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doing live webinars where we can share best practices and topics of interest to you to learn more and to access the resources referenced in this video please scroll down to the video description it looks like people are getting settled into place so we will begin so thank you for joining today's lunch and learn which is about the missouri home care community and we're targeted to the missouri home care community and we're going to talk about best practices from missouri today so we're going to do a quick welcome and we do have a lot of missouri best practices i think this is going to be one of our most ambitious and longest webinars but we're going to try to move through the materials quickly and then we'll also take your questions down the road so just to welcome the community here if you haven't been to an encoder webinar before we're really all about the concept that home care is a very important industry and we're all uh there's an opportunity for us all to be successful and that includes technology vendors like us and so many of the providers like you who are on the lines and thank you to all of you who are our customers and that type of thing but we're really trying to make the webinars open to a full community and we're just here to facilitate and share what we know and we're always looking for good inputs from the audience and share best practices and today we're and you know in general we're really just not trying to only sell our software or even sell our software today we're going to talk about best practices that should apply regardless of what software you use the only exception to that would be that uh there are a couple specific examples or of how things work and the only software we have to show you how they work is in the encoder software but it's really a broad open community event and thank you for being here and i hope you feel very welcome so the topics today we actually have two sets of topics or two columns of topics anyway we're going to talk really through the whole process of using software for compliance with your agency so we're going to talk about best practices for onboarding your clients demographics authorizations care plans getting scheduling done titration might be a word that not all of you use we'll get to that that's about how you can make sure that you're using all of your units in the month and especially in short months so we'll talk more about that and we'll talk about accrued minutes electronic visit verification the arrival and departure and a couple bonuses at the bottom one about cobit 19 and what some of our missouri agencies are doing on that front as well as a bonus regarding what the latest information is that we're aware of on how missouri is implementing edd so with that we will go on to the before we start slide a few things here is that this presentation will be put on youtube and one of the things a little trick we've learned with youtube videos is that we have the ability to set a little timeline in the bottom of the video and so you'll be able to sort of scroll down below the video and say hey you know like i never heard of that titration thing let me see where titration is in the video and there will be a little timeline there and the ability i believe in youtube just to click on that item in the timeline it'll take you to the that portion of the video but if you have any questions as we go please go ahead and type them in and if they are relevant to what we're talking about at the moment sarah will read them and interrupt me otherwise we'll save them for the end okay so without further ado we're going to talk about best practices for onboarding clients and we always love getting new clients so onboarding clients is a joyous activity for all of us but one thing that we really stress and we do this in our training as well is you want to start with putting your client demographics in and making sure that it matches what came from your cyber access plan of care you have the name right the diagnosis code right and then once you get them in we have sort of this trinity of the authorization the care plan and the schedule and if you start from the authorization which again is on that cyber access plan of care it really helps you to be on track and we'll kind of walk through best practices in that order so uh this is uh so far we're talking mostly about our medicaid clients and that are fed to us from cyber access and then build through emomed but we also of course handle our private pay clients our va clients aaa clients whatever cases that you have and we'll talk about those as well and in some of those areas certainly for the va you have authorizations as well whereas for private pay you generally don't but we'll we'll talk through those cases as we go all right so number one is demographics and some best practices are really we want to make sure that we get our client id which in missouri we call our medicaid id the dcn that's really the code that the state is going to use for an emo med specifically is going to use for billing so you have to have that right and in missouri a lot of them have leading zeros and you have to have just the right number of digits and the leading zeros need to be there and then just little things like spelling the name correctly and having well i'd say more important the diagnosis code entered correctly are important and we we highly recommend as the state is moving to enforcing electronic verification that you work towards double checking the address and double checking the phone number because this is what's used in electronic visit verification we use the address to make sure that if the caregiver used the mobile app that their gps location is right where the address is and if they dialed in for telephony that they dialed from the right phone number so double check those things all right so moving on to authorizations the real critical things here that you want to put in are your start date and date visit type and your units per month so missouri uh you know different states do it different ways some states are more about units per week or units over the entire time period but emo med all the authorizations are looking at units per month so that's why it's really critical to put it in as as units per month and it'll keep you on track that way and in missouri in our in-home program we'll often have a series of services so we might have personal care then homemaker and then respite would be a typical thing and you definitely need to put those authorizations in separately and you need to bill for them separately and that type of thing we'll talk about that uh later because one of the the best practices you should be looking for is even though there's three services on the visit like personal care homemaker and respite you want your caregiver to only clock in once and only out once and that's something that you should look for in your system one other note there is that when you have cds sometimes clients get confused between cds and essential transportation and they'll put in two authorizations for that and we we definitely don't recommend that we recommend that you take your uh your cds number of units and you put that in and then you treat your essential transportation essentially as a task that's just like the other tasks on your your plan of care and that's how that works out okay so moving down is that another thing that happens in missouri is that uh in general when you get an authorization so if i got one today on july the 14th then it would likely go through june 30th of 2021 and that's great having said that