where we're eating charges I mean I I honestly they're all important um Kelly so I guess I trying to figure out what clinical staff is going to do probably is the beginning of it because if the patient is eligible based on solely the fact that they um fall into those categories those I think it's like six different categories uninsured um unin underinsured um under 19 native or you know those specific criteria if they're always going to be based on that and not whether the the location is vfc eligible and how the clinical staff is going to mark them that I think that's where you start because that's the beginning of the process um obviously we want to correct anything we can on the front end um in relation to even being able to schedule at certain sites for these ped's patients because you have them in ped's clinics and then you have them in Family Medicine as well so and I don't know that we have a bunch of the Family Medicine set up for vfc or not and and and actually do we have a list um of the sites that we currently have enrolled with odh for vfc so I do um pull up my screen here for you guys both a second so um I will say we do have a clinical working group as well so I'm hoping to answer I'm hoping with that group that we're going to answer those clinical front-end piece questions um so I I don't want to focus so much on what we need our frontend staff to do because those are those are issues that we need to address with that work group um okay so I think what I want to work on with this group is what can we fix what do we have currently with billing and documentation that we can fix currently or yeah so I guess that's the question what is it that we need to fix now all right so I have a ton of charges sitting in here for vfc all right so I have this in the holding take I do have some other stragglers sitting in my main War cues yet that are still in the process of being moved over we Mark things as like basically what it is if it's a related har if it's a vfc marked as eligible but they have commercial or or whatever it's supposed to be based on on that um so Mars I I we can kind of go through what each one are and maybe make a decision as far as workflow or process like each type of thing that's been identified as to what we're looking at or what we're seeing come over because I have no admin codes I have commercial um patient is 11 months so they would fall under the age group but they have commercial so process this there's there's no admins who's going to post the admins are we going to post the admins is coding operations going to post the admins like I guess that's so what what is this the site I I think that's my question because there's some sites where my team does evaluate Tech charges and other sites where they don't that there's another team that does it so I think that's the first question and I think the the second thing and I've been in touch with Kim preventure to see why um because if you post a uh vaccine the admin is supposed to be automated so well not with the commercial what I understood her her logic that she built or that they updated had something to do with the commercial wasn't going to generate the admin which I I don't understand why but um they're not posting so I mean I can I can definitely pull this spreadsheet and kind of we can look at discharge departments and see where the locations that are coming and you can see the different comments as to what these would actually be then was that one marked as eligible in the mar by chance like would that matter if it was eligible well they should all be eligible but again the logic is going to be based on whether they get a vfc um charge or they're going to be build like the full rate so the vfc is 2125 whereas maybe the other charges are 33 and above um your components are going to be based on payer and and we had an issue with the the quantity on the components um there's just a a lot of lot of lot of issues so so I I'm sorry this is Monique I had a question just um I'm I'm on Terrace team and um as we were reviewing some of the vfc um accounts um from the billing perspective we was seeing like inconsistency and it sound like that's what we're saying on the call um and I don't know if the inconsistency is impacting the way the claim is going through our Billing System so for instance um when you go into the chart review you'll see that the patient it'll say vfc eligible but then you don't see that the vaccine was taken from the vfc inventory or some accounts don't even have the question on the screen asking if it's vfc eligible you just see that the the stock it was you know taken from the vfc stock so I don't know and that's what me and Tera was trying to figure out is that does that have an impact on how the cases are falling into our Billing System it's the logic it's the logic and the way that it's set up so if if there's not a question indicating eligibility I think that's where the logic is set up it's it's pulling your EAP or your whatever specific charge that would be if they're eligible or not eligible it's going to give you a zero or it's going to give you a charge amount like your zeros would be on your your vaccines themselves and you'd have the 2125 on your admins and you're getting built you're you're actually seeing the ones that were charging full amount for vfc eligible patients because they either have medicate or fall within the criteria of you know what would be allowed like this patient is marked as not eligible okay and they're 17 and they have Medicaid so this is the edit we get because it's