Why Providers Struggle with EHR and Documentation

A big question for the future of technology in health and human services – how to make EHRs better serve the professionals delivering care? That was the focus of a discussion with Peter Flick, Chief Executive Officer of Remarkable Health, at a recent OPEN MINDS Technology & Analytics Institute.

The history of EHRs has created a challenge. Flick explained, “The best thinking in software in the 90s was, ‘let’s take our paper-based process and put it online.’ EHRs were designed to help a provider organization better manage information across the board and demonstrate meaningful use for compliance. They were not designed from the ground up to help make clinical professionals more efficient and effective. That’s kind of a backwards way to do things. The EHR is really powerful and can do the work of 10 to 40 staff once the data is in the system but getting the data into the EHR is a challenge and the bane of clinical professionals’ existence.”

Most clinical professionals are unable to do concurrent documentation, and the inevitable delays cause inaccuracies. Flick elaborated, “The average time from session to actual note signing is 3.3 days, which is a lot of time. The clinical professionals finally get the note in and then there’s a review process and a quality assurance process. Some provider organizations told us that they have certain programs that are that are only at 50% utilization, because they’re spending the other 50% of their time on documentation!”

Client Profiles was designed in 2020 to better manage the affordability, poor work flows, and low adoption and usage rates many providers struggle with using traditional EHR. Download the most recent Client Profiles Alerts fact sheet to learn more.

Tax Credits for Vaccination Time Off

The Internal Revenue Service and the Treasury Department announced further details of tax credits available under the American Rescue Plan to help small businesses, including providing paid leave for employees receiving COVID-19 vaccinations.

Eligible employers, such as businesses and tax-exempt organizations with fewer than 500 employees and certain governmental employers, can receive a tax credit for providing paid time off for each employee receiving the vaccine and for any time needed to recover from the vaccine. For example, if an eligible employer offers employees a paid day off in order to get vaccinated, the employer can receive a tax credit equal to the wages paid to employees for that day.

The American Rescue Plan Act of 2021 (ARP) allows small and midsize employers, and certain governmental employers, to claim refundable tax credits to reimburse for the cost of providing paid sick and family leave to their employees due to COVID-19. The ARP tax credits are available to eligible employers that pay sick and family leave for leave from April 1, 2021, through Sept. 30, 2021.

The paid leave credits under the ARP are tax credits against the employer’s share of the Medicare tax. The tax credits are refundable, which means that the employer is entitled to payment of the full amount of the credits if it exceeds the employer’s share of the Medicare tax.

Top 5 Benefits of an Integrated System

When running an agency, there are multiple operations that need to be tracked – schedules, trainings, clock-ins and outs, hiring, and more! Having multiple systems to track all of this can really bog down an agency’s operations. An integrated system has multiple benefits that impact all sectors of an agency.

1.     Reduced Data Entry

Entering data into an electronic system manually can be a frustrating and time-consuming job. Integration cuts this work by half. When fully integrated, the administrative burden is reduced and work efficiency improved. Eliminating data entry hassles result in time and money savings.

2.     Higher Reimbursement Velocity

Integration improves the first pass claim rates. Staff will spend less time working on rejections with an improved the first pass claim ratio.

3.     One Central Management Solution

An integrated solution reduces training needs and increases acceptance long term. Staff learn one integrated system that increases collaboration and accountability. Improved workflow should = improved care.

4.     Improved Interoperability

An integrated system improves the communication between the internal systems of your agency by creating a smooth channel for the flow of information.

5. Transparency

An integrated system empowers your agency with a transparent workflow. You can more easily track the number of individuals receiving service, submit claims more promptly, get paid earlier, minimize rejected claims, spot missed billing and manage receivables in a single place. A transparent workflow helps identify areas that require attention.

UK Care Givers Lose ‘Sleep-In Shift’ Pay

Care workers across the UK who have to sleep at their workplace they are needed are not entitled to the minimum wage for their whole shift, the UK Supreme Court has ruled.

The case was brought by Clare Tomlinson-Blake against the learning disability non-profit, Mencap.

The case sought to overturn a 2018 Court of Appeal ruling. The union, Unison, argued on her behalf that care staff should get the minimum wage for nightshifts, even if they are asleep.

If she had won, care providers feared an estimated £400m bill for back pay, which they said they could not afford.

