1. U N C H E A L T H C A R E S Y S T E M TIMETREX For Advanced Practice Providers (APPs) Last Update: 05/06/16

2. TimeTrex Log-on Screen

3. About TimeTrex  Health care programs funded by the federal government (Medicare, Medicaid, and TRICARE) require hospitals to submit cost reports  TimeTrex is a time-keeping system that allocates your total work hours for UNC Hospitals’ cost report  The cost report is the basis for calculating claims reimbursement for UNC Hospitals and submitting labor hours is a vital piece of this calculation

4. Why Do We Use TimeTrex?  TimeTrex is a tool developed and used by UNC HCS to accurately calculate our reimbursement for Part A activities  Part A activities are reported on UNC Hospitals’ cost reports and contribute to the calculated labor hours for UNC Hospitals  TimeTrex time sheets help the hospital get the appropriate reimbursement for claims

5. TimeTrex Users  You have a very important role in the TimeTrex process. Accurately capturing your time is vital in order to report your labor hours  To accurately complete TimeTrex, you need to understand how you spend your time and what information the time study is capturing

6. What Does TimeTrex Represent?  TimeTrex captures 1 week of your time every month  This week is to be representative of your work time for the week reported  In order to capture accurate time you should record your activity daily  All hours worked must be reported even if they are above or below 40 hours  Medicare requires hospitals to rotate weeks so that different weeks are represented each year

7. TimeTrex  You will receive 2 email reminders to complete your TimeTrex time sheet every month  The first email will occur on the 1 st day of each month  The second email will occur on the Saturday before a new time sheet starts the following day

8. TimeTrex  Your total reported time is a sample that is representative of the entire month  All Timetrex reports collectively are representative of the entire year  Part A time is reported to government payors to drive reimbursement and may also determine salary funding of the position between the hospital and the practice plan

9. Recording Time  All time worked should be included in the study o If you work 44 hours, you record 44 hours  Some time will have to be reported based on your best judgement  Intentionally filling out the document incorrectly may be considered fraud

10. Reimbursement for Services  Reimbursement is split into Part A (hospital services) Part B (professional services)  Hospitals receive reimbursement for hospital-related services  Physicians and APPs receive reimbursement for their professional services

11. Part A (Hospital Services – lines 1-5) Medicare’s “General Rule” of services that can be allocated to the hospital are defined as Part A (Hospital Services):  Services provided in the hospital or hospital-based clinics that are not billable professional services  Services that could otherwise be performed by an experienced registered nurse and do not require your advanced degree  To record time on Line 1-Residents Training, the trainer must have an advanced degree

12. Part A (Hospital Services – Line 1) Line 1:  Does not include training of any students, staff, nurses, pharmacy residents of any type, or APPs  The parsing of time between resident instruction and direct patient care should be done o An example may be if a surgical procedure is normally 2 hours but because a resident is being taught, the procedure takes 3 hours. The time will be split: 2 hours of direct patient care (line 6) and 1 hour of instruction of the resident (line 1)

13. Part A (Hospital Services – Line 2) Line 2:  Does not include training of any students, residents, or APPs. Medical residents are recorded on line 1 and students/APPs are placed on line 8  Do not put Hospital Based Clinic activities here. Professional activities in a Hospital Based Clinic are placed on line 6 and routine RN activities in a Hospital Based Clinic are placed on line 3 o An example may be training RNs to change specialty dressings on Neurosurgery patients

14. Part A (Hospital Services – Line 3) Line 3:  Only include RN activities performed in a Hospital Based Clinic. If you are not sure if your clinic is Hospital Based, please ask the clinic manager  A Hospital Based Clinic list is also available in the drop-down category for this line in TimeTrex

15. Part A (Hospital Services – Line 4) Line 4:  Reminder: Activities entered on this line do not require an advanced license to perform (i.e. could be provided by Case Management or a Registered Nurse)

16. Part A (Hospital Services – Line 5) Line 5:  If the committee or the quality initiative is for both the hospital and another entity, split the time between each entity, and place the SOM time on line 8

17. Part B (Professional Services – line 6) Medicare’s “General Rule” definition of Part B (Professional Services): Services provided in either hospital space or in physician clinics that are billable professional services Other services provided in physician clinic space or for the benefit of the physician clinic

18. Part B (Professional Services – Line 6) Line 6:

19. Part B (Professional Services – line 6)  Physicians and APPs typically perform services of evaluation and management, which includes history-taking, physical examination, medical decision-making, counseling and coordination of care  Other professional services may include activities such as lumbar puncture, central line placement, and intubation  These professional services are reimbursed based on CPT codes through Medicare Part B, Medicaid, and commercial payors

20. Part B (Clinical Administration–Line 7) Line 7:

21. Part B (SOM/Nursing and Other Activities–Line 8) Line 8:

22. Part B (Paid Leave Time and Other Mixed Time – Line 9) Line 9:

23. Logging in to TimeTrex is done by entering your Onyen ID and Password

24. Once logged in to TimeTrex, you can choose to enter new hours by selecting Cycle Management or older entries by selecting View Completed Cycles.