when i get next year's authorization it's probably going to come in with the june date so it would come in and would say okay you're now authorized for maybe more units as of june the 11th of 2021 so what we highly recommend you do there is that you put in your new authorization and then you end your old authorization in that case if you know you had this original authorization out through uh june the 30th of 2021 but now you got a new one that's effective june the 11th so end and the one that you had that ended uh originally on june 30. it change that to june 10th put the new one in and say it starts on june 11th and that way you will avoid any overlaps and you know really as soon as they give you that new authorization it supersedes the other one and there are certain reports and things you want to compare what's authorized to what's delivered in the month and things like that and using this approach is going to make sure that all of your report data is reflecting the authorization change at the time that it was authorized and changed okay so here's a typical scenario so um here the dates are a little different than i gave but yep it's you know october of 18 to the end of september of 19. we get the new one effective 914 and we set the expiration the old one to 9 13. so really i use different dates but it's the same example okay so next thing uh talking about authorizations is that we all have our nursing visits so in addition to our caregiving visits that are always authorized per unit our nursing visits are billed and authorized per visit and sometimes that nursing visit might be 45 minutes sometimes it might be an hour and five minutes and that sort of thing so on the the in the world of nursing it's going to be billed by the visit and your unit for billing is is a one unit uh you know kind of code so think of it that way so and when you see i guess what we see is what we call kind of patterns so a lot of times we'll see some of our clients don't have any nursing uh often they'll have their ghe which stands for the general health evaluation it's always when you get a ghe it's always two visits and they're always six months apart so if you get a january authorization you'll see that it's like february and august or your ghe and then you'll also see weekly and monthly and it's typical where you'll have both ghe and weekly or ghe and monthly but we haven't seen cases where you have both ghen weekly and monthly that would be a little bit unlikely and continuing here it's really again authorized per visit and what we see is that most agencies when they have their ghe visit they actually don't do an additional visit in that month they replace the weekly or the monthly visit if they have those with the ghe visit that week or that month okay so moving on to care plans and i'm going to move a little bit faster because we have a lot of information to cover is that we're going to get our care plan from cyber access and it includes in the information not only the care plan tasks but also the authorization and so and one thing that we've seen is that that will in our in-home program will have sometimes a client will get personal care and homemaker as we said earlier and we'll see that on the cyber access plan of care there's a good number of tasks on both but we will also see the case where there's a personal care authorization and it has what we generally recognize as one or two homemaker tasks or it could be the opposite we have a homemaker authorization it has one or two personal care tasks so i think what's going on there is that the assessor is saying hey this is really mostly a personal care case i don't want to create an authorization for an additional type of visit or type of service but i do want to add a task in that other category and so in your master list of of care plan items there are sometimes the the same type of task will be in both personal care and homemaker i guess it's a big takeaway of this and so when we get our care plans we actually want to set them up and say hey these are our personal care care plans and these are our homemaker care plans because we could have the case where one person is doing back-to-back personal care and homemaker visits but then the next day a different caregiver is only doing the homemaker part and in that case they only want the homemaker tasks so a lot to think about there all right and then talking more about you know multiple authorization we have a term that we call contiguous visits so basically you know a better term for that might be back to back visits so i i would say the most complicated case i've ever seen and we do see this in missouri is you'll see that one person in one visit will have services for advanced personal care then personal care then they'll have homemaker then they'll have advanced respite and then they'll have respite so it's it's possible in that case i can't remember if i listed five or six services but the scheduling best practice is to schedule those back to back and then as i mentioned earlier the caregiver could just clock in once and clock out once and the system knows because you've organized all your tasks your care plan tasks with the appropriate service to ask all the questions for all of those services whereas if if you know somebody was only doing a subset of those services then they would only be prompted for a subset of the tasks all right now some agencies we actually see this a lot more in other states than we do in missouri but also want the caregiver to be able to add additional items onto the the plan of care and we do this with both our telephony and our mobile app on the telephony there's codes so basically the caregiver would need to know oh if i am adding change linens i need to put in code 22 that sort of thing and then on the mobile app if it's configured for your agency they would be able to choose that from a drop down list but uh so that is a feature and we we have heard in meetings with the state that that's a feature that they consider desire global like i said most of our missouri agencies uh which we have over 50 um are not using that feature but if you want it just ask and we'll turn it on all right so finally and this is of course the biggest part i mean everything's about our clients so we put in our client our authorization our care plan and our now our schedule so just some scheduling best practices is that we want to we we actually meet some agencies that they reschedule every week or they reschedule every month and part of that is because they're trying to take advantage of all the units that are authorized for the month and it might be a short month and things like that but the way that we recommend that you uh schedule an ancoda is you look at your typical month which is a 31 day month and you say hey what should we do each week so that in a 31 day month we get all of the all the visits we need to do now the reality is that all seven days of the week are not the same so some of our clients we see on the weekdays and their family has them on the weekends and some sometimes it might be the opposite case so so what we do is you know we we start by putting in the weekly pattern and then if there's fewer days in the month we might have some extra units and we want to allocate those and that type of thing and when we do schedule back to back when we do have multiple services up i guess i'll put it that way we want to schedule them back to back and another best practice is to put the respite last right because we want to make sure that the caregivers are focusing on all of the tasks and the rest bit is more to give the family a break so you know