Your Current Processes:

• Supervisor reviews every visit note in detail
• Case Manager reviews every visit note in detail

Benefits If You Change Your Process:

• Immediate increase in revenue due to charges flowing in a timely manner
• Focus supervisor and case manager energy where it matters: OASIS visits 
• Reduce overload of clinical supervisors

New Process Details:

We've found, through studies of our customers' best practices, that supervisory review of each regular visit is not necessary. Instead, an audit of all incoming visits and a more detailed review of OASIS visits is a much more effective use of clinical supervisory time.  

Each day, the clinical supervisor should start the day by clicking the Recent Visits button on the first screen of Barnestorm Office. This will tell you: 

• Which visits were done
• Times and duration of visits
• MOST IMPORTANT: Visit Status

The most streamlined policy, both from the clinical and the billing perspective, is as follows:

• Clinicians are required to finish the visit note at the time of the visit OR in the car outside the patient home. The average time to document a visit in Barnestorm POC is 8 minutes. It takes much longer, and creates many opportunities for inaccuracies, when clinicians "finish" documenting "later". 
• Clinicians are required to lock all scheduled visits on the day they do the visit. This is easily accomplished when they document at the time of the visit.
• Clinicians should NOT lock OASIS visits until told to do so by the OASIS reviewer.
• Reviewers check the scheduled visits each day by clicking the Recent Visits button on the first screen of Barnestorm Office. Check for visit times, visit status (should be locked for all regular visits), and use the Print Visit button to check the visit note as needed.
• Review focus should be on OASIS visits, using the OASIS Compare to ensure consistent documentation, as well as any other OASIS review deemed appropriate by your agency.
• Supervisors should make notes of  shortcomings in clinical documentation and use Messaging to communicate to clinician what needs to be changed on the note, such as: "Your OASIS answer on M1036 is not consistent with previous OASIS--use the OASIS Compare and check that your answers are accurate. Message me when you have reviewed your answers. Be sure to Rebuild your OASIS if you change your answers."
• Clinicians who are not locking their scheduled visits on the day of the visit should be re-trained until they do so (Barnestorm can assist).
• The default import time for the agency to import locked visits should be shortened to 2-5 days.
• The only visit notes that should always be reviewed in detail should be OASIS-generating visits.
• Supervisors should review OASIS visits and be sure to use the OASIS Compare feature to ensure continuity of documentation.

Example Message Topic from Clinical Supervisor:  

"Your OASIS answer on M1036 is not consistent with previous OASIS--use the OASIS Compare and check that your answers are accurate. Message me when you have reviewed your answers. Be sure to Rebuild your OASIS if you change your answers."

Suggestion on how to start this process:

Supervisor Planning and Oversight

• How much time do you allow for your clinicians to complete a visit? 
• Is this enough time to allow for 8 minutes to document the visit in Barnestorm?
• How much travel time is allotted between visits? 
• What is the visit load per day for each clinician?
• Ensure that each clinician has the 8 minutes needed to document a scheduled visit in Barnestorm.
• Monitor clinician activity: how long, on average, does each clinician take between starting a visit and completing it?
• Does this additional time enhance or detract from accurate documentation?
• Is the clinician working extra hours at home at night completing visit notes? If this is the case, extra training in Barnestorm is needed.
• Helpful Tip: Ensure that only the REQUIRED screens are on the required list for scheduled visits. If you have too many required items, this makes the visit documentation time for a regular visit longer than it should be. Barnestorm can assist you with streamlining your required items on regular visits.
• Helpful Tip:  Make sure that any text that clinicians use over and over is pre-typed for them to save them time.
  
• Helpful Tip: If you normally use one block of text with options, you can create one text item and then add all choices in the phrase.  The clinician can simple delete any choices not needed. 

• Reduce the amount of time allowed for clinicians to complete notes. 
• Inform clinicians that the goal is to complete all regular visit documentation at the time of the visit, and that they should let you know if that's a problem. Set a date for this goal.
• Each clinician should sync daily.
• Inform clinicians that supervisors will communicate about visits via Messaging.
• Select experienced POC users to help less experienced users with tips.
• Schedule an in-service with Barnestorm for online training on POC quick tips.

Checks and Balances:

At first, supervisors should review visit notes to ensure that documentation is as needed. Once sure that an employee is documenting correctly, it's best to trust the clinician to document, and perform informal check on visits from Recent Visits, rather than performing detailed reviews of regular visits.  More attention is needed for OASIS visits, so the supervisory focus should be on those visits rather than regular visits.

Related Reports:

Front Page: Recent Visits

02.73 Visits by Employee

02.18 Employee Visit Counts By Day

02.25 Employee Visit Productivity Report

Related How-To Articles:

OASIS Compare: http://kb.barnestorm.biz/KnowledgebaseArticle50901.aspx

Add/Change/Delete Pre-Typed Text http://kb.barnestorm.biz/KnowledgebaseArticle50091.aspx

View Recent Visits: http://kb.barnestorm.biz/KnowledgebaseArticle50409.aspx