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Category Archives: Medicare

LTC – Long Term Care IT Implementation

Posted on July 25, 2016 | Categories: HealthCare, HealthCare IT, Managed Long Term Care, Medicaid Long Term Care, Medicare, MLTC, PACE, Program and Project Management | Posted by: admin

LTC – Long Term Care IT Implementation

 

  • Overview of Long Term Care (LTC)
    • CNA – Certified Nursing Assistant
    • CNH – Certified Nursing Homes
    • CNF – Certified Nursing Facilities
    • Traditional Long Term Care (TLTC) Vs Person Centered Care (PCC)
    • SNF – Skilled Nursing Facilities

 

  • Long-Term Care Services / Activities covered
    • Activities & Exercises
    • Bathing
    • Dining
    • Measurement – Program Quality, Resident Satisfaction, Staff Interaction
    • Medication Administration
    • Nurse Administration
    • Physician Administration
    • Transportation

 

  • LTC Leadership
    • Administrator / CEO/ COO
    • Director of Dietary
    • Director of Housekeeping
    • Director of Human Resources
    • Director of Maintenance/ Engineering
    • Director of Nursing
    • Director of Technology
    • Director of Training/Education
    • Medical Director

 

  • The Care Team
    • Activities Facilitator
    • CAN / / Nursing Aide
    • Dietary Aide
    • Housekeeper
    • Pharmacist
    • Social Worker
    • Unit Nurse (RN)

 

  • Health Information Technology (IT) in Long-Term Care (LTC) Settings per HHS
    • Completing government mandated data sets are distinct from the processes used to maintain EHRs
    • Health IT in LTC is well behind that of physician offices and hospitals but improving
    • Lack of Capital Resources & Lack of computer skills among LTC staff
    • lack of standards for sharing information in an interoperable manner

 

  • Benefits of EMR in LTC
    • Enhanced communication and information exchange between varied entities viz. physicians, staff, residents, families of residents, pharmacies, and others
    • Improved provider efficiency and satisfaction
    • Improved regulatory compliance
    • Reduced medical errors and increased resident and patient safety.
    • Valuable information available at the point of care

 

  • LTC Challenges
    • Discontinuity of Care
    • Dissatisfaction of Residents and Staff
    • Insufficient Funding
    • Lack of Interoperable Standards
    • Regulatory and Legal
    • Staff Turnover
    • Staff Turnover
    • Technology Upgrade

 

 

  • LTC Reimbursements / Payments for 40 million members
    • Medicaid – 60%
    • Medicare – 15%
    • Private Insurance – 25%

 

Contact – Manish for IT / EMR Implementation for LTC at 646.644.3049 or manish@techcusp.com

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Clinical IT Senior Project Manager – Roles & Responsibilities

Posted on July 21, 2016 | Categories: Health Insurance, HealthCare IT, Medicaid Long Term Care, Medicare, MLTC | Posted by: admin

Clinical IT Senior Project Manager – Roles & Responsibilities

 