25. Answer the Time Study questions to set the parameters of your time entries

26. How do I know what to put on each line? We will start by looking at a time sheet

28. Each line has a short description next to the line numbers

29. Dialog Box If you click on the line, a short description dialog box will appear to explain what that line represents

30. Part A (Hospital Services – lines 1-5) In some situations judgement will be required, and you may take into consideration things like: What is your purpose for being in this place? What services are you performing? How much time did an activity divert from your primary purpose? Could a nurse or care manager perform this task?

31. Part B (Professional Services – line 6) Again, in some situations judgment will be required, and you may take into consideration things like: What is your purpose for being in this place? What services are you performing? How much time did an activity divert from your primary purpose? Does the task require you to have your APP license (i.e. NP, PA, CNM, CRNA, CPP)?

32. Please enter your time the week of the assigned time period in order to provide the most accurate data

33. Common Questions:  When should I choose another week to do my time?  What do I do if I am out all month?  Why do you ask if I am on paid or unpaid leave if I am out for the entire month?  Why can’t I count “On Call” time?  Why do I have to certify my time sheet?  What does “I certify” mean?  What do I do to correct a time study I have already submitted?  Why can’t I do all of my time sheets early?  Why can’t I do all my time sheets for the year all at once?  Where is the “Notes” section?  What is the “Notes” Section used for?

34. When should I choose another week to do my time?  If you are out more than two days for paid or unpaid leave in the assigned time collection week o The reason for this is that the collection week is supposed to be representative of your entire month. If you are out more than two days you are missing a large amount of time for that month  Choose a different week by answering question #3 “yes” and using the drop down box to confirm the alternate week

36. Paid Leave  We must count time for every month  If you are on paid leave for the entire month (examples may include: illness, vacation, mission trips, sabbaticals, etc.) o Respond “yes” to question #2  No additional entries are needed, just certify

37. What do I do if I am out all month?

39. Unpaid leave  If you are on unpaid leave for the entire month o There is no reason to list any hours on the assigned time collection week o Just complete the first page of TimeTrex o Enter a note in “notes section” to note being off the entire month or on sabbatical, etc  You will be paid for 11 months of salary and you will have 11 months of time in the system

40. Why can’t I count On Call time?  Defined as time where the participant is not in the hospital performing duties but away from the hospital and required to call or come in when summoned  Medicare does not consider “on call” time as work time and is, therefore, not included in the TimeTrex system  If a participant was called into the hospital during “on call” time then that time is counted and documented in the appropriate category

41. Why do I have to certify my time sheet?  You are attesting to the accuracy and authenticity of the time record  The TimeTrex confirmation reads: “I certify that this time study reflects a reasonably true and accurate record of my time during the period indicated”  This is a requirement of Medicare/ Medicaid

43. What does “I certify” mean?  You are done with the time sheet input and ready to sign the sheet  Once you certify your time sheet, you cannot make any further changes without reopening the sheet o Reopening the time sheet requires your Associate Chair of Administration (ACA) or Reimbursement’s help

44. What does save without finalizing mean?  You would like to go back into the time sheet and make additional changes later but you are finished for now

45. What do I do to correct a time study I have already submitted?  Errors happen and they need to be corrected  Your Associate Chair of Administration (ACA) or our Reimbursement staff can reopen a previously submitted time study so that it can be corrected

46. Why can’t I do all of my time sheets early?  Time sheets are supposed to represent actual time o Therefore, you are not allowed to complete the time sheets ahead of time  Time sheets are time and date stamped so it would be obvious that you completed the time study before the time had occurred

47. Why can’t I do all my time sheets for the year all at once?  The expectation is to enter time the week of the assigned time period in order to provide the most accurate data  Time sheets are supposed to represent actual time

48. Where is the “Notes” Section?

49. What is the “Notes” Section used for? This is a “Free Text Box” that allows you to make notes to yourself or others in TimeTrex Examples of what individuals sometimes include in this box: Name and explanation of meeting you attended You’ve changed your FTE % Why you recorded certain time in a certain area Anything you may want to explain

50. Contact Information Thank you for your support of the TimeTrex system. Please feel free to contact Roberta Byrd at anytime with questions: Phone: 984-974-1181 email: Roberta.Byrd@unchealth.unc.eduRoberta.Byrd@unchealth.unc.edu