ACO 8.6 Procedures Guide

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Procedures Guide

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trademarks of their respective companies or organizations.

Systems Environment

Application Development: MS Visual C++ version 7.1

Desktop Database: MS Access 97 version 7.0 Server Database: Oracle Enterprise Server version 9.2.0

Oracle Call Interface and Objects for OLE version 10.1.0.0

MS Internet Explorer version 5.5 (Service Pack 2) or later to support the integrated Internet browser

Optional System Environments

MAPI Compliant E-mail client to support e-mail transfer of survey information

This document can be viewed online or printed in a duplex (two-sided) format. Blank pages have been automatically inserted as needed for correct pagination in the printed copy.

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ACO Procedures... 11

About this Procedures Guide ... 12

Managing Basic Provider Information in ASPEN ... 13

Provider Records... 13

CLIA Labs ... 13

Adding CLIA Lab Records ... 14

Enter Facility Definition Information... 14

Find Address Elements by Zip Code ... 16

Change CLIA Lab Type ... 17

Enter Additional Mailing Addresses ... 18

Enter Buildings/Wings Information ... 19

Specify Provider Associations... 21

Enter Administration Information ... 22

Enter Ownership Information... 24

Enter Licensing Information... 26

Enter Miscellaneous Information ... 26

Certification Process ... 27

Create a Certification Kit ... 27

Accredited/Deemed Providers ... 28

Accredited/Deemed Certifications ... 28

Date of Survey for Deemed Kits without Surveys... 29

Hospital ... 30

Carry Forward of Hospital Certification Data... 32

Hospital: Unaccredited... 33

Hospital: Accredited, No Survey ... 35

Hospital: Accredited with Non-validation Survey ... 37

Hospital: Accredited with Validation Survey ... 41

Hospital: Non-participating (NP)... 43 NH ... 45 HHA ... 46 XRAY... 47 OPT/SP... 47 ESRD ... 48 RHC ... 49 CORF ... 49 ICF/MR ... 50 ASC ... 51 Hospice ... 51 PRTF ... 52 OPO ... 53

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CMHC... 53

FQHC ... 54

Enter Certification Information... 54

Create and Conduct a Survey ... 56

Assign Regulation Sets... 58

Record Deficiencies ... 59

Create a Revisit Survey... 62

Complete/Print Certification Forms ... 63

Upload a Certification Kit... 85

Delete a Certification Kit ... 87

Review Initial and Flagged Certifications (RO)... 88

Identify Kits Requiring RO Action (RO) ... 88

Review and Upload a Certification Kit (RO) ... 89

Enter Survey-level POC Tracking Information ... 89

Record PPS Exemptions... 90

Track IDRs ... 91

Open the IDR window... 91

Enter IDR Information ... 92

Send Notices ... 92

Generate Letters... 93

Lock Letters ... 94

Define a Custom Batch Filter ... 95

Batch Print Letters ... 96

Track Notifications... 97

Merge a Survey into a Kit ... 98

Rebuild a Historical Kit ... 98

Assign HHA Branch ID (RO) ... 99

Assign OPT Extension ID (RO)... 100

Change Provider Status (RO) ... 102

Reactivate an HHA Branch (RO) ... 104

Reactivate an OPT Extension (RO) ... 104

Enter a CHOW... 105

Enter a CHOW with Assignment ... 105

Enter a CHOW without Assignment ... 105

Enter a Merger... 106

Terminate a Provider (RO) ... 107

Change Accredited/Deemed Status ... 107

Change Status to Unaccredited/Not Deemed... 107

Change Status to Accredited/Deemed ... 109

Change Accredited Hospital Status to Conduct Full Survey ... 110

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Track Upload Transactions ... 112

Transfer Surveys to ASE ... 113

Export Surveys ... 113

E-mail Surveys ... 114

Import Surveys into ASE... 115

Set Decryption Password (ACO) ... 116

Setup and Maintenance ... 116

Set Option/Tab/Button Security... 117

Set Survey View Security ... 117

Configure Groups in Tree View ... 118

Configure My Selections... 119

Action Items... 121

Filter Action Items... 122

Delete Action Items... 123

Configure Action Item E-mail Notification ... 123

Enable Action Item E-mail Delivery for Staff Members... 126

ACO Screens ... 129

Define New Facility/Facility Definition window ... 129

Facility Definition tab ... 130

Addresses tab... 131

Mailing Address window ... 131

Buildings/Wings tab ... 132

Define New/Edit Building window ... 133

Associations tab... 134

Administration tab... 135

Ownership tab ... 136

Licensing tab ... 137

Other tab... 138

Certification Kit Screens ... 139

Hospital screens ... 140 NH screens ... 140 HHA screens... 141 XRAY screens ... 142 OPT/SP screens ... 142 ESRD screens ... 142 RHC screens... 143 CORF screens ... 143 ICF/MR screens ... 143 ASC screens ... 144 Hospice screens... 144 PRTF screens... 144 OPO screens... 145 CMHC screens ... 145 FQHC screens... 145

Certification & Surveys tab ... 146

Certification Properties... 146

Citation List... 146

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Special Fields ... 149

Hospital Special Fields ... 149

Tracking tab ... 150

Transmittal (CMS-1539)... 150

CMS-1539 - Part I ... 150

CMS-1539 - Part II... 151

Hospital Application Worksheet ... 151

RHC App/CDE (CMS-29/30E) ... 153

CMS-29 - Request to Establish Eligibility... 153

CMS-30E - From RHC CDE... 154

CORF Application (CMS-359) ... 155

NH Application (CMS-671)... 156

CMS-671 - General Provider Information ... 156

CMS-671 - Facility Staffing ... 157

NH Census (CMS-672) ... 158

CMS-672 - Resident Census... 158

CMS-672 - Conditions of Residents ... 159

CMS-672 - Miscellaneous ... 160

HHA Application (CMS-1572A) ... 161

CMS-1572A - Description ... 161

CMS-1572A - Administration and Affiliations ... 162

CMS-1572A - Services and Staffing ... 162

CMS-1572A - Visits, Census, Other... 163

OPT/SP App/CDE (CMS-1856/1893E)... 163

CMS-1856 - Request for Certification ... 164

CMS-1893E - From OPT CDE ... 165

XRAY Application (CMS-1880)... 166 ESRD Application (CMS-3427) ... 167 CMS-3427 - Part I ... 167 CMS-3427 - Part II... 169 ICF/MR Application (CMS-3070G)... 169 Survey ... 169 Control ... 170