  • The Senior Project Manager of Clinical Integration is responsible for managing the performance and functions of assigned projects. This entails planning, reviewing and controlling the activities and conduct of project team members and/or team leaders for multiple project teams charged with the analysis, requirements definition, selection, implementation and review of major information technology systems.
  • The Senior Project Manager is responsible for pre-implementation analysis and process re-design affecting the business and care processes to support organizational operations, and for measuring the effectiveness of, and recommending post-implementation strategies for enhancing the usefulness of all assigned computer system application programs, technologies and systems required to support the needs of the organization.
  • The PM Provides assistance in the management of contracts and budgets for projects that may involve multi-million dollar agreements.
  • Analyzes and recommends procedural standards and changes to enhance user tasks and correct problem areas, as they become known, prior to systems go-live.
  • Confers with hardware and software vendors providing programming and analysis services.
  • Contacts vendors regarding systems issues to receive support information or assistance.
  • Demonstrates strong interpersonal skills, possesses good negotiating skills and promotes teamwork among IT, users, vendors and consultant team members.
  • Develop detailed project schedules for all assigned projects, mapping dates and resources to tasks. Monitor progress and resolve approved deviations from plan.
  • Developing technical project plans, budgets, and technical specifications.
  • Develops and implements effective tools to measure performance against quality standards, and to document and regularly report on all plans, priorities, schedules, budgets, team assignments, and the current status of assigned projects.
  • Develops and implements effective written mechanisms to document and report on all plans, priorities, schedules and the current status of all projects.
  • Develop, plan and manages detailed project budgets, tracking all capital and operational expenditures and regularly reporting the budgetary status of all assigned project budgets including hardware, software and support components.
  • Establishes and monitors project quality objectives, milestones and benchmarks.
  • Insures test plans are executed by qualified personnel and that test results are documented.
  • Insures that systems are brought live only after full validation of functionality based on results of testing and resolution of issues, including technical resolution and/or development of work-arounds acceptable to end-user and departmental leadership.
  • Insuring engineering, architecture, and design of technology infrastructure to support software products.
  • Interfaces with and supports staff in all areas and at all levels in the definition of requirements, selection, design, development, and implementation, of information systems.
  • Knowledge of middle-ware and database techniques used to exchange information between applications.
  • Maintains follow-up process for system deficiencies and issues reports.
  • Negotiates software fix delivery dates in order to maintain progress within defined project timelines and budgets.
  • Oversees development of detailed description of user-required program functions, and steps required for developing, implementing and/or modifying computer programs.
  • Plans, prioritizes, delegates and reviews the work of assigned project staff; establishes schedules and methods for achieving project goals and objectives; and reviews work products, makes corrections and coordinates staff training and development efforts.
  • Plans, prioritizes, manages and schedules of large, complex projects, often overseeing multiple efforts and coordinating activities of other project managers.
  • Provides effective oral and written communications to staff to facilitate understanding, ownership and accomplishment of project goals and objectives.
  • Provides ongoing leadership and motivation to ensure that the project teams are focused, committed and capable of producing expected results.
  • Provides oversight in the design and development of software applications, interfaces and custom programming, and testing processes through definition of test plans, test review and analysis, end-to-end system integration testing, and certification of software. Familiar with standard testing concepts, practices, and procedures.
  • Reviews, analyzes, and evaluates systems and user needs.
  • Supports implementation of software applications.
  • System Integration Planning: Designs plans for interfacing and integrating various software packages as necessary.
  • Utilizes complex project management tools to define boundaries, set priorities, plan, and manage multiple projects.
  • Works with IT and business stakeholders to formulate system parameters to parallel overall business strategies.

 

Contact – Manish at 646.644.3049 / manish@techcusp.com

Project Management for Insurance & HealthCare

Posted on March 18, 2016 | Categories: Account Manager, Agency Systems, ALIP, Analytics, Change Management, Claims, Clinical Services, Consulting, Development Project Manager, Document Management, EMR / EHR, ePrescription, eRx, Health Insurance, HealthCare, HealthCare IT, Insurance IT, IT Services, Medicare, MLTC, Mobile Health, PACE, Payers, PBMs | Posted by: admin

Project Management for Insurance & HealthCare

 

  • Casualty Insurance
  • Health System
  • Hospital Care
  • Life & Annuity Insurance
  • Property Insurance
  • Physicians Group
  • Inpatient
  • Out-Patient
  • Emergency Room

 

PMI approved Project Management – Scope, Time and Cost

 

  • Change Request Management – identifies and develops strategy for changes in scope, schedule, and cost.
  • Communications Management – creates and manages communications with stakeholders providing relevant details for informing and decision making in status reporting.
  • Cost Management – develops, monitors, and assesses project budgets through the entire project life cycle providing full transparency to stakeholders.
  • Documentation Management – Creates appropriate project documentation. Effectively negotiates tradeoffs between scope, schedule, and budget
  • Communication Management – Excellent communication, interpersonal, Presentation and written skills.
  • Implementation and Transition Management – creates transition plan, identifies lessons learned, and applies the lessons learned to future projects.
  • Integration Management – identifies and manages project interdependencies.
  • Quality Management – identifies relevant quality standards and defines governance, communication, and quality processes across SDLC – Dev, QA and Prod stages
  • Resource Management – identifies appropriate staff, defines roles and responsibilities, develop project organization chart and governance structure.
  • Risk & Issue Management – identifies and creates mitigation plans for risks and issues. Utilizes available tools for identifying and tracking issues.
  • Schedule Management – creates, manages, and understands impacts to project scope, constraints, and schedule via MS Project Plan and CA – Clarity
  • Organizational Management – Ability to work well on cross functional project teams including IT and business subject matter experts

