The Lone Star Bulletin - September 2007
From the Desk of The Executive Director
Moving into the electronic age: Welcome to the inaugural edition of the electronic Lone Star Bulletin. This transition is necessary to more efficiently use our limited resources that include real dollars saved on printing and human resources in staff time to compile mailings. PLEASE provide feedback on this change and your ideas for improvements! The Lone Star Newsletter, for patients, will continue in hard copy to ensure availability to all.
Coming from the Network in 07-08
While the Fistula First project will continue, the Medical Review Board recently selected Increasing Modality Awareness as the 07-08 NW 14 Quality Improvement Project. Here’s something that may surprise you-out of 399 facilities open at year end 2006, 258 had NO patients on any home modality for 2004-2006. Complex factors clearly are responsible for this finding that include centralized home programs, which may be best practice, and referrals for home training initially so that facilities offering only in-center hemodialysis show no home patients. Click here to see data.
Continued collaboration with the Texas Emergency ESRD Coalition (TEEC). Hurricane season is upon us and while we hope and pray none approach our shores, facility preparation and patient education should already be complete. For more information and resources go to:
- http://www.esrdnetwork.org/professionals/disaster-planning/index.asp;
- http://www.texasemergencyesrd.org;
- http://www.kcercoalition.com (the website of a national ESRD emergency coalition)
Or call the NW for assistance in developing your plan.
Save the date for the Network 14 Annual Meeting on April 1st, 2008, (no fooling) at the Gaylord Texan Hotel in Dallas from 1-5pm held in conjunction with the NKF Clinical Meetings 08. Watch for details soon!
Renewed focus on Involuntary Patient Discharge because the rate has risen dramatically in the first 6 months of 2007 after 4 consecutive years of decline. Click here to see the data trend chart. Call or email John Gowan at 469-916-3808 for assistance and visit esrdnetwork.org/professionals/dpc/ for resources.
Results of a pilot project with the Department of Aging and Disability Services (DARS) to establish ESRD specialist VR counselors and partnerships with SW’s. We thank you for all that you do for people with in Texas.
Helpful Information for Physicians...
If you are a physician who has patients with permanent kidney failure, there is a Medicare guide you need to read. It will tell you:
- How your patients get Medicare if their kidneys fail
- How Medicare helps to pay for kidney dialysis and kidney transplants
- Where to get help
This guide will explain how Medicare helps pay for kidney dialysis and kidney transplant services in the Original Medicare Plan, also known as “fee-for-service.” A similar guide has been made available to patients; however, it does not include detailed information about kidney failure, dialysis treatments, or kidney transplants. To learn more about these topics, patients should talk not only with you, their doctor, but with their entire health care team- their nurse, social worker, dietician, and dialysis technician. Based on the situation, you and your patient can then select the best treatment options. To view or download the complete Physician’s Guide to Medicare Coverage of Kidney Dialysis and Kidney Transplant Services; please Click here.
Dialysis and Long Term Care....
Finding a long-term care residence for a loved one can be a daunting task, especially to those whose family members are on dialysis. To help families select the choice that is right for them, the National Kidney Foundation has developed the People Like Us: Long-term Care Residence Chronic Kidney Disease Checklist.
Offering guidance and helping families in need, the Checklist identifies important questions to ask when visiting facilities for potential placement. The Checklist covers critical topics, including staff training, kidney-friendly diet and meals, communication, transportation and safety. “Placing a loved one in a long-term care residence is stressful under the best of circumstances,” says Laura Weber, a Patient Family Council Executive Committee member. “The NKF’s new Long-term Care Chronic Kidney Disease Checklist is an excellent resource to help families select the facility best equipped to care for the special needs of people with CKD. This tool will help guide family members through the process in an objective manner and ultimately ensure the best home for loved ones.”
The checklist can be downloaded at www.ltckidneychecklist.org
The ESRD Network of Texas would suggest and highly recommend that facilities develop a relationship with long term care facilities in their area, especially if your facility has long term care patients dialyzing at your facility. Open lines of communication between the long term care facilities and the dialysis units. You can assist one another to assure the best possible continuity of care for patients.
Is YOUR Facility Ready for a Survey?