Survey Team Composition ... 170

Facility Data ... 171

Staffing ... 171

Off-Campus Day Programs ... 171

Individual Characteristics ... 172

ASC App/CDE (CMS-377/378E)... 174

CMS-377 - ASC Request for Certification ... 174

ASC App/CDE (CMS-377/378E)... 175

Hospice Application (CMS-417) ... 176 Hospice Application (CMS-643) ... 177 Application PRTF ... 178 CMHC Skeleton Record ... 179 FQHC Skeleton Form ... 180 Upload tab ... 181

Other Certification Windows... 182

Certification Kits window ... 182

Please Specify Transactions window... 183

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Surveys (Merge Surveys) window... 185

Buildings/Wings window... 186

Define New/Edit Building window ... 186

Facility Status Change window - ARO ... 187

Survey and Other Windows ... 188

Create Survey/Survey Properties window ... 188

Citation Manager window ... 189

Citation Properties window ... 190

POC Tracking window ... 192

Informal Dispute Resolution window ... 193

Survey Attachment Documents window... 194

Select Form(s) to Print window ... 194

Staff Availability List window... 195

CMS 670 Workload Detail window... 196

Create Followup window... 196

Export window... 197

Find window ... 198

Action Item Filter Settings window ... 198

Notices History ... 199

Select Letters and Distribution Lists window ... 200

Notification Type window... 201

ACO Letter Word Processor window - old ... 201

ACO Letter Word Processor window - new ... 202

ACO Fields and Buttons ... 203

Define New Facility/Facility Definition Fields ... 203

Facility Definition ... 203

Addresses ... 205

Mailing Address ... 206

Buildings/Wings ... 206

Define New/Edit Building... 207

Associations ... 209

Administration ... 210

Ownership ... 210

Licensing ... 211

Other ... 211

Certification Kit Fields ... 213

Certification & Surveys tab ... 213

Certification Properties... 213

Citation List - Health tab ... 214

Citation List - LSC tab... 216

Survey List - Surveys tab ... 218

Survey List - LSC 2786 (K9) tab... 221

Certification & Surveys - Special Fields... 222

Certification & Surveys - Hospital Special Fields ... 223

Transmittal (CMS-1539)... 225

CMS-1539 Part I ... 225

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Hospital Application Worksheet ... 231

Hospital/CAH Medicare Database Worksheet ... 231

Facility Relationship Manager - Off-site... 234

Facility Relationship Manager - Affiliations ... 235

RHC App/CDE (CMS-29/30E) ... 235

CMS-29 - Request to Establish Eligibility... 235

CMS-30E - From RHC CDE... 236

CORF Application (CMS-359) ... 237

ASC App/CDE (CMS-377/378E)... 238

HOSPICE Application (CMS-417) ... 239

HOSPICE Survey and Deficiencies Report (CMS-643) ... 240

NH Application (CMS-671)... 241 CMS-671 - General Information ... 241 CMS-671 - Facility Staffing ... 243 CMS-671 - Services... 244 NH Census (CMS-672) ... 247 CMS-672 - Census ... 247 CMS-672 - Conditions of Residents ... 248 CMS-672 - Conditions A & B ... 248 CMS-672 - Conditions C & D ... 249 CMS-672 - Condition E... 250 CMS-672 - Conditions F & G ... 251 CMS-672 - Miscellaneous ... 253

HHA Application (CMS-1572A) ... 253

CMS-1572A - Description ... 253

CMS-1572A - Administration & Affiliations ... 253

CMS-1572A - Services and Staffing ... 255

CMS-1572A - Visits, Census, Other... 255

OPT/SP App/CDE (CMS-1856/1893E)... 256

CMS-1856 - Request for Certification ... 256

CMS-1893E - From OPT CDE ... 257

XRAY Application (CMS-1880)... 258

ICF/MR Application (CMS-3070G)... 259

CMS-3070G - Survey Information ... 259

CMS-3070G - Control Information ... 259

CMS-3070G - Survey Team Composition ... 260

CMS-3070G - Facility Data ... 260

CMS-3070G - Staffing... 261

CMS-3070G - Off-Campus Day Programs... 261

CMS-3070G - Age and Gender ... 262

CMS-3070G - Disabilities... 262

CMS-3070G - Other Disabilities... 263

CMS-3070G - Other Individual Characteristics... 263

CMS-3070G - Allegations of Abuse and Neglect ... 264

CMS-3070G - Number of Deaths ... 264 ESRD Application (CMS-3427) ... 265 CMS-3427 Part I ... 265 CMS-3427 Part II ... 267 Application PRTF ... 267 CMHC Skeleton Record ... 268 FQHC Skeleton Form ... 269

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Upload tab ... 269

Prior Certification Kit Uploads ... 269

Upload Transaction Errors... 271

Other Certification Fields... 271

Certification Kits (Tracking) ... 271

Please Specify Transactions To List ... 272

Transactions ... 272

Surveys (Merge Surveys) ... 274

Facility Status Change - ARO ... 274

Survey and Other Fields ... 275

Create Health/LSC Survey, Survey Properties... 275

Citation Manager ... 278

Citation Properties ... 279

POC Tracking... 281

Informal Dispute Resolution (NH Only)... 281

Survey Attachment Documents ... 283

Select Form(s) to print ... 283

Staff Availability List ... 285

CMS 670 Workload Detail ... 287

Create Followup ... 288

Export ... 289

Find ... 289

Action Item Filter Settings... 289

Notices History ... 290

Select Letters and Distribution Lists... 291

Notification Type ... 291

ACO Letter Word Processor - old ... 292

ACO Letter Word Processor - new... 293

Supporting Materials ... 295

State Facility ID and Provider ID ... 295

Implicit Transactions... 298

Implicit... 298

Implicit-Spec ... 299

CLIA 220-224: Extracted Facility Properties ... 299

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ASPEN (Automated Survey Processing Environment) Central Office is a Windows®-based program that enables State Agencies (SAs) to implement information-based certification and oversight of the health care providers under their supervision. ASPEN Central Office (ACO) stores data about certified providers regulated by the Centers for Medicare & Medicaid Services (CMS) and the regulations pertinent to those providers. ACO can be extended to include provider categories for state licensure. A built-in Internet browser provides easy access to resources on the World Wide Web.

ACO includes full support for Federal certification operations. SAs can enter and maintain certification data and transmit it to OSCAR. State licensure records are also accommodated but not uploaded. Different categories of surveys can be performed at the same time as one integrated survey. For writing citations, ACO includes a fully functional word processor that also offers instant access to the text of and interpretive guidelines for the relevant regulations. An extensive reporting capability aids review and analysis of all processes.

