Transcript BCCCNP Orientation Overview - Michigan Cancer Consortium

BCCCNP ORIENTATION
OVERVIEW
E.J. Siegl, Program Director/Nurse Consultant
Ann Garvin, Nurse Consultant
BCCCNP
Program Management
1. Assure eligible women receive
needed breast and/or cervical cancer
caseload/navigation-only services.
2. Agency achievement of all Minimum
Program Requirements for both
caseload and navigation services.
BCCCNP Caseload Services
• Assist uninsured/underinsured clients (< 250% FPL)
in obtaining appropriate screening and diagnostic
services through the program in a timely manner
• Monitor delivery and documentation of clinical
services according to CDC Clinical Performance
Indicators of Timeliness and Completeness
• Monitor appropriate reimbursement of BCCCNP
approved services for program clients
BCCCNP Navigation Services
• Assist insured clients(< 250% FPL) in
identifying and addressing individual
barriers that may impede their access
to receiving screening, diagnostic,
and/or treatment services through the
healthcare system.
BCCCNP Coordinator Responsibilities
Program Management
• Adherence to Minimum Program Requirements (includes
program policies/procedures)
• Caseload Monitoring – bi-monthly report
• Client Outreach/Recruitment for program services
• Provider Outreach/Relationship Building
• Fiscal management
Program Management
MPR Review
• Accreditation review every 3 years: off-site review
• Requested documents sent to MDHHS reviewer
Caseload Monitoring
• Bi-monthly report posted on DCH File Transfer
• Coordination reimbursement: $175/enrolled woman
• To count in caseload: at least 1 service paid by program
• FY 16 caseload requirements: must achieve 97% of
caseload
Program Management:
Client Outreach/Recruitment
1. Challenge to agencies: Identifying women eligible
for both caseload and navigation-only services
2. Annual Outreach/Recruitment Plan
• Should include strategies to target eligible women
• Use of MIYO patient education resources
Program Management:
Provider Outreach/Relationship Building
1. Work with health care providers, and other
organizations (I.e. FQHC’s, Mammography
Facilities) to identify eligible women that can be
referred to BCCCNP
2. Link with community providers (CHWs)
3. Market the program’s services for all women
(insured and uninsured)
4. Maintain frequent contact with providers
Program Management
Caseload Financial Requirements
Monitor reimbursement for BCCCNP approved services
1. Assure BCCCNP is compliant with the “funds of last
resort” requirement in the federal law.
2. Work with providers to assure reimbursement amount
for each BCCCNP approved service is accepted as
payment in full.
3. Program Financial resources
- Unit Cost Reimbursement Rate Schedule
- Financial Reports (Pended, Paid), Provider and
Facility Form
BCCCNP Coordinator Responsibilities
Overseeing Caseload Services
• Monitoring clinical service delivery according to BCCCNP
Medical Protocol and CDC clinical performance indicators
• Monitoring reimbursement of approved BCCCNP clinical
services
• Assuring accurate documentation of all program data
BCCCNP Coordinator Responsibilities
Overseeing Caseload Services
• Monitoring clinical service delivery according to BCCCNP
Medical Protocol and CDC clinical performance indicators
• Monitoring reimbursement of approved BCCCNP clinical
services
• Assuring accurate documentation of all program data
BCCCNP Caseload Service Components
Clinical
Care
Delivery
Caseload
Services
Documentation
of Program
Data
Reimbursement
of Clinical
Services
Caseload Services:
Clinical Service Delivery
Monitoring clinical services:
• Abnormal breast or cervical screening results according to
BCCCNP Medical Protocol and CDC clinical performance
indicators
• Eligibility to receive cancer treatment according to BCCCNP
Medicaid Treatment Act Protocol
BCCCNP Funding based on achievement of CDC’s clinical
performance indicators of timeliness and completeness.
