.
True or False
Notification of Inpatient admission meets criteria if you received notice on the day after admission through 3 days after.
False
The day of admission through 2 days (3 days total)
True or False:
Both of the statements listed below are not acceptable documentation for instructions for patient care post -discharge
"No Follow up needed"
"Change dressing 2x daily"
False,
Either statement is acceptable for Instructions for patient care as long as you have the rest of the criteria for RDI (all 6 items found in the discharge summary plus evidence of receipt of RDI)
When is the acceptable timeframe for documentation of Medication Reconciliation Post Discharge?
The date of discharge through 30 days after discharge (31 total days)
Is a Home Health visit and a Home Health Certification acceptable for PE?
No,
Only Home Health visit is acceptable. Home Health certification is unacceptable.
Yes/No
If the initial and the readmission/direct transfer discharge occurs after Dec 1 of the MY, do you still abstract?
No
You may see all discharges on or between Jan 1 and Dec 1. After Dec 1st we do not abstract documentation.
Two part Question
1. Name 3 types of communication that are acceptable between outpatient provider and inpatient hospital staff for NIA.
2. Yes or No:
Can you accept documentation for NIA with a "sent" date?
A. phone call
B. email
C. Fax
2. No, all documentation must be scanned into the outpatient record with date scanned/received or filed.
Name at least 4 Unacceptable notifications for RDI
1. Missing ANY of the 6 RDI components
2. Services documented outside the measure timeframe
3. Family members notifies PCP or OCP of d/c
4. No documented timestamp when the d/c information was placed in the OP medical record
5. Any inpatient record that is NOT contained in the OP medical record, or that you can not establish that it is part of a Shared EMR.
6. Continuity of Care Documents (CCDs)
7. Health Information Exchange (HIEs)
8. In-home assessments (IHAs) and health risk assessments (HRAs) if these are the only documents in the chart image
9. Telehealth is unacceptable-member reported is unacceptable documentation for RDI
List 4 things to review/verify when abstracting compliant documentation for MRP.
1. Verify DOS in timeframe
2. Verify provider type that completed med rec
3. Verify Medication list is present
4. Confirm review/reconciled or appropriate provider signed the note.
Name 4 types of documentation that meet patient engagement criteria.
1. Outpatient visit, including office visits and home visits.
2. Telephone visit (patient does not need to come in person)
3. A synchronous telehealth visit where real-time interaction occurred between the member and provider using audio and video communication.
4. An e-visit or virtual check-in (asynchronous telehealth where two-way interaction, which was not real-time, occurred between the member and provider
What are 4 ways to identify that a record is a "Shared" EMR?
1. Matching MRN number on inpatient documentation and outpatient office notes.
2. Matching health system names/logos in documentation headers
3. A web address located at the bottom of the medical record indicates the location of the EMR system from which it was printed. (https://)
4. Encounter summary that includes both inpatient and outpatient office visits.
Yes or No
When an ED visit results in an inpatient admission, does the notification that a provider sent the member to the ED meet criteria?
No
Only evidence in outpatient record that the PCP/OCP communicated with the ED about the admission meets criteria
Name three examples of documentation that does not count as numerator compliant for RDI.
1. Notification done by the members family to the PCP/OCO
2. Any documentation of RDI that is incomplete or missing any of the 6 requirements.
3. Documentation without evidence of when the information was placed in the outpatient medical record (timestamp, file date)
A discharge summary alone, does not meet criteria
Daily Double!!
Is the office note below acceptable for MRP as long as it is dated within correct timeframe?
Reason for visit: follow up post knee surgery
HPI:
Patient had knee surgery on (date) and was given prednisone and amoxicillin. Medications were reviewed/reconciled
Current Medication List
Metoprolol
Eliquis
Prednisone
Amoxicillin
Signed: Dr. Jovi
Not acceptable:
The office note did not mention hospitalization. Post surgery alone is not acceptable.
What provider type is acceptable for the Patient Engagement after discharge?
The engagement visit may be performed by RN, clinical pharmacist, other prescribing practitioner, a physical therapist, occupational therapist or a speech therapist Any visit (e.g. office visits, home visits or telehealth visits) documented in the outpatient medical record accessible to the PCP or OCP within 30 days of discharge, meets criteria, regardless of the provider type and the reason for the visit.
If you receive inpatient records from an emergency visit note and a hospital discharge summary that includes the same MRN# listed on both, is this acceptable documentation for TRC?
No
Because the medical record received does not have any Outpatient notes or anything indicating it has both IP and OP records.
Only information in an Outpatient medical record is acceptable for all 4 components of TRC. From the list below, which facilities are considered Outpatient?
1. Hospital
2. Provider or Specialist office
3. Behavioral Health Facility
4. Skilled Nursing facility
5. Memory Care Unit
6. Urgent Care Center
7. Rehab Center
8. Assisted Living
9. Long Term Care
10. Nursing Home
11. Home Health
Outpatient facilities:
Provider or Specialist office
Urgent Care Center
Assisted Living
Home Health
Documentation in the outpatient medical record must include evidence of receipt of discharge information on the day of discharge through 2 days.
What are the 6 elements you will need in addition to the evidence of receipt of discharge?
1. The practitioner responsible for the member’s care during the inpatient stay
2. Diagnoses at discharge
3. Procedures or treatment provided (e.g. CABG, any treatment like IV infusion or surgery)
4. Current medication list and discharge medications given
5. Testing results, or documentation of pending tests or no tests pending
6. Instructions for patient post-discharge care
List at least 3 out of 7 acceptable documentation for evidence of medication reconciliation post discharge in the outpatient medical record.
Any of the following in the outpatient medical record meet criteria:
1.Documentation of the current medications with a notation that the provider reconciled the current and discharge medications
2. Documentation of the current medications with a notation that references the discharge medications (e.g., no changes in medications since discharge, same medications at discharge, discontinue all discharge medications)
3. Documentation of the member’s current medications with a notation that the discharge medications were reviewed
4. Documentation of a current medication list, a discharge medication list, and notation that both lists were reviewed on the same date of service
5. Documentation of the current medications with evidenced that the member was seen for post-discharge hospital follow-up with evidence of medication reconciliation or review.
6. Documentation in the discharge summary that the discharge medications were reconciled with the most recent medication list in the outpatient medical record. **There must be evidence that the discharge summary was filed in the outpatient chart on the date of discharge through 30 days after discharge (31 total days)
7. Notation that no medications were prescribed or ordered upon discharge.
Name 5 Unacceptable documentation for PE
1. Patient Engagement over 30 days after discharge (out of timeframe)
2. Home Health Certification
3. Speaking with a caregiver without clear documentation the member is unable to communicate with the provider. (Member being unavailable is not acceptable for unable to communicate evidence.)
4. Continuity of Care documents (CCDs)
5. Health Information Exchange (HIEs)