ASPEN Regional Office (ARO) is the counterpart to ACO for CMS Regional Offices (ROs). ARO and ACO both fully support the information-based

administration of health care providers. To facilitate data entry, ARO and ACO both provide real-time access to the same databases. This enables SA and RO personnel to enter the information for which they are each responsible

whenever they are ready. The information is seamlessly integrated into the databases. ARO gives an RO full access to all the state databases under its jurisdiction, and read-only access to state databases outside its assigned region. ACO allows a state to access only its own databases.

Many functions are virtually the same in ARO and ACO, for example, the creation and maintenance of provider records. Other functions differ between ARO and ACO; for example, there are different mechanisms for assigning survey team members. In some cases, data entry screens are identical for functions in ARO and ACO, but different fields are enabled or disabled

depending on the information the RO or State is responsible for providing. This is particularly true for the Certification screen.

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About this Procedures Guide

The ACO Procedures Guide gives you the information you will need to create and maintain provider records and process certifications using ASPEN software. Functions specific to ARO and differences between ACO and ARO are identified.

Note: This guide assumes that you are familiar with basic Windows operations

and that you have attended ACO training offered by your agency.

This chapter contains procedures for creating and maintaining provider records and certification kits for the supported provider types. If you need more information, links to additional material are included. The second chapter has pictures and brief descriptions of facility, certification, survey, and other ACO screens and windows. The third chapter presents descriptions of the fields and buttons on those screens. The last chapter contains supplemental reference items.

While it is designed to be used easily online, you can print this document if you prefer.

You must have Acrobat Reader 5.0 or later installed to view this document online. You can download it from

http://www.adobe.com/products/acrobat/readstep2.html.

If you view this document online

Use the bookmarks in the left pane of Acrobat Reader to locate and go to relevant procedure(s) in this chapter. On any page, you can click or to adjust the print size to your comfort level.

In the procedures, there are two types of links (cross-references) to additional material:

For best viewing quality in the Acrobat Reader, select Edit | Preferences | General | Display and select the checkboxes for the three Smoothing options: Smooth Text, Smooth Line Art, Smooth Images.

Click the link to go the indicated

procedure. “Upload a Certification Kit“ on page 85

Click the link to go to a graphic of the

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If you print this document

If you print this procedures guide, use the Table of Contents to locate the procedure(s) you need in this chapter. Links (cross-references) from the procedures to additional material in this document include page numbers; simply go to the indicated page. Cross-references to the ACO Reference Guide give chapter number and section title; use the Table of Contents in the

Reference Guide to find the page number for the topic.

Managing Basic Provider Information in ASPEN

ASPEN Central Office lets you build a comprehensive record for each provider. You must add a provider to ASPEN before you can create surveys or certification kits for it. You can include identifying and descriptive information about the provider, buildings, agency associations, administration, ownership, etc.

Note: The terms “provider” and “facility” are used as synonyms in this guide.

Provider Records

A record must exist in ASPEN for a provider before you can create certification kits, surveys, and complaint/incident intakes for that provider. Special rules apply for labs as discussed in the following section.

You use the Define New Facility window to add provider records (by specifying facility properties) to ASPEN. When you modify an existing provider record, i.e., update facility properties, the window title is <Facility Name> Definition; it is referred to as the Facility Definition window in this guide. This window

comprises eight tabs that let you build a complete provider record: Facility Definition, Addresses, Buildings/Wings, Associations, Administration, Ownership, Licensing, and Other.

CLIA Labs

With ASPEN 8.6, CLIA provider information is added and maintained

automatically based on information entered in the OSCAR CLIA system. You only can add new labs in ASPEN of subtype 225-No CLIA Number (NOCN). The automatic update of CLIA provider information in ASPEN from the OSCAR CLIA system is performed during a nightly extract and load process.

Note: ASPEN does not include Labs terminated before January 1, 2000, unless

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Adding CLIA Lab Records

A new lab completes a CMS-116 application for certification. This application must be entered in OSCAR CLIA in order for a CLIA number to be assigned to the lab. Once a number is assigned, a record will be automatically created in ASPEN that evening and assigned to the correct ASPEN CLIA subtype: 220 LAB-PEND, 221 LAB-CMPL, 222 LAB-WAIV, 223 LAB-ACCR, or 224 LAB-PPMP. The 225 CLIA subtype lets you add and modify labs in ASPEN even if they do not yet have a provider number. This makes it possible to enter complaints against Federal labs that do not exist yet in OSCAR CLIA and are not part of the nightly extract process. OSCAR CLIA does not “know about” these 225 labs. As with other facility categories in ASPEN, you can also add state-licensure labs in ASPEN by creating your own CLIA subtype, such as 22L-Licensed Labs. However, subtype 225 is not intended for licensed-only labs.

The information you can modify in the Facility Definition window depends on whether the lab is of type 225 or types 220-224.

220-224

All fields that are pulled from OSCAR CLIA as part of the nightly update process are read-only in ASPEN. For example, you cannot modify addresses on either the Facility Definition or Addresses tab. Changes to these fields must be made in OSCAR CLIA. ASPEN will then be updated to reflect the changes during the nightly update process. See “CLIA 220-224: Extracted Facility Properties“ on page 299 for a list of read-only fields.

Other facility property fields can be edited or not according to established rules (for field descriptions, see “Facility Definition“ on page 203). OSCAR CLIA will not reflect changes made in ASPEN to editable fields.

225

You can modify all fields in provider records for 225 labs except those that are read-only for all providers, e.g., Addr Type on the Mailing Address tab.

Enter Facility Definition Information

The Facility Definition tab in the Define New Facility/Facility Definition window contains the basic identification, description, and contact information for a provider.

To add facility definition information:

1 Click on the ACO Explorer toolbar, or from the File menu, select New Facility.

The Define New Facility window opens with the Facility Definition tab selected.

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2 On the Facility Definition tab, as applicable, enter the Facility ID, the Provider Number, Medicaid ID, Employer ID, and State Key for the provider.

CLIA - Do not enter a Provider Number (aka CLIA Number, Medicare ID) as none has been assigned.

3 Select the applicable provider Type.

CLIA - Select 225 Lab-CLIA-No CLIA Number as the lab’s Type. 225 is the only Federal provider type that can be assigned to new labs. ACO does not permit you to create a CLIA provider of any other CLIA subtype.

Any licensure-only provider categories your state has defined are included in the list for selection.

4 Select the Current Operating Status, and enter the Opened date and Closed On date (if applicable) for the provider.

When a closed date is specified, an X appears on the lab’s icon in the Tree view.