PLEASE READ: Texas Department of State Health Services revisits could cost the facility $1,490! Important Announcement Regarding Revisit User Fee The revisit user fee regulation became effective, Wednesday, September 19, 2007. CMS will start collecting user fees for revisits after this date. Essentially, this regulation specifies that if a Medicare provider (with some exceptions) is found out of compliance and requires an onsite revisit by the state survey agency to verify correction, they will be getting a bill for the revisit. If they don’t pay CMS can terminate their Medicare provider agreement.
Please pass this information along. We want as many providers as possible
to know that the regulation is now in effect.
Shortcut to: http://www.cms.hhs.gov/SurveyCertificationGenInfo/06_RevisitUserFeeProgram.asp.
Many facilities that have been the recipients of recent Texas Department of State Health Services (DSHS) surveys have realized (too late) that their facilities were not ready! Being able to proactively prevent Corrective Action Plans and/or loss of licensure (and the accompanying stress and panic) is a prudent course of action for all Texas facilities. The time to ask – “Is our facility adequately prepared for a DSHS survey?” – is NOW! In other words, don’t wait for the surveyor to walk through your door on the busiest day of the week...
The first step towards a positive survey is becoming familiar with the Texas and CMS ESRD Licensure Rules and Regulations. To help facilities prepare for the survey process, DSHS has published the following itemized survey tools for Federal and State surveys:
- End Stage Renal Disease Facility Audit Tool. Word File 1,526KB, 109 pages
- Stage Disease Facility Federal Tool. Word File 484KB, 52 pages
The tools are available for downloading at: http://www.dshs.state.tx.us/HFP/esrd/shtm.
We encourage you to utilize these tools to evaluate and prepare your facility for survey. The tools will help you identify deficiencies in facility practices and processes prior to being surveyed. Proactive identification of deficiencies, coupled with planning and timely implementation of corrective actions addressing the deficiencies will help you avoid citations during an official survey. To help identify deficiencies on a timely basis, consider incorporating self-evaluation with the survey tools into your facility’s QI plan and scheduling annual or bi-annual facility self-evaluations.
If you have any questions about survey activity or need clarification about survey tool items, please contact your DSHS state surveyor. You may also contact Angie Wieler, Quality Improvement Coordinator at the ESRD Network (469.916.3806) or awieler@nw14.esrd.net.
BE: Proactive
BE: Ready
BE: Prepared
Network 14 Data Department FAQs
Q: I need a copy of a patient’s 2728 form, how do I go about getting it from the Network?
A: If requesting a copy of a patient’s 2728, 2746 or snapshot report, a 2728/2746 request form must be submitted to the network via fax @ 972-503-3219. A copy of this form can be sent to your unit by calling either Casey Contreras (469-916-3809) or Jennie Conley (469-916-3811). If a 2728 request is made and the patient is not deceased a patient signature is required per HIPAA regulations.
Q: I have a patient that has returned to dialysis after a failed transplant, do I need to complete another 2728 form?
A: The patient will need a re-entitlement 2728 if the patient returns to dialysis greater than 36 months after the transplant date. A good resource for answering questions about when to complete a 2728 is located on our website www.esrdnetwork.org. Just go to the CMS forms link and click CMS 2728. Under the “Tips and Tricks” heading is “When to complete a 2728” which will help answer most of these types of questions.
Q: I have received a Missing Forms report from the Network regarding a patient who died after leaving my facility. Why am I being asked to complete a 2746 form by the network?
A: If a patient dies within 30 days of the loss date reported (Lost to Follow Up, Discontinue, Transfer Out), your unit will still be responsible for completing that patient’s 2746 form.
Q: I have new patients. How do I obtain their IDNUMs for their emergency wristbands? ( This applies to Gulf Coast units only )
A: All requests for IDNUMs can be handled by Casey Contreras (469-916-3809) or Jennie Conley (469-916-3811). If your patient is brand new and we have not received their 2728 or new event on the PAR, the IDNUM will not have been assigned to that patient. Please wait until you have sent that information to the Network before requesting the IDNUM. If requesting IDNUMs for more than 10 patients, please fax a list of the patient names, Social Security Numbers, and Dates of Birth to Network #14 at 972-503-3219.
Q: Am I using the newest version of the PAR at my facility?