a mismatch and you see I have charges for the flu for the drug itself and then I have the full amount on the admin but they're eligible but because they're not marked that way here that's the problem so I have to have clinical update this in order to trigger the background to to flow accordingly and that doesn't always work as well so can you just um break it down what is the logic again um the question is this patient uhuh so the logic is based on currently this question if this isn't being marked as eligible then you'll see the charge for the both the the vaccine and the the larger amount on the admin okay and if this is not available for specific areas because it looked like you I didn't even see where on some of those emails I was looking at the encounter like your M doesn't even have have the question I don't even know it's not showing it could be there but it's not visible to in My Views I I don't know and that's the clinical side of it so can I can I ask a question is clinical the only one that can update that answer like changing it to vfc eligible they they're the only one that should be I mean yeah there's there's capabilities of uping U uh updating these questionnaires um to eligible or not eligible but really the clinical staff is the one giving it they're the one that marking it in the mar they should be doing it no I know they're supposed to be doing it I'm saying now that we have all of these sitting in a queue that need to be fixed I'm asking they can it be done yeah it can be done by somebody else that has the proper access yes okay well and then what do you do with the vaccine itself so was this vaccine was it taken from regular stock or vfc stock right and that would be based on whether this this location is set up so good question I've come across accounts where where they actually have multiple vaccines given on the on the data service and it the inventory says both vaccine for children and then the next one will say it's General stock so I wasn't sure if that's something um we would need to or it was an Overlook it could be that it was overlooked or it could be that that wasn't truly taken and we're playing a guessing game with it at this point because I don't know only what I can see in the chart and the way I mean you'd really have to clarify and some of these um nurse managers and you know clinical staff are not really helpful in that sense I do know that if if the if the if the vfc site doesn't have stock like if they're out of stock which rarely happens but if they don't have the stock they borrow from their General stock but they have to do like a whole paperwork like it's a transfer yeah great so well the two that I came across they based off the old list I don't you said you had an updated list but based off the old list they were not um participating sites and they had that they were taking from vfc stock they were they weren't that they were and they so and they were taking from from vfc stock that's what they have documented in the mar like I I can the Mar Medical is the Mar Medical account record it's the medication administration record oh look at me trying now I I I just want to jump in too um and ask a couple of questions so something else that um we ran into um the patient the question could be answered patient is um vfc eligible but you don't see that the vaccine was taken from the vfc stock but um then the account the patient also qualifies for charity so in those situations do we suppose to um like what trumps is if if is vfc eligible then should we be adjusting those charges just to um BFC or if they qualify for charity and when you look in the front end in the in the um in the medical records and you can't determine whether the patient is eligible for vfc but it has a vfc code in the billing you know that's some of the things that I've been coming across and now what are you currently I mean like what normally would like if you had in in a different scenario like if they were Insurance didn't cover something and they qualified for charity wouldn't the charity be applied I guess it would have to be it have to go back to that like and and I think that may may be a different ball of wax altogether because that's like dealing with different writeoffs so yeah we're eating it if if it's not an eligible site and they are eligible based on just the patient itself themselves then yeah that's you know we're going to be writing those things off um because we can't bill it out if they're eligible so are are you saying and again we're confused because we see that the patient says that they're vfc eligible and we don't see that anything was drawn from the vfc stock so are we to assume that this is in a true vfc pay and just move forward with Charity or well is it that do they have okay so do they have insurance are these uninsured um underinsured are like what are they qualifying for charity for yeah um no insurance no insurance and they couldn't get Medicaid because I know that there was a process in relation to our related heart issue where the customer service decided that they needed a workflow to to avoid having a billing issue because you can only Bill that one uh particular charge out one time or do a patient bill or something to that effect I'm not exactly sure on the ins and outs but with that being said it's like um they're they're different they're different issues and they were missing a piece in between where they were actually s Centuria Centuria or I for yeah they will bet the patient to see if they can get them Medicaid coverage and when they they