5 In the section below Operating Status, select the checkbox(es) indicating the payor source(s).

6 Enter the Name of the provider.

The Name appears in the Tree and List views, and in survey forms, reports, and letters that you create in ACO for the provider. ACO displays the name in upper case (all capital letters) in this window, but displays it in mixed case (initial capital letters) in lists, reports, and letters.

7 Enter the Legal Name of the provider.

When you first create a provider record, Legal Name is populated from the Name field. You can change that as appropriate. No matter what case(s) you use here, ACO displays the legal name in mixed case (initial capital letters) in lists, reports, and letters.

When it is necessary to include the legal name of the provider in a letter, the Facility Legal Name macro that references the legal name can be inserted in the applicable letter template.

8 Enter the Address for the provider; use Address 2 for a second address line.

9 Click to open the Zip Code Search window so you can locate and enter the Zip, City, and County for the provider.

“Find Address Elements by Zip Code“ on page 16

When you select the applicable match from your search, ACO fills in the Zip, City, and County fields for you. If the Zip Code covers more than one City or County, ACO provides a drop-down list that you can select from. State is automatically entered and is read-only.

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Find Address Elements by Zip Code

You can open the Zip Code Search window from the Facility Definition tab and search the ASPEN provider database by Zip Code, City, or County. When you select a match from the Search Results list, ACO populates the Zip, City, and County fields on the Facility Definition tab.

10Enter Phone and Fax numbers for the provider.

11If a default value is not entered for OSCAR State Region, select the correct value.

12In the Contact Information section, enter the name of the Emerg. Contact, and the emergency contact’s Phone number, Extension, and E-Mail address.

13Enter the name of the Assessment Contact.

14Select another tab, or click OK to save the information and exit the Define New Facility window.

To modify facility definition information:

1 Locate the facility in the Tree view, right-click it, and select Facility Properties.

2 On the Facility Definition tab, make changes as needed.

CLIA

220-224

You cannot modify fields that are updated by the nightly extract from OSCAR CLIA.

“CLIA 220-224: Extracted Facility Properties“ on page 299

You can modify fields not maintained on OSCAR CLIA according to

established rules.

For field descriptions:

“Facility Definition“ on page 203

225

You can modify all fields that are normally editable.

For field descriptions:

“Facility Definition“ on page 203

If you change Type to 220-224, you must enter Provider Number (CLIA Number) as well.

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Change CLIA Lab Type

You cannot change provider type in ASPEN for labs maintained on OSCAR CLIA, i.e., CLIA subtypes 220-224. However, if a provider record for a lab is added to OSCAR CLIA after it has been entered in ASPEN as a 225 NOCN, you need to update its Type on the Facility Definition tab and enter the Provider Number from OSCAR CLIA. The provider record in ASPEN will then be maintained by the nightly extract from OSCAR CLIA.

1 On the Facility Definition tab, click in the Description section to open the Zip Code Search window.

2 In the Text field, enter all or part of the address element you want to search for.

If the search text you enter does not appear at the start of the number or name, type an asterisk (*) before the text, e.g., *alw.

3 Select the address element Type you want to search in the ASPEN provider database: Zip Code, City, or County.

You can perform only one type of search at a time.

Note: The search is not restricted to your state, so be sure the item you

select applies to your state. 4 Click

The address elements that match the search criteria appear in the Search Results section.

5 Select one of the entries in the Results list and click

-or-Double-click an entry in the Search Results list.

ACO enters the associated Zip, City, and County in the Description section on the Facility Definition tab.

To change CLIA 225 to another CLIA subtype:

1 Locate the lab in the Tree view, right-click it, and select Facility Properties.

2 Enter the Provider Number (CLIA Number) assigned to the lab on OSCAR CLIA.

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Enter Additional Mailing Addresses

Use the Addresses tab to enter additional mailing addresses, or to change the designated primary address. The Addresses tab lists the provider address entered on the Facility Definition tab as the physical address of the provider and designates it as primary. Additional addresses are all given an Address Type of 02 Mailing.

To add an address:

1 Click the Addresses tab in the Define New Facility/Facility Definition window.

Addresses tab on page 131

2 Click to open the Mailing Address window.

Mailing Address window on page 131

CLIA - You cannot add mailing addresses for lab types 220-224.

3 Enter the Care Of name, the street Address and Address 2 (for a second address line), City, and Zip.

State defaults to the current state. You can change it if needed. Address (Addr) Type defaults to 02 Mailing. You cannot change it.

4 Click OK to save the information and return to the Addresses tab.

The additional mailing address is listed.

5 To designate the address you added as Primary, select it and click

6 Select another tab, or click OK to save the information and exit the Define New Facility/Facility Definition window.

To modify an address:

1 On the Addresses tab, select the address you want to modify and click

CLIA - You cannot modify addresses for lab types 220-224.

2 In the Mailing Address window, make the necessary changes.

You can only modify the Care Of information for the physical address here; other changes must be made on the Facility Definition tab.

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Enter Buildings/Wings Information

Entering information in ASPEN about buildings/wings is essential for providers that receive Life Safety Code (LSC) surveys: NHs, ICF/MRs, ASCs, Hospices, and some Hospitals. ASPEN requires that every LSC deficiency be linked to a specific building.

Note: Although the Buildings/Wings tab is enabled for all provider types, you

should add building/wing records only for those types that receive LSC surveys.

To delete an address:

1 On the Addresses tab, select the address you want to delete and click

CLIA - You cannot delete addresses for lab types 220-224. 2 Click Yes in the confirmation message.

If you delete the existing primary address, a message reminds you to select another primary mailing address.

To add a building/wing:

1 In the Define New

Facility/Facility Definition window, click the

Buildings/Wings tab.

Buildings/Wings tab on page 132

-or-Click on the Certification & Surveys tab of the Certification window to open the Buildings/Wings window.

This window displays the information from the Buildings/Wings tab.

2 Click to open the Define New Building window.

Define New/Edit Building window on page 133

3 Enter a two-character Building/Wing ID.

4 Enter the Effective date for the building, i.e., the date the building became part of the facility.

Where applicable, Effective date defaults to the original participation date for the provider.

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5 If the building is closed, enter a Closed On date.

Closed buildings are not brought forward into new surveys.

6 Enter the Plan Approval date for the building, i.e., the date the building plan was approved.

7 Enter the Name/Reference of the building.

8 Select the applicable CMS Type (K3).

9 If the CMS Type is A or B, also enter the number of Building Stories.

10Select the Construction Type and describe the Location of the building.

11Select the LSC Form Indicator (K7).

This specifies the LSC regulation set that applies to the building and that’s displayed in the Survey Properties window.

Note: Building records created on or after the ASPEN 7.1 release

(9/11/03) can be assigned only K-2000 form numbers. Building records that existed before ASPEN 7.1 retain the older form numbers.