A: The newest version of the PAR was mailed to all units May 31, 2007 along with the Quarterly Event Validations. The PAR is due to the Network by the 8th of each month. Remember to include all patient identifiers (SSN, DOB), modalities, and information on where the patient is going to or coming from. If the patient is going to a unit with a pending Medicare Provider Number please specify that on the PAR. If your facility needs a new version of the PAR, one can be requested from either Casey Contreras (469-916-3809) or Jennie Conley (469-916-3811) (Available on the Website in the Fall of 2007.)
Q: When do I use the event code 6C on my PAR?
A: An event code 6C is used only for patients who are involuntarily discharged from your facility for the following reasons: Verbal/written threat or abuse, threatening or causing property damage, and threatening or causing physical harm.
Q: When do I use the event code 6B on my PAR?
A: 6B event code should be used for any patient who transfers out to a facility without an ESRD Medicare provider number: this includes nursing homes, rehab centers, prison, out of country or any other inpatient setting. Call the Network if you are unsure if a facility is an ESRD Medicare provider.
Q: I have a patient at my facility who is going to receive a transplant. What is the appropriate event code to use on my PAR to discharge the patient?
A: The event code 5A should be used for any patient who will receive a transplant in the United States. If the patient is receiving a transplant outside of the United States, 5B is the appropriate event code. The most current version of the PAR indicates “5A TRANSFER OUT FOR TRPLNT IN THE US” in the event code key.
Q: I received a PAR adjustment fax from the Network, which stated that the transfer out I listed for a patient on my PAR was not made, why?
A: CMS asks the Network not to transfer a patient out of a facility if the receiving facility is a Medicare provider and has not indicated a Transfer IN on their PAR. Contact the receiving facility by telephone and ask them if the patient was actually admitted to their unit and what day they will report the transfer in to the Network. This will help you determine what date needs to be listed on your PAR. If you are unsuccessful in contacting the receiving unit, you may call either Casey Contreras (469-916-3809) or Jennie Conley (469-916-3811) to help resolve the issue.
New Certification Rule for Organ Transplant Centers
Countdown is underway for current Medicare-approved organ transplant centers to request certification under the new rule. All hospital transplant centers currently approved for Medicare participation (approved either under the ESRD Conditions of Coverage or the National Coverage Decisions) must submit a request for new approval under the Conditions of Participation established by the new regulation that was issued by CMS on March 30, 2007. Your request must be submitted to CMS by December 26, 2007 (180 days from the effective date of the regulation). Please Note: If an Organ Transplant Center does not submit a request for approval under the new Conditions of Participation by December 26, 2007, CMS will conclude that the center no longer desires Medicare participation and will begin the process to withdraw Medicare approval. There is no application form. Transplant centers must send a request (e.g. a letter) to CMS with specific information. For a list of all transplant centers covered by the regulation and a listing of the minimum information that must be included in all requests to CMS for approval of your transplant center, please visit the transplant web page at: www.cms.hhs.gov/CertificationandCompliance/20_Transplant.asp. Transplant centers desiring first time Medicare certification must send a request to CMS with the same information. This can be done any time the center is ready for initial Medicare certification. If you have any questions concerning the approval requests, timelines for the regulation, the information that must be submitted with the approval request, or the survey and certification process, please direct your inquiries to Sherry Clark in the Survey and Certification Group at CMS at 410-786-8476.
Have you heard this before????
There is no enrollment period for ESRD patients. The Network is working with the Regional office of CMS to ensure a notice is sent out to the local field offices to educate the staff. An active 2728 is an entitlement document, which allows ESRD patients to access services. If you are being told by your local SSA office that an ESRD patient has to wait for general enrollment to access Medicare benefits for dialysis, we want to hear from you. Please email Geli King-Brown, Outreach Coordinator at gbrown@nw14.esrd.net.
Still Confused about NPI?
Group Practices that conduct ANY HIPAA standard transactions MUST have an NPI! Not sure what an NPI is and how you can get it, share it and use it? As always, more information and education on the can be found through the CMS NPI page www.cms.hhs.gov/National ProvidersStand on the CMS website. Providers can apply for an NPI online at https://nppes.cmshhs.gov or can call the NPI enumerator to request a paper application at 1-800-465-3203.
