Clinical Support Services Technology Supports Medicare’s Care Transition Initiative

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Clinical Support Services, Inc. (CSS) has developed new technology to help Community-based Care Transition Program organizations improve care for Medicare beneficiaries. The software provides secure methods of storing and tracking patient data, and gives CCTP coalitions the ability to offer each patient access to a Personal Health Record.

New CSS technology supports Medicare’s Care Transition initiative

As CMS has pointed out, communities must come together to identify the root causes of readmissions within the Medicare population, and identification is the first step.

New technology developed by Clinical Support Services, Inc. (CSS) will help Community-based Care Transition Program (CCTP) coalitions track patients and document required interviews and other data, as mandated by the Centers for Medicare & Medicaid Services (CMS).

The success of this national program will depend largely upon key factors such as communications, compliance, data compilation, reporting and billing (involving both the CMS List Bill and payment scheduled for providers). CSS has developed software and new Auto Enroller functionality to help CCTP agencies track patients and document required interviews and other data. CSS’s List Bill functionality uploads patient information to enable participating facilities to receive reimbursement for their services from Medicare.

CSS’s software provides a registry function that assigns all data into discrete, queriable fields. The software provides secure methods of storing and tracking patient data, thus avoiding any potential HIPAA violations. Communication components include a secure electronic messaging system to provide HIPAA-compliant transfer of data among the primary stakeholders: hospitals, community-based coaching organizations and individual transition coaches. CSS’s technology gives CCTP coalitions the ability to offer each patient access to a Personal Health Record.

CSS’s CCTP-specific programming also:

  •     Includes a 180-day “auto-enroller” which allows users to confirm whether the patient has received CCTP coaching within that timeframe from anywhere within the coalition’s network of hospitals.
  • Includes parent-child account structure which lets the Program Coordinator (“parent”) assign patients within each “child” account and manage the viewing/editing permissions granted to it. Each parent account may access all of its child accounts to monitor quality assurance issues, run reports (based on various program parameters), List Bills and provider billing.
  • Supports the Eric Coleman Care Transitions Program® model.
  • Offers the ability to auto-assign a patient 24/7 and alerts the transition coach (or other provider) by secure email that an eligible patient is expected to be discharged with a defined timeframe.
  • Includes the integration of the patient interview (to be performed within the home) and the survey tool (to be offered upon the conclusion of the patient interaction).

“As CMS has pointed out, communities must come together to identify the root causes of readmissions within the Medicare population, and identification is the first step,” said CSS President James Notaro, Ph. D., RPh. “Our software will help CCTPs make needed interventions, which will help patient care and reduce medical costs.”

Created under the Affordable Care Act, Medicare’s CCTP seeks to improve care for Medicare beneficiaries leaving the inpatient hospital setting and going to other care settings, such as a private home or nursing home. The focus is on improving quality of care and reducing hospital readmissions.

About the company: Founded in 1999 by pharmacists and information technologists, CSS is staffed by experienced clinicians, software developers and operations personnel who develop innovative and proprietary technology tools that improve patient care while providing financial value. At the heart of the business is Medication Pathfinder – built in a S-O-A-P (Subjective-Objective Assessment Plan) Note structure to help pharmacists move more quickly through complex patient Medication Therapy Management (MTM) assessment procedures. Structured data storage is one of the main differentiating features of the MTMPath system. Additional CSS software solutions include iDealTherapy and Star Ratings Booster.

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Cheryl Krajna
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