we the natural way of conducting the business is that the caregiver's gonna go in and they're gonna do their uh their personal care and their homemaker and then then they'll stay more time toward the end to give the family a break and as i think i mentioned three or four times the caregiver gets the in and out only once and the way that we allocate it is because it's rare for the visit to be the exact perfect amount of time so if we have let's say an hour of personal care followed by an hour of homemaker and they were there for two hours and five minutes so they were there five minutes over we would allocate the first hour to the personal care and then the remaining time in this example the hour and five minutes the homemaker and we'll talk about what to do with those extra minutes in a little bit all right so a couple special considerations for cds sorry about that i got to go backwards here is that the uh the client is really the person as implied by the name is consumer directed services so the consumer is rea ly the one who's scheduling their caregiver and your job as the agency is to administer the program and so in order to do that what the best practice that we recommend is is that you schedule it is good to put a schedule in there so that you are allocating your time for the month so just to give a very simple example if i have let's say one hour a day seven day week case that would be 124 units right so it would be great if you said okay hey if you're going to do seven days let's put an hour on the schedule for every one of those of those 31 days of the month and it's there but you know you aren't really the one or you're not the one who's directing what time they go so just put it on and say there's just an hour of duration i'll show you what that looks like in the system on the encoder system in a little bit and that type of thing and then if you um let's see and then another thing that happens with cds is sometimes the caregiver lives in the home and they're providing care for that individual all day and in that situation like let's say that the state is paying them for three hours of care per day but they're providing more uh another best practice that we do is you put that three hour duration in there and there's a setting to say hey after the three hours then you would uh you know kind of stop the time because the caregivers aren't all that religious in that case of saying okay well i just clocked in for my uh paid time at 8 17 a.m i have to out at 11 17 a.m they might instead just clock out in the middle of the afternoon and in that case um the system will you know just just allocate the three hours now one little thing it's not on the slide here but in that case if if there are certain things where the cds attendant wants to do less time on one day and more time on another day and that was directed by the consumer then you have to make some schedule changes and they should call the office to to do that with you in that way keeps everything straight all right so i mentioned this term a couple times it's called titration and what this means is that we have you know situations where most of our months you know there's that old poem 30 days have september april june and november and of course february had 29 days this year but usually has 28 and using the kovid 19 joke here in 2020 it's felt like march had about 48 days in april had about 73 days but i'll take that off the off the equation for now but basically the cyber access allocation is always based on a 31 day month so if you do have that let's say february that 21 day month and you're normally getting 248 units you're going to have you know those extra units so if it's a 30-day month you'll have one day's worth of extra units if it's uh february you might have two or three days worth of extra units depending on whether it's leap year and then what you could do is you know if we continue with this example 30-day month yeah that does the math for me has the eight extra units the 28-day month will have 24 extra units and then the best practice is before the month even starts you just spread those units out on other days so you're making sure that your client is getting all the care that they're authorized for and so that's the benefit uh there is that you you get to use all those units and if you do use the encoder system it'll do that automatically for you so when you go into let's say what are we in now so july and august are 31 day months but then when you go into september and it's a 30-day month it would take those extra units and automatically allocate them to the early days in september i will say that there's also this concept of titration within the month so normally we want to schedule and have everybody follow that schedule but if let's say there's a hospitalization and you were supposed to be delivering eight units a day and they were in the hospital for three days well now very similar you you have those 24 units and so in that case i mean what you might want to do is say hey they just got out of the hospital so i'm going to give them more time and more help over the next couple days but there is also an opportunity if a caregiver is a header behind their units in the month to use that titration function to spread the remaining units within the month all right and then this is one of the the big missouri curveballs i think the only other state that we're aware of this happening is in virginia but what happens is that um in the the world of of home care uh with evv people don't always work the exact amount of time so if it's scheduled for three hours they might have worked two hours and 58 minutes or they might have worked three hours and six minutes and that kind of thing so it's typical for it not to be perfect so in this example they were scheduled eight to ten they got there at eight and they left at 1004 and in this case what you could do is like keep a little bucket on the side as just was depicted is you could put those those four buckets in there or there's four extra minutes in the bucket and then and then the next day if they work an additional 11 minutes you can combine the 11 and the four and you get another 15 minutes and when that happens um you get to build another unit so again if on monday i worked um you know two hours and four minutes on tuesday i worked two hours and 14 minutes now i have more you know 14 plus 4 i have 18 minutes so i could build an extra unit once i cross over that and again the encoder system takes care of that automatically for you behind the scenes all right so this next one ev three little letters but there's a lot to it and this is one of the biggest topics in in home care nationwide in the medicaid community this year as this all goes into effect but we do have multiple ways of doing evv the first is the the the word when people see it the first time they sometimes call it telephony but the actual pronunciation is telephony and basically what means what that means is that the caregiver is cocking in from the client's home phone or we're using caller id to verify that they are at the home it has to be a landline and then the next most popular is or i would say actually even probably the most popular now is agencies using a mobile app and using gps which is the global positioning satellite location just like when you're using google maps it knows where you are to match to the client's location we will do a demo of this in a second but i will mention fob so fobs are and i have a picture on another slide are a way that if the the client doesn't have a home phone and the caregiver doesn't want to use their mobile phone you could put