Mrs. Tomlinson-Blake was paid by Mencap for a sleep-in shift between 10pm and 7am. Although she could sleep, she was expected to keep a “listening ear” out for the home’s residents and provide them with support if needed during the night.

Over 16 months, she was called on six times, receiving no extra money for the first hour she was called, although after that she was paid at the full day-time rate. A second case was brought by John Shannon, a care worker whose case was heard at the same time as Mrs. Tomlinson-Blake’s. His case against his former employers was also dismissed.

The Supreme Court concluded there was an exemption in national minimum wage legislation which applied to sleep-ins. The court’s written ruling, said that “sleep-in workers… are not doing time work for the purposes of the national minimum wage if they are not awake”.

In 2017 the Employment Tribunal found Mrs. Tomlinson-Blake used her “listening ear” and experience to know when she was needed – so she was “working” even when asleep. This meant she was entitled to an hourly minimum wage. But in 2018, the Court of Appeal ruled that “sleepers-in” were to be characterized as “available for work… rather than actually working”. This meant, “the only time that counts for national minimum wage purposes is time when the worker is required to be awake for the purposes of working”.

Edel Harris, chief executive of Mencap, said, “Support workers within Mencap and across the sector do an exceptional job. They are dedicated in their care for people with a learning disability and should be paid more.” But she added, “It is no exaggeration to say that if the ruling had been different, it would have severely impacted on a sector which is already underfunded and stretched to breaking point. Some providers would have gone bust and, ultimately, the people who rely on care would have suffered.”

For more information on managing overnight shifts, download the myCheckIn fact sheet.

American Rescue Plan Continued

It was recently announced that The American Rescue Plan would provide billions of dollars for HCBS programs. Below are more details about the package. Check out the first blog to learn more.

  • Increases the total dollars available for Medicaid HCBS, as states are required to maintain their current HCBS spending to qualify for the enhanced federal funds. Specifically, states have to maintain their level of HCBS spending as of April 1, 2021. The proposed 10 percentage point increase for HCBS is added to the state’s regular Medicaid matching rate (which ranges from 50% to 78% in FY 2022), as well as to other FMAP increases available to states, including the 6% percentage point increase for Community First Choice attendant care services, the 6.2% increase provided to address the COVID-19 public health emergency (PHE) under the Families First Coronavirus Response Act, any disaster recovery FMAP (available to states with a federally declared disaster and a certain amount of FMAP decline), and the 90% federal matching rate for Medicaid expansion adults under the ACA, as well as a proposed 5% in the regular matching rate for states newly adopting the ACA expansion provided in a separate section of the bill. The cumulative enhanced matching rate for Medicaid HCBS under the bill is capped at 95%.

  • Estimated total Medicaid HCBS spending varies widely by state, ranging from $198 million dollars in Wyoming to nearly $22 billion in California. The additional $11.4 billion federal dollars from this FMAP increase is distributed proportional to the size of state HCBS programs, with California receiving nearly $2.2 billion additional federal dollars, Missouri $226 million and Wyoming receiving about $19.8 million additional federal dollars.

  • States have a new option to provide community-based mobile crisis intervention services with 85% federal matching funds for the first 3 years. The additional funds must supplement, not supplant, the level of state spending for these services in the fiscal year before the first quarter that a state elects this option. Services must be otherwise covered by Medicaid and provided by a multidisciplinary team to enrollees experiencing a mental health or substance use disorder crisis outside of a hospital or other facility setting. These services generally do not have to be offered statewide, do not have to be comparable for all enrollees, and can restrict enrollees’ free choice of provider. The new option is available to states for 5 years, beginning April 1, 2022. The law also authorizes $15 million for state planning grants, to be awarded by the HHS Secretary as soon as practicable.

  • Autistic individuals and their families have benefited from the economic impact payments provided by previous COVID-19 relief bills. However, those bills excluded dependents over the age of 16 from eligibility. The American Rescue Plan incorporates legislation to ensure that dependents over the age of 16 will qualify for $1,400 stimulus checks.

  • The American Rescue Plan includes $3 billion in dedicated funding for Individuals with Disabilities Education Act (IDEA) programs.

  • States may not use these funds to directly or indirectly reduce net tax revenue. This restriction will remain in place from March 3, 2021 until a state spends all remaining funds. If states violate this restriction, they must repay an equivalent amount of the federal aid.

Use this chart to see how much funding your state will receive.