12If applicable, select the Licensed Only checkbox.

13ICF/MR - Select the ICF/MR Indicator.

14Specify whether the building has separate hazardous areas–Haz. Area Separate (K29).

If the building has no hazardous areas, select 3 - Not Applicable.

15Enter the FSES Date (Fire Safety Equivalency System inspection date) and the date the building was Constructed.

16Select the appropriate options for the Is Sprinkler Required? (K56) and Sprinkler Status (K180).

17Click OK.

The building is added to the grid on the Buildings/Wings tab.

18Select another tab, or click OK to save the information and exit the Define New Facility/Facility Definition window.

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Specify Provider Associations

The Associations tab is used to assign State Agency units, accreditations, and congressional representatives to a provider.

Note: This tab is not customized for labs.

To modify a building/wing:

1 On the Building/Wings tab or in the Building/Wings window (opened from the certification kit), select a building and click

2 In the Edit Building window, make your changes and click OK.

You cannot change K7. If the Federal regulation set changes, you must delete the current building and create a new building record.

To delete a building/wing:

1 On the Building/Wings tab or in the Building/Wings window (opened from the certification kit), select a building and click

You cannot delete a building that is linked to a citation.

A message asks if you want to delete the building. If it is included in one or more certification kits for the provider, the message indicates that the building will be removed from all of those kits.

2 Click Yes in the confirmation message.

When you delete a building, OSCAR building numbers are re-sequenced. For example, if you remove building #3 of 6 buildings, the former building 6 will now be 5, 5 will be 4, and so on.

1 In the Define New Facility/Facility Definition window, click the Associations tab (see page 134).

2 In the Agency Associations section, select the Management Unit, Supervisory/Work Unit, and LSC/DSI Unit assigned to the

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Enter Administration Information

Use the Administration tab to assign administrators to providers and designate primary administrators. You can modify administrator assignment information and remove assigned administrators. You can also add administrator records to ASPEN. Only administrators in ASPEN can be assigned to providers.

3 In the External Associations section, select the Accreditation(s) for the provider.

You can select a maximum of two accreditations.

Note: Accreditation information is optional on this tab. Accreditation

details for certified providers are maintained on the CMS-1539 form of the provider certification kit.

4 Select the congressional House District and Senate District representatives for the provider.

To assign an administrator:

1 In the Define New Facility/Facility Definition window, click the Administration tab (see page 135).

2 Search in the Administration Directory for the administrator you want to assign: enter all or part of the administrator’s last name in the Name field and click

Administrators who match the search criteria are listed.

3 Select the administrator you want to assign to the provider and choose

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4 In the Administrator Information window that appears, enter the Started and Ended dates for the administrator, select the

appropriate Administrator Type, and click OK.

The administrator is now listed in the Administrators Linked to this Facility section on the Administration tab.

Note: If the Ended date is prior to today’s date, the administrator will be

listed in Tree view under the Former Administration node for the provider. 5 To designate an administrator as the primary administrator for

the provider, select the administrator and click

The primary administrator is indicated by an asterisk. The first administrator assigned is automatically designated the primary administrator.

Note: Admin macros use the primary administrator when form letters are

generated.

To modify administrator assignment information:

1 In the Administrators Linked to this Facility section on the Administration tab, select the applicable administrator and click

2 In the Administrator Information window, make the necessary modifications and click OK.

To delete an assigned administrator:

1 In the Administrators Linked to this Facility section on the Administration tab, select the applicable administrator.

No confirmation message appears, so be sure you want to remove the selected administrator.

2 Click to delete the administrator from the list of Administrators Linked to this Facility.

If you remove the primary administrator, a reminder to select another primary administrator appears.

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Enter Ownership Information

Use the Ownership tab to assign owner companies to providers and designate primary owners. You can modify ownership information and remove assigned owner companies. You can also add owner companies to ASPEN. Only owner companies in ASPEN can be assigned to providers.

To add an administrator to ASPEN:

1 Under the Administrator Directory Search section on the Administration tab, click

2 In the Enter Administrator Information window, provide the requested information.

To assign an owner company:

1 In the Define New Facility/Facility Definition window, click the Ownership tab.

2 Search in the Owner Directory for the owner company you want to assign: enter all or part of the company name in the Name field and click

Owner companies that match the search criteria are listed.

3 Select the owner company you want to assign to the provider and choose

-or-Double-click the applicable owner company.

4 In the Owner Properties window that appears, enter the requested information and click OK.

The owner company is now listed in the Owners Linked to this Facility section on the Administration tab.

5 To designate an owner company as the primary owner of the provider, select the owner company and click

The primary owner is indicated by an asterisk. The first owner company assigned is automatically designated the primary owner.

Note: Applicable macros insert the primary owner when form letters are

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6 To designate an owner company as the primary owner of the provider, select the owner company and click

The primary owner is indicated by an asterisk. The first owner company assigned is automatically designated the primary owner.

Note: Applicable macros insert the primary owner when form letters are

generated.

To modify ownership properties:

1 In the Owners Linked to this Facility section on the Administration tab, select the applicable owner and click

2 In the Owner Properties window, make the necessary modifications and click OK.

To delete an assigned owner company:

1 In the Owners Linked to this Facility section on the Administration tab, select the applicable owner company.

No confirmation message appears, so be sure you want to remove the selected owner.

2 Click to delete the owner from the list of Owners Linked to this Facility.

If you remove the primary owner company, a reminder to select another primary owner appears.

To add an owner company to ASPEN:

1 Under the Owner Directory Search section on the Administration tab, click

2 In the Enter Owner Company Information window, provide the requested information and click OK.

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Enter Licensing Information

The Licensing tab captures basic information about a provider’s state-issued license whether the provider is licensure-only or both federally certified and state-licensed.

Enter Miscellaneous Information

Use the Other tab to enter optional miscellaneous information about a provider such as the geographic location, insurance expiration date, media contact, etc. Applicable fields vary according to provider type.

1 In the Define New Facility/Facility Definition window, click the Licensing tab.

License Number is entered automatically by ACO from the License Number field on the Facility Definition tab.

2 Select the License Type.

3 Enter the License Issue Date, License Effective From date, and License Effective To date.

4 Select the License Continuing? box if the answer is Yes.

1 In the Define New Facility/Facility Definition window, click the Other tab.

2 Enter information in applicable fields:

• Latitude and Longitude - Latitude and longitude of facility location. • Insurance Expiration - Date the provider’s insurance expires. • Surety Bond - Status of surety bond.

• Fiscal Year End - Month in which provider’s fiscal year ends. Use numbers, such as 02 for February.