a device in the home and then they could uh call from you know at that point you have this little device that keeps track of of the arrival time and departure time by pushing a button and getting a secret code off of the device but we have heard in and this comes later in the presentation but we have heard from the state that the the state really is trying to move off of of uh the concept of you know of having people um use the fobs as they go into ebv so we'll talk more about that later but we did promise in the lead up to this webinar that we give a demo of how offline mobile works so with that and without further ado i'm going to jump to a screen here so this is just a demo environment where i'm looking at this visit for um so what you're seeing here is we have this caregiver carrie the caregiver we're seeing this week and we're actually speaking today is tuesday july the 14th and we have this visit where carrie the caregiver is providing service to betty white and this uh this blue collar indicates that they've already arrived and so what i'm going to bring up now onto the screen is what my mobile app looks like and i'm doing this actually um with my phone so i have an android phone if you have an iphone it looks almost identical but slightly different and so here um you know as as you compare it to the schedule board here i'll just kind of move it out of the way is that we have this schedule and they have this uh visit with morgan freeman that's scheduled we have this consumer directed visit where they uh have arrived at 12 29 and now they want to go ahead and uh out for that visit so i'm just going to do it on my phone and you'll see that you know so here i'm going to click this on my phone you'll see that what goes on is well right now i guess my phone is online and if i were to report the departure it would reflect on the screen in real time but what i'm going to do on my phone first is i'm going to go back to my home screen i'm going to go into settings going to go in connections and i'm going to go to my mobile network and hold on one second or data usage rather and i'm going to turn off my mobile data so at this point i no longer have access to the mobile network so my phone is offline so i'm doing this this way to you know kind of simulate being offline because i do have you know mobile covers i'm also not on my wi-fi so at this point the phone is totally offline and i'm going to go back to the home page and i'm going to go back into the encoder caregiver app but the important thing here is that it remembers that i clocked in and it would have been fine if i clocked in when i was offline as well it knows i need to report departure so i'm clicking that here and here it is at 127 i'm accepting my time and i'm confirming my departure it's letting me report all my tasks i'm just going to say that i did clean the bath i cleaned the floor we did the dressing and grooming i could say that the laundry wasn't needed today and that we did the tidy and dusting and then i'm going to save that and then i go on to my page and by the way these are optional but you could if you want you could capture a client signature you could capture a caregiver signature and you could put you know notes on the page and you know so we're all set there but once you know once we have everything captured then i'm going to go ahead and submit that my visit was completed and it knows that my time was from 1229 to 127 which is great and i'm going to submit that and from the perspective of me on my mobile app i'm done and i could go back to my home screen and i could start driving over to morgan freeman's house for my my next visit because this one is closed out and this one's still scheduled so i'm all good from my mobile perspective as a caregiver but i'm offline even if i don't know i'm offline and just to kind of prove that they're offline here i'm going to refresh this screen and it's going to still show this visit as in the arrived state at 12 29 it's not going to know anything about this departure and um you know because let's say at this point the caregiver is still alive but now as the caregiver i'm driving down the road and i get back into mobile coverage when i get a little closer to the highway let's say so here if i bring back onto the screen my phone and i simulate that again by going into the settings the connections um and by the way this is something you would never need to do unless you wanted to train it but you probably never even need to do that go back into data usage and now i'm going to turn my mobile data back on okay so now i'm good to go and that's really all i need to do and if i go back to my ancoda system the fact that it got its network back the the ancoda app is going to be waiting you know behind the scenes for or it's going to say hey you know do i have mobile do i have mobile do i have mobile and as soon as it has mobile it's going to go ahead and report you know they did have that mobile access and it's going to you know kind of update the system on the back end and when we refresh the screen again we're going to see here that now the visit is in the closed status and it changed colors to dark green and we know that we actually departed at 128 so um so that's the way that goes one um so yeah so that's kind of that all right so we're going to jump back into our webinar slides here and keep going with our best practice marathon here and we'll just keep on hammering down thank you for i see a couple questions have come in so thank you for those we'll get to them in a little bit all right so next one is uh continuing on the topic of electronic visit verification is a best practice is to tell the caregiver when to clock out so uh i've mentioned this scenario but you know if my schedule is from 10 to 1 on some days the traffic might be good and i get there at 9 56 or i get there at 9 45 even and in other days my traffic might be bad and i don't get there until 1005 that sort of thing so what what the system is going to do is when they in based on their arrival time it's going to look at the duration and it's going to say when they should out so it will you know tell them right when they arrive if they're on the telephony it'll say arrival time is 10 03 am your departure time is your expected departure time is 103 pm so it'll tell them that and so it kind of gives them a little oh yeah i guess i was a couple minutes late i'm gonna have to stay a couple minutes late and that way it helps you get your fully scheduled time and your fully scheduled units done and that happens on both the telephony and on the mobile app and as it says here again with the encoder system it can be configured to tell them that and then on the departure end it'll tell them if they're leaving early so let's say they forget about that they clocked in at 1003. now they're trying to leave at exactly one o'clock or maybe even 1259 the system's going to say you know your expected departure time is not until 103 if you want to complete your fully scheduled time please hang up and log back in after 103 pm that's sort of that's what it says all right so another best practice is that we do have a situation where caregivers will uh arrive and then they finish for the day and they just forget to out and it just happens even to the best of caregivers now and again so the way that we handle that in encode is we have something that runs overnight and says um you know hmm we have a in without a out we have a provision in there it knows if this visit was scheduled for overnight and in that case it knows it's fine but if they were supposed to out at two o'clock in the afternoon in the