BCCCNP Medical Protocol
1. Provision of clinical care for average risk
women
2. Follow-up abnormal breast/cervical screening
results according to CDC clinical indicators of
timeliness and completeness
3. Guidelines for reimbursement of BCCCNP
screening and diagnostic Services
CDC Clinical Indicators
Timeliness of Care (Immediate follow-up only)
• 75% abnormal BREAST cases require final diagnosis within 60
days
• 75% abnormal CERVICAL cases require final diagnosis within
90 days
• 80% of all breast and cervical cancer diagnoses should begin
treatment within 60 days of the final diagnosis
Completeness of care:
• 90% of abnormal breast or cervical cases requiring follow-up
have at least ONE follow-up diagnostic procedure and a final
diagnosis documented
• 100% of cases with a breast or cervical cancer diagnosis have
a treatment disposition documented within 100 days of the
diagnosis
Abnormal Results Requiring Immediate
Follow-up
CBE Results
Abnormality - R/O Breast
Cancer” (includes the
following results:
• Dominant mass
• Nipple discharge-no
palpable mass
• Asymmetric thickening/
nodularity
• Skin changes
(Peau d’orange,
erythema, nipple
excoriation, scaling,
eczema, skin ulcers)
Mammogram
• ACR 0 – Assessment
Incomplete-additional
imaging required
Pap test
• ASC-US with
POSITIVE HPV
–
• ACR 4 - Suspicious
Abnormality
• ACR 5 - Highly
Suggestive of Malignancy
• ASC-H
• LSIL
• HSIL
• AGC
• Squamous cell
carcinoma
• Adenocarcinoma
Documenting
Clinical Services
1. Client Enrollment Form
2. Screening/Follow-up Forms
3. BCCCNP Informed Consent
4. Medicaid Application Form
5. Michigan Quit Line Fax Referral Form
http://www.michigancancer.org/BCCCP
(Follow this tree: LCA Information/Forms)
Clinical Forms
1. Client Enrollment Form
2. Screening Form
3. Breast Follow-up Form
4. Cervical Follow-up Form
• NOT A MANDATE TO USE FORMS
• However, ALL information on forms must be collected and
documented in MBCIS
Clinical Services:
BCCCNP Informed Consent
Key Points to Discuss with Women
• Program eligibility for uninsured/underinsured women.
• Potential consequences for the client if insurance status is
not accurately reported.
• Description of breast and cervical cancer screening/
diagnostic tests available through the program
• Statement that not all screening and diagnostic services
are reimbursed by the program
• Assistance to obtain cancer treatment if the woman is
diagnosed through the program.
• Statement that the contents of the form are in effect one
year from date signed.
FY15: Case Management
• Monthly, list received w/ abnormal screening data.
• Data gaps are in comments on form: Abnormal Exams - Incomplete
Clinical Information FY 15
• Once data are complete – approved for CM. Form: Approved for
Case Management Report FY 15
• Posted on DCH File Transfer
• Use date and code found on form, and bill – only through
FY15
• Current Reimbursement: $95.00
• Process will continue under different reimbursement and
different title
“Case Management” – in FY16, will be
under Diagnostic Navigation
• CBE: “Abnormality, rule/out cancer” need diagnostic
mammogram and/or ultrasound or surgical consult to
establish final dx. NO EXCEPTIONS.
• Women with a significantly abnormal breast/cervical
screening must continue to receive indicated follow-up
diagnostic testing
• Must have testing
• Must have a final diagnosis (cancer/not cancer)
• If cancer, must have a treatment disposition
Diagnostic Navigation Process
• Monthly, list received w/ abnormal screening data.
• Data gaps are in comments on form: Abnormal Exams -
Incomplete Clinical Information FY16
• Posted on DCH File Transfer
• Process needs to continue as before; once care is
complete in MBCIS, name will come off of form: Abnormal
Exams - Incomplete Clinical Information FY16
Our work with Title X agencies (cervical)
• In brief: women who are patients of Title X agencies (HD
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FP clinics/Planned Parenthood)
Have abnormal Pap needing colposcopy (MUST follow
ASCCP Guidelines for women <age 25)
Income ≤250% FPL, uninsured or underinsured
BCCCNP pays for follow-up dx testing
If treatment indicated (≥CIN2 final dx), put on BCCCNP
Medicaid Treatment Act to pay for treatment
Contact Ann Garvin ([email protected] or 517-3359087) for diagnostic LEEP or Cone and EMB
New in FY15 (breast)
• Women <age 40 with abnormal CBE indicating a possible
breast cancer diagnosis
• Income ≤250% FPL, uninsured or underinsured
• Agency refers to BCCCNP to schedule ultrasound (and, if
indicated by results, surgical consult and/or mammogram)
• Contact Ann Garvin to discuss management if any questions
• If treatment indicated (DCIS, LCIS or Invasive Breast
Cancer diagnosis), put on BCCCNP Medicaid Treatment
Act to pay for treatment
BCCCNP Medicaid Treatment Act
• Client Eligibility
• Client Enrollment (via Caseload Services or
Navigation-Only Services)
• Duration of Coverage for Cervical
Treatment
• CIN 2 (2-3 months), CIN 3 (6-7 months)
(Guide for documenting Treatment Start Date)
• Yearly Re-Determination
• Hearing/Appeals
BCCCNP Coordinator Responsibilities
Overseeing Navigation Services
Establish a network of medical and community providers to
assist in:
• Identifying insured eligible women (<250% FPL) requiring
assistance in obtaining needed breast/cervical cancer
services
• Identifying resources for resolving barriers that may
impede the woman from receiving breast/cervical cancer
services
Navigation-Only Services
1. Readiness to Learn
2. Form completion:
- Intake Assessment
- Encounter Summary
- MTA Encounter Summary
October 1, 2015
Algorithm to Assess Client’s Readiness to Screen
NO
Client NOT Eligible for
Navigation-Only Services
1. Client due for
breast/cervical
screening?