• Special Operating Hours? Indicates facility has special operating hours. Enter hours in ACO notepad.

• Bankrupt - Indicates provider is bankrupt. • Petition Date - Date of petition for bankruptcy. • End Date - Date of final bankruptcy court order.

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Certification Process

As part of the CMS system standardization strategy, all certification data captured at the SA and RO levels by ACO/ARO will ultimately be integrated into the OSCAR production system. OSCAR is the master national repository for provider enrollment, certification, and survey information. ACO/ARO 8.6 fully supports an integrated certification process for all Federal provider types except CLIA labs.

Note: ACO also accommodates State licensure records, but they are not

uploaded to OSCAR or CASPER.

Create a Certification Kit

When you create a certification kit, whether initial or recertification, it will be the current kit. It is possible to have two current kits: one that has been uploaded successfully to OSCAR and a new certification kit that hasn’t been completed. You cannot change the exit date(s) of the accepted kit’s standard survey(s).

Current kits are listed as Current on the Alpha and Type tabs and as Open or Closed on the Cert/Survey tab.

Prior kits cannot be modified, with the exception of revisit dates, and CMS-670 and CMS-2567 (Statement of Deficiency) data. You can add followup surveys to Prior kits.

• Special Focus - Indicates a Special Focus Facility (SFF). • Begin Date - Start date of SFF monitoring.

• End Date - End date of SFF monitoring. • NATCEP Loss - Read-only. Yes or blank.

• Last Day - Read-only. Last day of most recent NATCEP loss.

• Last Day of Waiver - Read-only. Last day of waiver applied to NATCEP loss.

• Restored Based on CHOW Date - Read-only. Date NATCEP was restored following a change of ownership (CHOW).

• Media Contact - Name of media contact for facility. • Chain - Name of chain that provider is part of. • DOJ Contact - Name of DOJ contact for facility.

• Intermediary/Carrier No. - Read-only. Name of provider’s intermediary from CMS-1539 (L31).

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You can create certification kits for the following provider types:

Accredited/Deemed Providers

You can create and upload certification kits without surveys for all provider types that may be deemed.

➥

For accredited Hospitals, you can enter and upload survey, deficiency, and workload information only for validation, swing bed, or psychiatric surveys.

➥

For deemed HHAs, ASCs, and Hospices, you need to enter and upload only validation surveys as part of deemed provider certification kits.

If accredited or deemed status changes, you must perform the appropriate update tasks. See “Change Accredited/Deemed Status“ on page 107.

Accredited/Deemed Certifications

ACO/ARO automatically ensures that you enter only necessary survey data based on the provider category, category subtype, and the Deemed? indicator on the CMS-1539.

Note: For historical stub kits, ASPEN does not know if a certification is deemed

until you rebuild it from history (see “Rebuild a Historical Kit“ on page 98), so unbuilt kit stubs are not displayed in blue italics.

Hospital NH HHA XRAY OPT/SP ESRD RHC ICF/MR ASC Hospice PRTF OPO CMHC FQHC CORF

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indicates validation surveys and certifications.

Note: Due to the existing framework in OSCAR, ASPEN can pick up only the

most recent accreditation indicator for Hospitals, which it applies to all the prior kits—whether or not the provider was accredited at the time of the prior certification. For this reason, you may see older “accredited” certification kits that contain survey data.

Date of Survey for Deemed Kits without Surveys

For certification kits with surveys, ASPEN generates the Date of Survey (L34) on the CMS-1539, also referred to as the Certification Exit Date. For these kits, L34 is set to the exit date of the later of the Health or LSC survey.

Certification kits for accredited/deemed Hospitals, Non-participating Hospitals, and other deemed providers (HHAs, ASCs, Hospices) may not contain survey events. Therefore, there may not be a direct source for this date, but it must be entered nonetheless.

For deemed kits that do not have surveys, ASPEN adds the field Survey Date (L34) to the CMS-1539 tab. This field is updated according to the following rules:

• For initial certifications of regular (i.e., not having swing beds or psychiatric surveys) accredited Hospitals and other deemed providers, Survey Date (L34) is set to the Original Participation Date (L24) and cannot be changed.

• For recertifications of regular accredited Hospitals and other deemed providers, Survey Date (L34) is required and must be entered by the user.

• For recertifications of regular newly-accredited/deemed providers using the Create Accredited/Deemed Cert Kit option (“Change Status to Accredited/Deemed“ on page 109): Survey Date (L34) is set to the previous certification kit’s Exit Date + 1 day. It can be changed as needed.

• For Non-participating Hospitals, Original Participation Date (L24) is not entered, so Survey Date (L34) is set to the date of the certification’s first successful upload to the national system. It can be changed when 1539 information is updated.

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Hospital

ASPEN fully supports the certification process for all nine Hospital subtypes described below.

Data requirements and collection procedures for Hospital certification vary depending on accreditation status, Hospital subtype, swing bed status, and other factors. The following table indicates the survey(s), if any, that are required or can be optionally performed according to these factors. ASPEN automatically enables or disables survey creation for Hospitals accordingly.

OSCAR Subtype Code

ASPEN Facility Type

Description ASPENFacType Code ASPEN FacType Abbrev. Valid Provider Number Ranges

01 Short Term 011 HOSP-ACU 0001-0879

02 Long Term 015 HOSP-LT 2000-2299

03 Religious Nonmedical Health Care Institution (RNHCI)

017 HOSP-RNC 1990-1999

04 Psychiatric 012 HOSP-PSY 4000-4499

05 Rehabilitation 013 HOSP-RHB 3025-3099

06 Children’s 016 HOSP-CHD 3300-3399

07 Distinct Part Psychiatric 018 HOSP-DPP 4000-4499

11 Critical Access 014 HOSP-CAH 1300-1399

Blank Non-participating:

Emergency. Federal 019 HOSP-NP E, F is sixth character in provider number

Hospital: Allowed Surveys by Subtype and Type of

Action Health LSC

Emergency/Non-Participating (HOSP-NP, FacType:

019) No No

Regular Non-Accredited (1539 L10 Accreditation

Status < 1) for HOSP-ACU, HOSP-PSY, HOSP-RHB, HOSP-CAH, HOSP-LT, HOSP-CHD, HOSP-RNC, HOSP-DPP (FacType: 011, 012, 013, 014, 015, 016, 017, 018)

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In addition, ASPEN automatically determines and displays the appropriate Federal regulation set for a given Hospital survey. The following table indicates the regulation sets allowed for Health surveys according to Hospital subtype.