Nephrology Today & Tomorrow
Nephrology Today & Tomorrow 2007 will be held on Tuesday, April 1 at the Gaylord Texas in Grapevine. Attendees of the Network meeting will receive a discount to attend the National Kidney Foundation Clinical Meetings CM08. Mark your calendar and look for more information coming soon...
Vocational Rehabilitation Activity Report
Your facility should have received its Vocational that was mailed in July. This report compares your facility with the state averages of patients receiving vocational rehabilitation services. The ESRD Network of Texas recognizes that multiple barriers exist that make it difficult for patients to access vocational rehabilitation services. Our goal is to improve the system so that patients and providers can work more efficiently to assist patients in retaining or gaining employment.
The ESRD Network of Texas and Texas Department of Assistive and Rehabilitative Services (DARS) are collaborating to increase the number of ESRD patients who can benefit from the many services DARS offers. DARS has new directives that emphasize serving the disabled populations and revised internal processes that we believe will reduce disincentives to working with our patients.
The initial phase of the pilot project will begin in October starting with various Dallas area DARS offices. Education will be provided to vocational counselors regarding the complexities of chronic illness and the specifics of ESRD and its treatment. Following this outreach, DARS will identify counselors with a passion for working with our patients to serve as DARS ESRD specialists, and they will provide education to nephrology Social Workers on the DARS process for assessment and services.
By helping to establish ongoing, collaborative relationships between specialized DARS counselors and nephrology social workers, we hope to improve the quality of life for patients in Texas through improved access to vocational rehabilitation services.
If you are interested in being part of an ESRD Network of Texas sub-committee on this project, please contact, John Gowan, LMSW, Patient Services Coordinator at (469) 916-3808 or Mary Beth Callahan, ACSW/LCSW, Committee Chairperson, at 214-358-2300. We look forward to hearing from you.
www.esrdnetwork.org
Next time you have a question that requires a call to the Network office... check out our website first. In an effort to become more efficient, the Network has had to develop better ways to disseminate information to the community. Therefore, our website will continue to evolve in order to accommodate frequent requests from facilities, patients and professionals. We want to hear from you. Please feel free to send us your comments or suggestion regarding the website and items you would like to see posted to the website for your convenience. Please send your comments or suggestions to gbrown@nw14.esrd.net.
Who is your NPR?
The Network has asked each facility to recommend or seek nominations from patients for a Patient Representative (NPR). This is a very important role for a patient within the facility. The NPR will receive information and resources from the Network in order to provide assistance to fellow patients. This position is flexible and should not be viewed as a burden or extra work. However, the reason for the NPR is to ensure that each facility in the state of Texas has a knowledgeable patient advocate within the facility to assist the facility staff and the Network with promoting compliance and reducing complaints and most importantly providing information and resources to patients. The NPR should work with the facility staff on any projects or suggestions they may have to enhance patient participation within the facility. We encourage the NPR to contact the Network for suggestions or examples of how other NPR’s have developed their role within the facilities. The NPR can also contact one of the PAC members in their region for additional advice, suggestions or support. For more information or to update your facility NPR information, please contact Geli Brown, Outreach Coordinator at gbrown@nw14.esrd.net or 469-916-3800.
Called the Network office lately?
On September 5, 2007, callers to the Network office noticed a change in the way their call was being answered when we switched to an auto-answer system. This difficult decision was necessary due to the high volume of calls and the ever-increasing workload without an increase in Network staff. Over the next few months we will be “fine tuning” the automated system so we are requesting everyone’s patience with this process.
Please click on the link listed below to download the staff list that includes job duties, email addresses, extensions and direct dial numbers. We strongly recommend that this list be placed beside all phones in your clinic and that staff be encouraged to use the direct dial phone numbers to save time and trouble when seeking assistance from the Network office.
THANKS FOR THE SUPPORT.......!
We appreciate your comments or suggestion to bring you information and tools you need. Please email gbrown@nw14.esrd.net to make suggestions, comments or corrections. Or if you wish to be removed from or added to this distribution list, please let us know.
This newsletter is published by the ESRD Network of Texas, Inc. #14 under contract #HHS-500-2006-NW014C with The Centers for Medicare & Medicaid Services (CMS).