YES
NO
2. Client WILLING to
receive needed
services?
DO NOT COMPLETE
NAVIGATION
FORMS OR ENTER
DATA IN MBCIS
YES
NO
FINAL CLIENT ENCOUNTER
Complete Navigation
Encounter Form
Navigation-Only
Services Completed
**Assistance/Intervention Needed for:
·
System Barriers,
·
Financia Barriers,
·
Psychosocial Barriers,
·
Communication Barriers
FIRST CLIENT ENCOUNTER
Complete Navigation
Intake Assessment Form
3. Client needs agency
help in scheduling
services? **
YES
YES
4. Client received
needed services?
NO
Data Management
Program Data Requirements
1. MBCIS User Agreement/User Access Form- All
applications
• Documenting Clinical/Non-Clinical Data in MBCIS
• Caseload Reports – BI-weekly reports from Mike Carr
• DCH File Transfer for confidential patient information
ACCESS to Applications – Step 1
• User Agreement
Form
• MBCIS
• Discoverer
• Patient Navigation
• DCH File Transfer
• Cancer Mapper
• Fax to 517-335-8752
Single Sign On – Step 2
• SSO Application Portal
• https://sso.state.mi.us
• Subscribe to Applications
MBCIS, Discoverer, DCH File Transfer &
Cancer Mapper Access Instructions
• For complete, step-by-step instructions, please go to:
www.michigancancer.org/BCCCP
• LCA Information > Manuals > MBCIS, Discoverer, DCH File
Transfer, or Cancer Mapper
MBCIS Access Instructions
Discoverer Access Instructions
DCH File Transfer Access Instructions
Cancer Mapper User Guide and Access Instructions
Website Utilization www.michigancancer.gov/BCCCP
• BCCCNP Caseload Eligibility & Services
• How to Become a Provider
• Benefits of Becoming a Provider
• Patient Navigation
• Patient Navigation Protocol
• Forms
• Rates & Codes
• Presentations
• LCA Information
• Agency Best Practices
• Clinical
• Clinical Webinars
• Early Detection Clinical Protocols
• BCCCNP Medical Protocol
• BCCCNP Medicaid Treatment Act
Website Utilization www.michigancancer.gov/BCCCP
• Resources & Materials
• Affordable Care Act (ACA) & Healthy Michigan Plan (HMP)
• BCCCNP Annual Meetings
• MDHHS Cancer Fact Sheets
• Patient Education
• Webinars
• Federal Poverty Guidelines
• Miscellaneous
• Breast Cancer Awareness License Plate
• Breast & Cervical Cancer Screening Brouchure
• Patient Information
• Breast Density Info
• Cervical Cancer Info
Website Utilization www.michigancancer.gov/BCCCP
• Billing & Reimbursement
• Rate Schedules
• ICD-10 Codes
• Revenue Codes
• Place of Service Codes
• Hold Codes
• Billing & Reimbursement Guide
• Billing Guidelines – Paper & Electronic Claim
Submission
• Procedure Code Reference Chart
Website Utilization www.michigancancer.gov/BCCCP
• LCA Information > Manuals >
• MBCIS
• MBCIS Access Instructions
• MBCIS Online Training for Clinical Access
• MBCIS Basic Data Entry
• MBCIS Clinical Data Entry
• Cancer Mapper
• DCH File Transfer
• Discoverer
• LCA Information > Forms
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Client Enrollment Form
Screening and Follow-Up Forms
Informed Consent
Medicaid Application
MBCIS User Application Form
Provider & Facility Form
Michigan Tobacco Quit line Fax Referral Form
HPV Materials Order Form
DISCOVERER
• User Name = same as
your SSO login for
MBCIS
• Password – if you have
forgotten your password,
or need it reset, please
contact Tory Doney at
517-335-8854 or
[email protected].
• Database = pbc2
(peanut butter cookies)
DISCOVERER
DISCOVERER - *NEW* PEND
• The MOST IMPORTANT Billing & Reimbursement report
that can be run!
DISCOVERER - *NEW* PEND
DISCOVERER - *NEW* Payments
DISCOVERER - *NEW* Payments
Questions????
Contact Information:
• Ann Garvin ([email protected]; 517-335-9087)
(Clinical, Breast and Cervical Cancer, Case Management,
<age 40 Questions)
• E.J. Siegl ([email protected]; 517-335-8814)
(Program, MTA, QI Questions)
• Tory Doney ([email protected]; 517-335-8854)
(Billing and Reimbursement Questions)
• Sam Burke ([email protected] ; 517-241-6913)
(Billing and Reimbursement Questions)