Regular Accredited (1539 L10 Accreditation Status>0

and 1539 L8 Type of Action <> 5 Validation) for

HOSP-ACU, HOSP-PSY, HOSP-RHB, HOSP-CAH, HOSP-LT, HOSP-CHD, HOSP-DPP (FacType: 011, 012, 013, 014, 015, 016, 018)

No No

Accredited Validation (1539 L10 Accreditation

Status>0 and 1539 L8 Type of Action = 5 Validation) for HOSP-ACU, HOSP-PSY, HOSP-RHB, HOSP-CAH, HOSP-LT, HOSP-CHD, HOSP-DPP (FacType: 011, 012, 013, 014, 015, 016, 018)

Yes Optional

Accredited Swing Bed 1539 L10 Accreditation

Status>0 and Special Fields Swing Bed Indicator=’Yes’) for HOSP-ACU, HOSP-RHB, HOSP-CAH, HOSP-LT, (FacType: 011, 013, 014, 015)

Yes No

Accredited Psychiatric (non-validation survey) 1539

L10 Accreditation Status>0 and 1539 L8 Type of Action <> 5 Validation for HOSP-PSY, HOSP-DPP (FacType: 012, 018)

Yes No

Hospital: Allowed Health Regulation Sets

Non-Accred Accredited

Type Code

Hospital Subtype Regular

Survey Validation Survey Non-Validation Survey 011 SHORT TERM A A A

(Swing bed only)

015 LONG TERM A A A

(Swing bed only)

017 RNHCI R

012 PSYCHIATRIC A, B A, B B

013 REHABILITATION A A A

(Swing bed only)

016 CHILDREN’S A A

018 DISTINCT PART PSYCH HOSP A, B A, B B 014 CRITICAL ACCESS HOSPITAL A, C A, C A

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The rules underlying the generation of certification kits for Hospitals that reflect the multiple interrelated conditions are certainly complex. As an ASPEN user, however, you need only create or open a certification kit, complete the required fields, and enter survey information as necessary. The software does the work of determining which fields as well as which surveys are required for each type of Hospital.

The procedures that follow tell you how to complete Hospital certifications for the situations listed below:

Note: ASPEN duplicates OSCAR capabilities for Hospitals; it does not extend

them. ASPEN does not record workload information other than that supported in OSCAR.

Carry Forward of Hospital Certification Data

When you use the Create Certification option (right-click a provider in the Tree view) to open a new certification kit for a Hospital, ASPEN brings forward the following information (as applicable) from the current kit for the provider into the new certification kit.

• Hospital Special Fields

• Accreditation Status and Deemed indicator • CHOW date (if any)

• Total Facility Beds

• Unaccredited Hospital “Hospital: Unaccredited“ on page 33

• Accredited Hospital - no survey

required “Hospital: Accredited, No Survey“ on page 35

• Accredited Hospital - non-validation

survey required “Hospital: Accredited with _{Non-validation Survey“ on} page 37

- Psychiatric B-tag survey “Accredited Psychiatric Hospital: B-tag Survey Only“ on page 38

- Swing bed survey “Accredited Hospital: Swing Bed Survey“ on page 39

• Accredited Hospital - validation

survey “Hospital: Accredited with Validation Survey“ on page 41

• Accredited Hospital - full survey after

finding condition-level deficiencies “Change Accredited Hospital Status to Conduct Full Survey“ on page 110

• Non-participating Hospital “Hospital: Non-participating (NP)“ on page 43

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• Intermediary/Carrier No. • Fiscal Year Ending Date

Hospital: Unaccredited

The certification process for unaccredited Hospitals is like that for other unaccredited provider categories. The applicable Hospital subtypes are:

When:

Accreditation Status (L10) on CMS-1539 = 0 Unaccredited

Required Surveys:

Health LSC

You can combine a swing bed survey with a general Hospital survey.

Note: If an unaccredited Hospital becomes accredited before the next survey,

you must create a new certification kit. See “Change Status to Accredited/Deemed“ on page 109.

OSCAR

Subtype Description ASPENFacType Abbreviation

01 SHORT TERM 011 HOSP-ACU

02 LONG TERM 015 HOSP-LT

03 RELIGIOUS NONMEDICAL HEALTHCARE INSTITUTION (RNHCI) 017 HOSP-RNC 04 PSYCHIATRIC 012 HOSP-PSY 05 REHABILITATION 013 HOSP-RHB 06 CHILDREN’S 016 HOSP-CHD

07 DISTINCT PART PSYCH HOSPITAL 018 HOSP-DPP

11 CRITICAL ACCESS HOSPITAL 014 HOSP-CAH

1 Create a new provider record if

necessary. “Provider Records“ on page 13

2 Locate the provider in Tree view, right-click the provider name, and select Create Certification.

The Create Certification command brings forward information from the current kit for the provider into the new certification kit to save data entry time. For specifics, see “Carry Forward of Hospital Certification Data“ on page 32.

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3 On the Certification & Surveys tab of the Certification window, complete required and relevant fields including Hospital Special Fields.

“Enter Certification Information“ on page 54

4 Add or modify buildings/wings as needed.

You are required to define at least one building/wing record for Hospitals.

“Enter Buildings/Wings Information“ on page 19

5 Create/schedule survey(s) and

enter citation information. “Create and Conduct a Survey“ on page 56 “Record Deficiencies“ on page 59

Both Health and LSC surveys are required for unaccredited Hospitals.

Note: To combine a swing bed survey with a general Hospital survey, be

sure to set Provides Swing Beds (SF44) to Yes and select the appropriate Size Code (SF28) in Hospital Special Fields on the Certification & Surveys tab.

6 Create/schedule revisit surveys

as needed. “Create a Revisit Survey“ on page 62

7 Complete CMS-670 and print

CMS-2567 for each survey. “Enter CMS-670 Data“ on page 63“Print CMS-2567“ on page 64

8 Complete required forms. “Enter CMS-1539 Data“ on page 65 “Enter Application Worksheet Data - HOSPITAL“ on page 68

9 Upload the completed kit to

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Hospital: Accredited, No Survey

For an accredited Hospital that does not require a survey, you complete the following:

• Hospital Special Fields • CMS-1539

• Application Worksheet

The applicable Hospital subtypes are:

When:

Accreditation Status (L10) on CMS-1539 ≠ 0 Unaccredited Deemed? indicator = Yes

Required Surveys:

None

Accredited/deemed certification kits display in blue italics in the Tree view.

OSCAR

04 PSYCHIATRIC 012 HOSP-PSY

05 REHABILITATION 013 HOSP-RHB

06 CHILDREN’S 016 HOSP-CHD

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Note: If an accredited Hospital loses its accreditation before the next survey,

you must create a new certification kit and survey(s). See “Change Status to Unaccredited/Not Deemed“ on page 107.