middle of the night it's saying you know they didn't out let me put this visit on hold so the next morning the office will know and they can contact the caregiver and the client and uh and and figure out what really happened so when that happens then the office will know to contact the caregiver and then as a follow-up our recommendation is to have them do a a one-visit timesheet and i'm going to talk about that more in a minute all right and i'm not even in a minute in five seconds so um agencies before even you know or before like hawking with telephony and mobile and by the way i mean missouri's been ahead of the pack and most agencies have had a system for a while is that if there is um you know before i guess you're on a system like this there's generally like a full week timesheet but um one of the best practices when you move to having an automated system is to just have a single visit timesheet and that way if a mistake is made you just have to get a sign off for that one visit and that the uh you know whatever the discrepancy was caregiver forgot to clock out or the client's phone died it could be written down you get a caregiver signature and a client signature and now you have a record of it so if you're going to get an audit okay so then kind of moving on the next best practice is that sometimes your caregivers when either you bring edd for the first time or they're new they're going to say that you know hey the evv isn't working and sometimes what you experience is it's really just they're a little bit resistant to change or maybe they fear the technology and um that kind of thing so what we recommend as a best practice is that when they call in the office and they say it doesn't work or maybe you've called them to say hey i don't see you cocked in and they say oh it's because the evv didn't work we recommend that the office be trained to say hey let's just try it together and then the you know the office manager could in uh even from their cell phone as the u as if they were that caregiver and you know capture the time and then in and say okay you know i mean it seemed like it worked for my side you know are you sure you want to try it on your side now and then you know you could go through the arrival and departure but again if you know this is a great training exercise but of course if the office clocked in you're going to have a you know hey the the caulking was from the wrong phone number and you are going to have to um you know get the get the single visit timesheet in that case as well but it is it is in general sometimes it's just a little bit of fear and um you know in general when we bring an organization live you know around 80 percent of the caregivers get it right away and then there's there's some that have a little bit of fear or need a little bit of hand holding and this is a good best practice all right so i mentioned this next one early on is that if you have back-to-back visits so here i have that our client rhonda rocket has visits for personal care and homemaker with cameron diaz and uh and it's scheduled noon to two for the personal care and two to three for the homemaker and these are again what we've called contiguous visits so um but from the caregiver's perspective they just see it scheduled from from noon to three so you don't need your caregiver to out in the middle and say okay i'm done with my personal care now and i'm moving on to my homemaker because the reality is that when they're in the home they're going to do what's needed at the time that it's needed you know they're going to get the laundry right in and they're going to feed the client their meals when they need their meals and that type of thing so they're going to work on all the tasks but this is going to know what tasks are on their list let them caulk in once and let them out ones that's how it works on the mobile okay so when it comes down to electronic verification there's a lot of options as well to deal with some of the failures that you see so you know sometimes if the address is wrong you correct it you correct the location if you do have a client whose service in multiple locations you can put both of them in we will by the way when the state finalizes their edv plans we'll double check that ruling there's also if there's multiple valid phone numbers so let's say that there's the there's two landlines in the phone one for the client and one for the you know for the live-in you know for the live-in caregiver that type of thing if there are multiple valid land lines you could have both of them in there and um so another you know option is available is you can let the caregiver in from a known client phone even if a visit isn't scheduled so this is something you would have to ask us to do but if you know some of our customers have it so if you dial from a certain phone number we know that that's mrs johnson's phone number then we'll just create a visit for mrs johnson with that caregiver so that's another one and the mobile app is a great option i'd say more and more of our customers are using the mobile app rather than the telephony and missouri i'd say compared to other states missouri's been a little behind in that but we're seeing more and more and so the fob is that option as i mentioned earlier to use that there's no home phone and the caregiver doesn't want to use their cell phone we also have options don't let the caregiver caulk in if they're not using the right phone so we can just restrict them or don't let them in if it's too early or too late and don't let the caulking caregiver it if they're too far away so you know sometimes we've seen caregivers running late but they're like i'll just in from my car and that'll of course flag the error but we also have a way of saying hey you're not you're not close enough to the home and won't let them in all right so fobs are gonna we've talked about this but this is just to give you an example this is what the fob looks like and this is essentially every fob is different there's a little serial number on the back but if i push on one fob and i get this number six four one nine six six you know based on that one fob it's going to say oh okay it's um it's now july the 14th at 1 38 p.m but no other fob is going to give that exact same code at the same time they're all different so that's how that works and we do by the way recommend that you uh zip tie that in the in the home so you know because it is important that it be you know kind of placed and affixed in the locations that's another best practice all right so we're flying through and we're we're about two thirds of the way through but we're going to keep going and try to go even faster but the next area is visit approval so some best practices here are that if the visit is compliant then it should auto approve right and in most of our agencies we see we recommend even when people go live that you should try to be very quickly over 80 compliant and um you know and ultimately most of our agencies that have been using the system for a while are over 90 percent compliant and but the visits that aren't compliant they need to be reviewed and approved so you can make sure the times are right and as we get into state evv that's going to become more and more important all right so what do you want to check there is you want to make sure you have the right phone number or gps the right duration it's within the authorization and if it was a visit that was quote unquote created on the fly and not scheduled that's something you want to get to the bottom of if that's the way that you work and so these are some of the the minimum checks and by the way