cannot that's fine that goes the bill goes out and the patient um would be build or I guess I don't really know that word for I shouldn't say that but but anyway if they do become eligible um the problem was they were splitting the hars so you had your admins on one hor and you had your office visit vaccines on another har but they were not combining them once that patient became eligible coverage should be attached to the PF account and not the related har and coverage is being attached to both so you have claims going out um you have that office visit and the vaccines going out already and then you have what's hitting my work que for related um because those are um the ad admin codes are sitting on that related har so like this is an example of that so here I have um I have the HB vaccine for Peds on this particular heart I have my admin codes when I look and see um where my other charges are you can see here's my other charges so they don't combine them and that's a workflow issue um with them so these I have my clinic visit and my my actual vaccines but yet when they became eligible for Medicaid you see Medicaid's attached to this har and Medicaid's also attached to this har which should not be because this is your this is your related har and they should actually be combined these should be transferred these charges should be transferred to that other hor so who should be doing that though yeah that's my problem it's like I don't know it's a front-end thing because this is when they create when they're looking to establish eligibility that's there's that's the missing piece there's a how they get these charges back to the right account well I I think so for coding because you've got um a number of coding folks on here that I think the issue we run into is that so this patient is eligible they're eligible and they received vaccines okay they have a commercial um or they have they're in a site that's not participating but they received vaccines and they may have received vfc vaccines what am I supposed to do I gotta I have to code it based on the documentation that's presented so if there is something else that we need to do in that middle off office then I think that needs to be clarified in how we are to handle that because I I can't help if a nonparticipating site gives a vaccine I can't prevent that right right but I do have to it's my responsibility to review the documentation and then submit those codes as they are presented to me and if they say it's vfc I got to take their word for it I can't say well you're Notting so you must be lying but they right and why it it it comes down to is there a way to identify an epic the sites that are actually participating H how can we create some type of do yeah but then what do I do with that so I have the list participating so what what do I do with that they say they've given vfc they technically don't participate but the patient qualifies patient qualifies we're going to if the patient qualifies the charge that that should go out whether um so if they're nonparticipating and they qualify it's like we're we're adjusting we're billing out um guess we're not building anything we're not buing anything non yeah if they're going to a non BFC if they're going I'm sorry if they're going to we're eating that charge is what we're doing yeah right so I understand so somebody has to take that adjustment that's not coding because we don't take adjustments at that like I what am you know what I mean I still have to code the charge right you're coding a charge but the logic is the problem because when when you have that triggering based on your Mar on whether the the charge goes to vfc or if it goes to just a regular EAP code that you know a normal like a commercial plan would utilize that that's the problem well then I not sure that you have the right people on the meeting right that's that was just gonna say it sounds like we need somebody maybe from Clinical epic it or something on here also yeah you come up with some different logic so I think but I'm I'm trying to get to the problem of this entire work CU that we have that's sitting here how are we to manage all the issues that are in the current work now like how do we handle those because the logic piece is already been submitted I've already submitted a ticket for that that part is being done to add sites to Epic and and I'm I'm working with a front- end team to try to get workflows and get education out but I think what I'm trying I think what we're trying to do here is try to figure out all of the ones that are sitting in a work UE or in a holding pattern what what what do we do with all these accounts now so I'm going to say it again I don't think you have the right people on this call that's I don't think that's coding coding's decision to make um okay so h i I'm not sure I think I would uh probably okay so escalate it wanted to include like um you know if you want coding technical coding or like Melissa monac just Bowen um or Finance or I I just don't know do you have speaking for my team that I just don't think we can answer your question a list of whom uh I was going to say um a list of well not for you I guess it would be for for Kelly um do we have a list of the sites like what site would be sent it in the chat I just sent so so from that those sites um what would your people be responsible for you know what departments would be where you're you're reconciling the charges so if you saw the fact that this came over and it had a flu and a and we don't have any admin what departments would that be um