Note: If you set Provides Swing Beds (SF44) to Yes, a survey is required.

See “Hospital: Accredited with Non-validation Survey“ on page 37

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Hospital: Accredited with Non-validation Survey

For an accredited Hospital that requires a non-validation survey, you complete the following:

• Application Worksheet • Survey and Forms

ACO limits surveys and citations for non-validation surveys of accredited Hospitals to the allowed Federal regulation sets for the situation. For an accredited Psychiatric Hospital, you can survey and cite only B tags. For an accredited Hospital with swing beds, only tags A1500-A1599 are permitted on upload. You can also work with applicable state regulation sets. LSC surveys are not allowed in either case.

OSCAR

Psychiatric

Swing Bed

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Accredited Psychiatric Hospital: B-tag Survey Only The applicable Hospital subtypes are:

When:

Accreditation Status (L10) on CMS-1539 ≠ 0 Unaccredited Type of Action (L8) on CMS-1539 ≠ 5 Validation

Required Survey:

Health OSCAR

3 On the Transmittal (CMS-1539) tab of the Certification window, verify the Accreditation Status (L10).

It must not be 0 Unaccredited. 4 On the Certification & Surveys

tab of the Certification window, complete required and relevant fields including Hospital Special Fields.

6 Create/schedule a B-tag Health survey and enter citation

information.

You can cite only B tags.

“Create and Conduct a Survey“ on page 56

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Accredited Hospital: Swing Bed Survey The applicable Hospital subtypes are:

When:

Accreditation Status (L10) on CMS-1539 ≠ 0 Unaccredited Type of Action (L8) on CMS-1539 ≠ 5 Validation

Provides Swing Beds (SF44) in Hospital Special Fields = Yes

Required Survey:

Health (swing bed)

Only tags A1500-1599 will be uploaded. 7 Create/schedule revisit surveys

10Upload the completed kit to

OSCAR. “Upload a Certification Kit“ on page 85

OSCAR

11 CRITICAL ACCESS HOSPITAL 014 HOSP-CAH

3 On the Certification & Surveys tab of the Certification window, set Provides Swing Beds (SF44) in Hospital Special Fields to Yes.

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Note: If you need to change Provides Swing Beds (SF44) from Yes to No for an

accredited Hospital and the certification kit has not been uploaded, you must first delete the existing survey. If the kit has been uploaded, you must create a new certification kit.

4 On the Transmittal (CMS-1539) tab, verify the Accreditation Status (L10).

It must not be 0 Unaccredited. 5 On the Certification & Surveys

tab of the Certification window, complete required and relevant fields including Hospital Special Fields.

7 Create/schedule a swing bed Health survey and enter citation information.

To maintain compatibility with ASE, ACO does not prohibit A-tag

citations. For accredited Hospitals, however, only swing bed tags (A1500-1599) are uploaded.

“Record Deficiencies“ on page 59

10Complete required forms. “Enter CMS-1539 Data“ on page 65 “Enter Application Worksheet Data - HOSPITAL“ on page 68

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Hospital: Accredited with Validation Survey

For an accredited Hospital that requires a Validation survey, you complete the following:

• Application Worksheet • Survey(s) and forms

When:

Accreditation Status (L10) on CMS-1539 ≠ 0 Unaccredited Type of Action (L8) on CMS-1539 = 5 Validation

Survey(s):

Health (required) LSC (optional)

OSCAR

06 CHILDREN’S 016 HOSP-CHD

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3 On the Transmittal (CMS-1539) tab of the Certification window, verify the Accreditation Status (L10).

It must not be 0 Unaccredited.

4 For Type of Action (L8), select 5 Validation.

7 Create/schedule a Health survey and enter citations if deficiencies are found.

“Record Deficiencies“ on page 59

In the Create Health Survey/Survey Properties window, I-Recertification and G-Validation are pre-selected for Type of Survey. In Hospital Special Fields on the Certification & Surveys tab, ASPEN inserts the survey Exit date (X3) as the Validation Survey Date (SF32).

Note: You can add an LSC survey as appropriate, but it is not required for

upload.

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Hospital: Non-participating (NP)

Emergency and Federal Non-participating Hospitals (HOSP-NP) have skeleton records similar to those for OPOs and FQHCs, although there is not a separate skeleton form. The skeleton record consists of the basic provider information captured on the 1539.

The 8.5 history build created initial certification kit stubs for all

Non-participating Hospitals already in the database. You cannot add new certification kits to existing NP Hospitals. When new information is received, simply update the existing certification. You can, however, create a new initial certification kit if you add an NP Hospital to the database.

The applicable Hospital subtype is:

For an existing NP Hospital:

• Rebuild the initial certification from the stub kit. • Update NP provider data on the CMS-1539. For a new NP Hospital:

• Add a provider record to the database.

Only ROs can create a provider record for Canadian or Mexican NP Hospitals.

• Create an initial certification kit.

• Enter NP provider data on the CMS-1539. 9 Complete CMS-670 and print

10Complete required forms.

State should use their previously established procedures to notify the Regional Office of validation survey results. RO Receipt Date (L32) is required for validation surveys.

“Enter CMS-1539 Data“ on page 65 “Enter Application Worksheet Data - HOSPITAL“ on page 68

OSCAR

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Existing Non-participating Hospital For an existing NP Hospital, you must:

• Rebuild the initial certification from the stub kit. • Update NP provider data on the CMS-1539.

New Non-participating Hospital For a new NP Hospital, you must:

• Add a provider record to the database.

Only ROs can create a provider record for Canadian or Mexican NP Hospitals.

• Create an initial certification kit.

• Enter NP provider data on the CMS-1539. 1 Rebuild the initial certification

kit from the stub. “Rebuild a Historical Kit“ on page 98

2 Right-click the rebuilt certification, and select Certification Kit.

3 On the Certification & Surveys tab of the Certification window, complete relevant fields.

Hospital Special Fields are not enabled for Non-participating Hospitals.

4 On the Transmittal (CMS-1539) tab of the Certification window, complete the required fields: Survey Date (L34), bed counts (L18, L17), and Termination Code (L30).

You can optionally complete Facility Meets and Intermediary/Carrier No. (L31).

“Transmittal (CMS-1539)“ on page 225

1 For a new NP provider in the U.S., create a HOSP-NP provider record.

“Provider Records“ on page 13

RO - To create provider records for NP Hospitals in Canada or Mexico: • On the Type tab, right-click the 01- Hospital node and select

Create Canadian Hospital or Create Mexican Hospital as applicable.