the system of course does these automatically and it just brings them to a visit approval dashboard for you so another best practice is that for every visit that needs to be approved you you want to not be approving the same problem like a wrong phone number every day and so maybe that that client's home phone number was keyed in wrong in the first place you don't want your your team seeing an exception on that same person every day just fix the phone number and that's something that um you know sometimes the schedules aren't aware you could do or there's even a way sometimes the the address that uh you know if you say hey we're at one franklin street then you know that mailbox might be on the road but if you're in a rural area that that house might be half a mile down a long driveway and in that case you have to fix the gps location and sometimes you what you'll find is with some caregivers the it'll say the gps is not provided so the first time you run the mobile app the mobile app is going to say you need to enable your gps but sometimes caregivers will say no to that question so if you're seeing you know time after time that a certain caregiver isn't providing gps then you'll you'll need to reach out to them and get them to enable gps for the encoder app or the app that you're using all right then repeated caregiver error again you know try to train the caregiver try not to put up with it all all day long and uh it's really important to look at your approval rate and you know again the auto approval rate should be greater than 80 on day one and like like i said with most of our agencies they're well over 90 a little bit down the road all right still flying through billing and payroll so one thing we really recommend you do is to approve visits every day because if something is wrong with the visit you want to talk to the consumer or the client and your caregiver or attendant right away and not let it linger because if you call next monday and you say hey there was something wrong on your timesheet on wednesday they're not going to remember the details whereas if you call the next day or approve even the same day say hey you know it said that uh you cocked out from the wrong phone what's going on you can get the answer right away so the rationale of course is that you know you get it when you know while the information is there and also then you don't have a big bunch of work to do when it's billing time you you know if you're approving these as you go and then you know monday is payroll you know calculation day or maybe wednesday is emo med billing day the fact that you've taken care of these as they're coming through is going to uh you know make your your billing and payroll very smooth all right so billing best practices is and here it's actually i call it but it's actually the missouri rules you have to round down for medicaid to completed 15 minutes of billing so if the person's scheduled for an hour they're there 58 minutes you can only bill for 45 but good news is you can hold on to that 13 minutes and bill it later so that's the next best practice is accumulate the minutes um and uh what i'd say is in our in-home agencies most don't round the payroll for employees so if they work that extra four minutes they'll pay them for that four minutes right away but then they'll hold on to it for billing whereas with the cds attendance where like again we have that typical scenario where they're going to be paid for three hours a day but they're there all day then um the rule is more you know is uh pay for what you could bill and and then when that accumulated minutes uh comes up for the cds you could pay the attendant at the same time that you're billing it all right so some more building best practices you could build as often as you like some agencies run every day and get it out of the way others do it weekly others every two weeks whatever your case may be so cyberacts is only going to pay you every two weeks so i guess the most efficient is to probably only do your billing every two weeks but um especially when you're when you're new to the process we like you to bill every day and if there are any errors that um you know in your data let's say you have a wrong dcn you want to find those things right away another one is that there's a cut off on fridays in missouri on our billing weeks at friday i believe at five o'clock central time don't quote me on that but we need to so we really recommend that you don't start your billing friday afternoon and then find errors because you might not be able to resolve the errors that quickly so we we recommend to all our agencies that on the weeks when cyber access is you know has the cutoff for billing that you run your billing process no later than wednesday and uh and then when you submit to cyber access the next morning you're getting what's called a claim confirmation and it'll tell you if everything looked good and that's a really good indicator that everything's going to be you know set for paying the next one is we have this um you know we have this concept called the start of billing date so let's say that you signed up with an coda today after this webinar you went live on august 1st then we would set your start a billing data august first and what that does is that if in october you know some caregiver says oh my gosh i didn't really understand the ebv in august i i forgot to give you this paper timesheet then the system's always going to go back and capture anything you know as soon as you're aware of it and and of course the system's smart enough to only bill once so that's that and then when we talk about our other you know we've mostly talked about medicaid today but when we talked about our veterans administration billing our private pay and our others we have you know we can make a very pretty invoice with your logo if you have an invoice today we'll try to replicate it as close as possible and then for the va um we have actually some bill va with uh cms 1500 paper claims some with the uv04 but more and more of the agencies are moving to electronic billing through a clearinghouse and we can help you with that if you want and we also uh have worked out now there's like uh you know platte county i know is one of them where there's um kind of split billing and we we have that all worked out now where um the the the consumer might have to pay a portion of the bill and it'll allocate you know like uh typical as a 80 20 case where the county will pay 80 of the visit and the consumer will pay 20 so that's all other things but if you have other payers you know let us know and we'll we'll help you with all the payers all right getting down toward the end so onto payroll um there's two approaches is what we recommend is just like the billing the system knows what you've you know what's been completed and approved that hasn't been paid and then it'll you know pay for that up to your payroll cut-off date and that's what we recommend and you know and then this way that you know just make sure that anything that was like from an old timesheet takes care of it we do have a couple agencies who say you know no as soon as the visit's closed i want to pay for it even if i'm waiting for an approval thing and they run it a little bit differently but but those are two approaches that we've seen with agencies in missouri and we could make the payroll um you know in general whatever format you need for getting that over to your paycheck writing company uh we could usually provide that in the format that you need all right so more on payroll side there's um you know again a lot of variation on uncertain how