I have no idea I guess that's more for yeah do you like you said different sites do different things right well yeah so in Ohio Maine uh the the coders that are PBB sites they do run a Reconciliation for pro and Tech um I I can work on getting you a list of what departments they are but we still can't help the fact um if this is a non-participating site and they said that they give vfc that's the way we're going to code it because we don't have it that's what's in the chart does that make sense um it it makes sense um I I get where you're coming from but if I don't have an admin code and so you're saying that this went through the like it would have gone through the process and I don't know what site this is to know if it's one of our sites that we code tech for because we you know which site you code tech for that you that you could tell me like off the top of your head that we can look at or Jen Edwards do you have one of your sites I'm gonna have to pull something up yeah that is an 81530 um and we did escalate this um about the admins to Kim preventure I had a conversation with um with her about that as well was my understanding um she was looking at it and I think there's a whole she has a whole work UE with a bunch of these uh I don't know if it's still out there the vaccine hold work que yeah yeah that's still out there but I think that's like a combination of everything that they test um so like Med Med Peds Willoughby or what about Peds Wooster well Peds woosters PB only so that's not gonna be on here um ped's Broadview Heights okay so Broad View Broadview Heights okay so here's a Broadview Heights and Broad View Heights let's see is this on trying to find what's on the list of the associated or the vfc sites that are U broad viiew Heights is not it's not a vfc it's not a vfc site okay what what can you find another one John um I don't have anything that tells me if it's vfc or not I just have a list of my depart yeah I just need I just need your department I I want to know what your coders are looking at so I can look at the sites P's Chesterland is one of ours Chesterland okay hold on I'm looking here Chester's in Chesterland okay so let's look at one of these all right so this one came over and it has a flu and admin and then this Mar let's see what the heck is going on uh not eligible so we have charges so that's what you're reconciling like I I guess I would we're not reconciling whether or not they're eligible okay when we run a Reconciliation Report it says I've got a hundred appointments and I've got a hundred charges and when I'm reviewing those charges I think it is reasonable to say I've got out of those 100 patients 25 of them received a vaccine so I expect to see 25 admins that is reasonable we can't use the Reconciliation Report to say are they eligible for vfc and is that documented we would have to go into every single chart um in order to do that um and that's not on the reconciliation so that would be a massive undertaking well that's what we're doing that's basically what's happening because now it goes through charge review it goes through all that and it's hitting an edit and point then that needs to be escalated to Melissa monac um as the Director because currently that is not part of reconciliation that we're going in and checking we expect that you know if a if it's documented in the chart and we don't look at every single chart so if there are no edits on it and it passes the reconciliation we don't even look at it it's just on a four-day hold and it goes and it goes okay and that I mean we're not trying to create problems or more work for everybody and that's I think where the solution comes in is is there a way to identify specific locations if they're vfc eligible and and what can we do on the front end that would reduce the amount of you know manual processes that were you're doing on your side and on my side because this is this is a big problem I have tons and tons of accounts that I you know I can't necessarily the clinical staff needs to update this because yes they're eligible they have Care Source Medicaid and that's why the edit's firing but because of this is marked this way it brings in play the the vaccine is being charged at full the vaccine is being charged and the admin is being charged at full price and so so how did it get how did it get to you because if it's saying it's non-eligible technically because because it's payer driven any medicate attached to coverage okay yeah and and they're marked as not eligible it's gonna flag here okay I got it um all right I think I'm gonna have to have a conversation with Melissa and Jess and Boden and see how they want to handle this because with such a large um I'd like to start moving them even if we have to do this like you know I don't know like can we have permissions on you know updating the Mars I I don't know that's truly the answer but you know dealing with the the clinical staff has been difficult um some get done some don't get done some stay on the spread you forever in a day um you know because that's what we were doing with Mary when Mary Beach was still around we were trying to work with the clinical staff to get this situated up okay all right so let me um let me uh pull in Melissa and Jess and see um if we can one give you a get you access to start moving the accounts and then two on a bigger picture what they want to do with all of the issues that we have currently I'm I'm not and I'm not talking front end I'm talking about you know what's going on now with the with how things are getting