American Rescue Plan Funds HCBS

Good news has arrived for agencies! The American Rescue Plan includes a 10% (over $12 BILLION) dollar FMAP bump for HCBS!

The provision dedicates HCBS funding of $12.67 Billion, with a FMAP increase of 10% from April 1, 2021 to March 31, 2022. This is an increase from the House passed version with a 7.35% FMAP for HCBS.

The amount of Federal payments to a State depends on two factors. The first is the actual amount spent that qualifies as match-able under Medicaid and the FMAP. The Federal Medical Assistance Percentage (FMAP) is computed from a formula that takes into account the average per capita income for each State relative to the national average. By law, the FMAP cannot be less than 50%.

The FMAP formula is designed so that the federal government pays a larger portion of Medicaid costs in states with lower per capita incomes relative to the national average (and vice versa for states with higher per capita incomes). FMAP rates have a statutory minimum of 50% and a statutory maximum of 83%. For FY2021, regular FMAP rates range from 50.00% (13 states) to 77.76% (Mississippi). Relatively more FMAP money goes to states with a lower average per capita income.

This extra funding is good news for all providers to help offset higher overtime costs in 2020/21, pay for the transition to new mandates like EVV, and retool systems for the future. 

In addition, the American Rescue Plan includes:

  • Expansion of the Paycheck Protection Program (PPP). Makes larger nonprofit organizations eligible for PPP loans by considering the number of employees at a particular site, rather than the total number of employees. For example, a nonprofit provider with 1,000 employees would previously have been considered ineligible; if those employees are spread across different states, they should be eligible to apply.
  • $350 billion in funding for state and local governments.
  • A 10 percent increase in the federal Medicaid match percentage (FMAP).

Ensure your state fully leverages the plan’s 10% increase in the federal Medicaid match rate for the HCBS program.

For more information on how your agency can plan for the future, download the following publications:

Electronic Health Records (EHR) and Workforce Management All-in-One

Should Providers Offer Incentive Pay?

The Complete Guide to Scheduling for Providers

Integration with Pay On Demand Platforms

Agency Workforce Management integrates with multiple pay on demand platforms such as Pay On Demand, Square Wallet, Dayforce On Demand, and more to help providers compete in hiring and retention.

Bi-weekly and semi-monthly payroll cycles may be on the way out. To better compete with other industries in the hiring war, agencies are using time and attendance to make a portion of their pay available to employees on a daily basis.

Pay on demand providers let your employees control when they get paid. Agencies can empower employees to meet financial goals and pay bills on time. Employees who reach financial security stay longer, reducing turnover and costs.

  • No employer fees
  • No more funding or managing advances
  • Instantly boost job satisfaction and employee retention
  • Help your agency stand-out in the crowd
  • Stop employees moving to other employers who don’t offer this benefit
  • Improve time and attendance compliance

How Time and Attendance Integrates with Pay On Demand Providers

  1. Each agency can create it’s own rules as to which employees are eligible, how much they are eligible for, etc.
  2. As soon as an employee completes a shift, Agency Workforce Management transmits the hours worked, and base pay, to the Pay On Demand provider.
  3. Clock-outs are captured in real time from biometrics, telephone, and internet enabled devices like smart phones, PC’s, and tablets.
  4. Employees who sign up with the pay on demand provider can access their payroll at anytime.
  5. There is a fee for the employee to get paid the next day; same day is usually higher. Fees vary by pay on demand provider.
  6. At the end of the pay period, MITC Time and Attendance integrates with your payroll sending the full payroll including adjustments, pay differentials, holiday pay, PTO, and overtime.
  7. The pay on demand provider deposits the remaining balance with the employee.
  8. Your payroll software/service does not need to change unless it does not support pay on demand. All major payroll providers offer integration. Tax filing, W2 procedures, 401K, and HSA filing all remain the same.

Pay on demand providers fund the advances. The employer runs and remits payroll as it normally does. Employees receive 100% of payroll on payday or earlier. The pay on demand provider gets paid back through the normal payroll process for any early transfers made.

Louisville, Kentucky based BrightSpring, which was formerly known as Rescare, is one of the largest providers of home and community-based health services in the United States. Its home care services line employs about 20,000 caregivers. BrightSpring started offering pay on demand recently.