different agencies that we work with in missouri do things some don't pay for travel um you know some like i would say the most standard cases they don't pay for travel to the first visit or home from the last visit but they do pay in between they pay for errand miles and that kind of thing so this is an area where we we're not saying that we know a best practice of how you should do what we're saying is the best practice is that you decide your approach and then you should you should approve it with your uh labor council and make sure that you know you're not going to have any legal issues with your approach down the road okay and then a couple things about cds payroll again as we've said a few times the consumer is the employer and most agencies cut separate checks but one of the encoded best practices is that if that let's say you have one caregivers doing some in-home and then they're working with two different cds consumers they could just have one id they could clock in do all their visits um you know has one individual and then on the back end you know we'll split it out to the different checks and handle all that i'm gonna go really fast through remittance um just because we're getting very short on time here but in the area of remittance processing what happens of course is that after you've submitted your claims to uh to emomed you're gonna get uh that you're going to get what's called remittance advice and you're going to get a deposit in your bank account is the reality of it and the remittance advice will come and tell you you know what's been approved what's been denied and that type of information and when you process that in the system it will uh it will you know go through your everything you build which is called your accounts receivable and it'll mark down what's been paid off and and you know kind of leave open what hasn't been paid off and then that tells you oh okay well yeah i i went over my authorization for whatever reason on this one so i can't rebuild that one or oh no this looks like it was you know a problem on their end and you know what you could rebuild and that's what that's all about so and these are you know some of the reasons not to get paid and what you have to fix is that you didn't submit the bill or it wasn't scheduled or um there were some information we try to work this out when we're getting a customer live to make sure it's all set up front we do sample claims with you with emomed and one that comes a lot is if the person does get two services in the same day they're going to reject that and you're going to need to submit all the units together that is something that will you know definitely change with ebv because with evv at the state level you're going to know um you know exactly what time they arrived but well i actually have some some news on how missouri is going to do which i think it i think from the billing side it might not change but there's you're definitely going to need to track the visits and their arrival and time and departure times individually all right let's kind of keep on going and finalizing your mittens here is there's some really good exceptions reports and you want to look at the exceptions reports and we have uh i think my favorite reports one called collection reconciliation it goes through everything that was in the 835 remittance and it tells you what was paid what wasn't paid and uh and then you know even when things are there you have to decide okay i'm going to fight to get paid for this or this one i'm not going to get paid for and then you want to balance your books to zero in all cases so if you're not going to get paid for you do want to write it off all right um on to some fun stuff in our last minutes here next thing you want to do is be able to optimize your revenue and so here are some things you do right away or you want to put in your authorization so you don't over bill you want to build for those extra three minutes six minutes here and you want to use all the units in the month and uh we have some really nice reports to help you know what to do and one of the best practices is to look on the 20th of the month and say hey you know this caregivers over their units you know what's going on let's make sure that they uh they come in right or this this caregiver is under the unit so yeah they add a hospitalization let's bump up those uh you know those hours or those units to get that person over the goal line so that's some things there all right very quickly we've seen we've helped a lot of agencies through covid19 with a few things i'm going to cover them here one is that if visits are cancelled due to cobit 19. we highly recommend that you keep that and you'd be able to keep that information and be able to build build a you know cancel due to covid report in the future you know so this one is cancelled due to weather and this one is those two were cancelled due to cobid so you'll have that information down the road another is that several of our agencies came up with covid care plans one agency is asking you know these around 10 or 11 questions this one's asking a smaller list of questions if you needed help with any of these things probably you know this is coming out in july um if you were going to do that you would have done it by now and then the last one is that there are authorizations that are sort of automatic now that anybody who has personal care or cds is authorized for 20 units of uh telephone calls so so you could have you know supervisory check-ins or even uh you know so you can basically you know call into the person and have somebody sitting in an office or even working from home and calling them and you can get reimbursed for that so if that's something that you're not doing you want help with uh let us know we're not exactly sure how long that program will stay in place but it is still in effect as of uh this date in july 2020. all right so a couple nuggets here on missouri state edd so you know what is it where to come from of course it came nationwide in the 21st century cures act and uh basically the original law was that it had to be in place by january 1st 2020 and at an agency level this is still the case i mean as an individual agency you could be audited for edv but the states need to collect and review that information and have asked for delays on that so really i mean this is from the evv law except for this last bullet what edv needs is you need to know what was the type of service who's receiving the service what was the date location the individual providing the service and the time and then missouri is also asking for the care plan items so that's something that we haven't seen in other states but bottom line is missouri's looking at that and saying hey this is great we could do an audit remotely and so you know so make sure that your information is in in good shape so today this is sort of an overfly oversimplified picture is that you send in your claims the client date of service type of service number units and the charge amount but nothing about the times and the locations but you need to keep these times and locations so you have them handy and ready for an audit what we've heard from the state is they're going to have what's called an aggregator and we believe it to be separate from emu meds we believe that claims are going to go straight to emomed but you're going to send all your evv information over to this aggregator and by the way there's a rule that your software company needs to needs to you know not charge you for the integration with the aggregator and so that's something you should be aware of but there's this new