Call us for Project Management & Program Management

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Medication Therapy Management Software (MTMS) by Techcusp.com

Posted on November 21, 2014 | Categories: HealthCare, Medicare, PBMs, Pharmacy Benefit Management (PBM), Tech Cusp, TechCusp.com | Posted by: admin

Medication Therapy Management Software (MTMS) by Techcusp.com

 

Techcusp (via Portal www.HealthAnalytical.com ) analyzed the whole process to understand the practices, implications and short-falls of the MTM processes in operation and taking guidance from the CMS requirements, a new optimized process for MTM Program was designed and implemented through proprietary MTM software called MTM System. This system is intended at optimizing therapeutic outcomes thus promoting safe and effective use of medications which can lead to overall reduction in health care expenditure both for the beneficiary as well as the PDP/PBM/Rx.

 

MTM – the Benefits

 

  • Optimize therapeutic outcomes for targeted beneficiaries through improved medication use by identifying/reporting and helping to resolving drug abuses
  • Reduces the risk of adverse events by identifying potential adverse drug events, reporting them to providers involved and help to avoid adverse events.
  • Is coordinated with any care management plan established for a targeted individual under a chronic care improvement program (CCIP)
  • Ability to identify and qualify patients for drug monitoring programs
  • Is coordinated with any care management plan established for a targeted individual under a chronic care improvement program (CCIP)
  • Reduces the risk of adverse events
  • Scripted interactive interventions based on established rules

 

MTM Software (MTMS) – Features

 

  • Automated calendaring of the assessment task based on drug or manufacturer criteria
  • Automated clinician assignment for additional patient evaluations activated by patient assessment answers
  • Automatically assign risk stratification to the patient based on assessment timing and questions
  • Business intelligence reporting tool for ad hoc and immediate reporting capability, along with canned reports
  • Capture complete patient history for assessment questions and answers
  • Real-time monitoring dashboard for proactive management approach
  • System based Drug conflicts avoidance approach – Algorithm driven automatic Identification of Drug conflicts like:

■Drug-Drug Interactions

■Therapeutic Duplications

■Drug-Allergy Interactions

■Drug-Disease Interactions

■Beers’ Alerts

■Adverse Drug Reactions

■Dosage/Compliance Alerts

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Medicare Advantage – Software Platform by Techcusp

Posted on November 9, 2014 | Categories: Analytics, Apps, BPM, Business Intelligence, Care Management, Consulting, CRM, Database, Document Management, Health Cusp, Health Exchange, Health Insurance, HealthCare, Insurance, Managed Long Term Care, Medicaid Long Term Care, Medicare, MLTC, Mobile Apps, PACE, Payers, Pharmacy Benefit Management (PBM), Portal, Qulaity Assurance (Testing), Software Development, Tech Cusp, TechCusp.com | Posted by: admin

Medicare Advantage – Software Platform by Techcusp

 

We could build custom software for your Medicare Advantage, MAPD, PDP, Self-funded, Health Co-Op, MLTC, PACE Plans to cover your niche workflows from Mobile Apps to Enrollment, Claims & Accounting Integration.

 

Salient features of Techcusp MA software

 

  • Analytics
  • Document reconciliation and management
  • EGWP
  • Eligibility management
  • Enrollment / disenrollment management
  • Member mail management (member record storage of in and outbound communications)
  • Multi-channel capability – phone, web, chat, SMS
  • PBM integration
  • Premium billing and collections
  • Reporting and Dashboard
  • Three-way reconciliation (CMS, fiduciary, PBM)

 

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425 Washington Blvd.,
Jersey City, New Jersey 07302, USA

Phone: +1 201.258.4704
Fax: +1 201.604.3480
E-mail: Contact@TechCusp.com

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