“Traditionally, we’ve paid people in a semi-monthly cycle, and that’s the way we’ve always done it,” Rexanne Domico, president of home health care services and neuro rehabilitation at BrightSpring, told Home Health Care News. “The idea really came up when we started talking about how do we pay more frequently? How can we crack that code?”

“The problem sometimes for this workforce is the ability to access pay when they need it,” she said.

With one in four caregivers living below the poverty line, lack of cash could discourage prospective caregivers and force them into different, more cash-rich, lucrative lines of work. For example, candidates could receive immediate money waiting tables or earn higher wages working for Amazon.

“We fully believe that the companies that are able to attract and retain caregivers are the companies that are going to see the growth in the coming months and years in the space,” Domico said. “The ability to solve [for pay challenges] for this workforce is a huge answer to this problem.”

BrightSpring began exploring its Pay On Demand initiative about a year ago. The program, which is called “Pay Out,” went live at the end of 2018. It allows employees across the organization — not just caregivers — to access pay as it’s earned.

Already, about 9,000 employees are using Pay Out, Domico said, and the program is achieving what it’s meant to: attracting employees and improving retention.

“We are seeing a lot of interest when we’re talking with our applicants about Pay Out,” Domico said. “We see caregivers saying they’re picking up additional hours because they can get paid for those hours quicker than working somewhere else. We also see some early impact on retention with the people who are engaging in Pay On Demand.”

EVV Weekly News Flash

EVV Training Every Monday, Every Week. Now 120 Minutes!

  • Every Monday at 2:00pm EST until further notice!
  • Due to continued registrations and more providers selecting Agency Workforce Management, EVV Training has been extended!
  • Includes a “What’s New” section at the start of each training. Providers who have joined an earlier training, can get updates at the start

DSP EVV Training Video

An EVV training video for direct support professionals will be available shortly to all customers. This will help providers standardize the training for staff and ensure DSP training is consistent and comprehensive.

Billing Preparation Update

In Quarters 3 and 4, providers getting ready for EVV requested a number of enhancements to Billing Preparation to help manage EVV and Billing transactions. This new fact sheet with a list of all the billing units, authorization, utilization, revenue and profit reports was included.

Idaho Confirms Details of EVV Roll Out

Some states have still not determined their EVV system. Idaho recently confirmed that all providers need to acquire their own system for EVV to submit data to the Idaho state aggregator. MITC was one of the software companies Idaho confirmed as being compatible.

Illinois has started communicating with providers on EVV. No dates published yet.

DSP Awards 2020

DSP’s have been one of the critical groups at the forefront of the fight against COVID-19.

To show our appreciation, MITC announced in April of 2020 that we would give away $10,000 to 31 hardworking and dedicated DSP’s who were nominated by someone from their agency. 

MITC values the hard work put forth by DSPs everyday, and hoped to show our appreciation through these prizes!

Over the course of several months, we received hundreds of nominations sharing the stories of incredibly hardworking and dedicated DSPs; each one unique and notable.

A team of MITC employees read through every story to pick the 31 winners, a task that was not taken lightly. Eventually, our winners were chosen and two presentations were given, sharing their remarkable stories.

The DSP community works hard every day, not just during a crisis, which is why MITC will be repeating the DSP Awards in 2021. DSP’s are deserving of all recognition possible, and MITC is hoping to contribute to that. Keep an eye out this summer for more information on how to nominate your DSP!

Thank you to all DSP’s for your hard work in 2020, as well as your continued efforts going into 2021.

Download the eBook to read the 2020 winners’ stories.

EVV News Flash

EVV Training Every Monday, Every Week. Now 120 Minutes

  • Every Monday at 2:00pm EST until January 31st
  • Includes a “What’s New” section at the start of each training. Providers who have joined an earlier training, can get updates at the start

Why use Schedules with EVV

Many providers are not used to using Schedules in HCBS programs as the actual time of the service may vary and the care givers often schedule around the individual or family needs.

Some providers do use schedules in these same programs. This is why:

  1. It is important to ensure an authorization is maximized so that the individual gets the services the individual is entitled to, and the agency gets the revenue.
  2. Verify the care giver uses the right service code on clocking-in. If the individual is entitled to Community Habilitation and Respite Care, the care giver will need to select the service on clock-in. If the care giver uses the wrong service code, the wrong authorization will be updated, the billing may be lower than optimum, and the wrong documentation may be completed.

Basically, the providers using Schedules think they achieve better service delivery and billing outcomes.