information so the location of surveys either the gps the massing phone number and also the tasks are going to have to go to the aggregator so this is when when they came out and this was actually in 2019 we were told that they would be putting out an rfp whether they would be applying to the federal government uh to for a good faith extension to not have this in place until january of 2021 and that they were going to put out a request for proposal for the aggregator and and that they were expecting the agencies to be fully compliant by 2021 but to my knowledge that request for a proposal hasn't gone out yet and what we are seeing with covet is that some states are uh have moved beyond january 1st of 2021 but this is really all we know at this time and you know really the best the best advice here is be ready for it and then just one last bonus we did a webinar a couple weeks ago with this guy handsome handsome guy here steve the hurricane steve is a home care marketing expert and just a quick story i wanted to share is that he said that he looked at nationwide data as accumulated by this group you might have heard of called home care pulse and home care poll said that 60 of agencies saw their visits decline in april and may of 2020 because of covid but you know what steve's group did is they actually went out and they um they coached all of their uh their agencies that they work with to look at this as an opportunity into and to you know figure out ways that they could reach out by phone and actually ninety percent of the agencies that they're doing coaching with had more visits in april uh or more more clients and more hours in april and even more in may so that's an opportunity and actually um on our webinars page this webinar is up there and there's even an offer from steve to give you a free consultation so look at um you know you could google uh or go to you know youtube and say encode as steve the hurricane so that's kind of the last bonus and here we are with a few minutes left and we're into the you've made it so i know that was a marathon so many things that make um the missouri medicaid program special and you know complicated and just from an encoder perspective and we really appreciate all of you hanging through this whole webinar and um you know and listening into all these these best practices we will make this available on youtube and uh you know we're really happy to have you and we're we're so happy that we could you know try to keep you focusing on care while we focus on the tech um a couple things here this is a little bit more toward our customers i think they know this but uh if you saw anything in the webinar that you don't have in your environment you want it just reach out to our support and um and you'll also you know getting be getting occasional calls from uh jed hamill who's our director of customer success and he'll you know when he reaches out to you you can say hey i saw this on the webinar you know can you help me get that implemented so he could help you as well and also if if there is something that you know we haven't learned about in missouri yet or that you think would make the product better let us know i mean you know for things that are not critical requests uh we usually get them into the into the software in about eight weeks you know of course anything that's an emergency we take care of it right away all right and you know and just i mean um you know we really in ancoda we focused on specific states you know missouri being one of them and the more customers we get in missouri the better we can do for missouri and that kind of thing so we do have a referral bonus to our customers if you refer a new agency to us and they sign up um then you know you could get a discount off your next bill or some customers or uh ask us to send it to them directly and we're happy to do that as well all right so with that we are almost out of time but um sarah why don't we take um you know maybe one or two questions at most okay great so let me start with this one i think you touched a little bit about it if you wanted to literally elaborate a bit about how missouri is doing in comparison to other states regarding ebv yeah it is a great question so i would say that there are some states that are ahead um and um i i guess i guess i would say that that missouri you know most providers already have telephony and mobile apps in place so from that perspective you're ahead of some states that have been uh for example in virginia we've been moving most people off of paper time sheets so from that perspective you're ahead but as far as the um the specific plans and the formats and how to get the the information to the aggregator you know now that it's already in july uh and with the deadline still officially being january 1st of 2021 i'm starting to feel a little pressure like it's a little behind but you know if you're working with ancoda we will be fully compliant for you um you know as soon as the deadlines are launched that's a great question you have one other one yep i do have one other one um they say i'm currently billing uh manually how quick can i get uh billing email med electronically oh got it so um so i i guess there's a couple scenarios one is if you're let's say using our system and uh you have you know and you're doing all the scheduling and that kind of thing and you just you know wanted to bill manually at first before moving over um you know i then it's really quick i mean we have your information and we could probably get you billing electronically in in a week or two that type of thing but if you're a brand new customer and you know our record is we we had a customer go live in three days in missouri but you know in general uh you know especially you know if you're a sizable agency um you know the average time to go from not having a system at all to having the encoder system and being able to you know bill and do payroll and everything is you know we recommend having um it's really up to the the agency on your side but you know the average is around four weeks and um you know up to six weeks for bigger agencies so that's the the time i'd say all right so with that i'm going to um you know just wrap up on a couple things i mean if you like what you heard today or maybe even you're watching this on youtube after the fact you say wow these guys i think they could help me reach out to sales encoder.com supporterdancoda.com reach out to either one you know it um you know we we're very proud of our support team and even if you're not a customer and you call them and you need some help or you want to learn more about the product uh they're great people to talk to or reach out to sales we try to make our phone number easy and coda and then we wrote the number down there but i guess for encode is a little bit easier to remember you can spell it we also i as i mentioned here we have um something we we've created a site that's really independent of an code called a home care community and we're trying to share best practices so here's a page where you have a forum and then we have like missouri specific discussions it looks like there's seven discussions going on among missouri agencies right now so that might be something that you want to check out with that we're going to say thank you and again a marathon uh webinar this i think will be the longest one we have on youtube and it was definitely the longest one we did and we're going to let you all go for now and uh wish you a great day for watching this video from ann cota for further information scroll down and click on the link in the video description below have a great day