sent and and what's sitting in this this huge holding tank so um Dani say I'd love to get some you know at least some kind of answers in from uh you know the larger fix because like they are accumulating and they've been on here and I going to be timely and you know then we're going to really eat more charges that we could have gotten out yeah oh yeah for sure I actually requested for a report too but I haven't heard back for not either so Danielle are you saying that they were marked eligible for vfc but it's at a nonparticipating site but then they said they got it from a vfc stock yeah there's multiple um vaccines that were given and one of them shows that they got it from the vfc stock but it's at a non-participating site correct I don't even know how that's possible well so this would follow the commercial coverage because they have MMOs primary so we would Bill everything um but this doesn't have any admins and but how are you getc stock at a non participating site because they're marking them so immunization given okay so here's your vfc eligible and let's see oh what did I just do um B oh crap sorry I thought I was um let's see okay so vfc eligible on the pneumonia I don't want I keep going out of that all right so di therea BFC eligible yeah that's the one that's marked vaccines for children from that stock the what location is that vfc eligible I mean so eligibility doesn't necessarily equal location I was talking about the inventory class the inventory class where are you yeah where they mark it it's above um the vfc eligible answer to the right it says general for this one oh okay and then that first one for the Tdap is vfc and I looked at the department and the department look up and the um address does not match anything JM RN and it's the same it's the same nurse too where is the location I'm right here this no I'm um oh what location is it it's um Lorraine fhc Lorraine and if you look up the address in the department um viewer it does not match the anything on the list Line West what's the we have I don't I wonder if that's Westtown Pediatrics oh no it's not never mind I don't know 400 like I know there's an address somewhere I know I looked these up before I'm like here 57 Cooper Foster Park 5700 I don't see that on the address let me look and see if it's I don't see so I just this is confusing to me because I don't even know how they got an option to choose vfc stock if they're at a non vfc location well that I think generates the like what the eligibility question I think generates for for all for all okay yeah for all locations because it doesn't matter the location if they're eligible they're eligible based on the other criteria and if they happen to schedule at a place that doesn't carry that stock then we're eating that and we're so because we didn't send them to a location that does have the stock okay all right let me um let me pull in we yeah I think a bigger discussion needs to be had with Melissa and and Jess to just figure out how we're going to handle this large do we know like total and is it just you Heather or are there other people who have these holding tanks of vfc uh accounts like Danielle do you have some or Mo'Nique do you have some like are we well Danielle's on in in my team okay yeah so we've been moving um out um but right now you have, 1500 well so in are holding so I still have you know like we move them out they my team will defer them and we move them over to the holding tank I did um actually go ahead and create a work UE just for our vfc accounts so they're not going in mainstream and I don't have to worry about them they' be all be together um but um like I do have more in here so this is our main orue okay so and then so these got to get moved over and then we do have the holding tank which I have not everything you're not pulling you're not getting anything from Florida right um I am not getting um Florida accounts no I don't know where those are going Ganan I think deferred a few accounts but I didn't look at them so I don't know so Community might have some and then I don't know what other Florida yeah okay all right um I have to hop off um but I am going to schedule something with Jess and um Melissa to have a larger discussion and then we do have a frontend and call center discussion um to discuss workflow on that side and then additionally we I have a work ticket in it's um under review right now so that has multiple pieces to it it's got the um sites going in it's got um it's got other pieces to it so I I just can't remember off the top of my head but it's got multiple um requests in it so we'll um you know if I get any updates on that I'll let you guys know but at this point I you know it's under review so who knows how long that's going to take but so I guess then at this point we don't really need do we need this group then until we have decision I'm cancel yeah I'll cancel this Cadence I'm going to keep the front Cadence um I'll cancel this Cadence and then once we meet with Melissa and Jess um Heather I'll pull you into that discussion but and then you can include whoever you want but um uh we I'll cancel this Cadence because I I think it's it's a waste of people's time if we're just going to you know it we're not going to be able to actually you know come up with any decision-making okay um answer so all right so we'll go from there um thank you everybody for your time I appreciate it I think this was at least um a helpful discussion and you know we have some next steps so thank you sure thank you all right take care all right bye bye