“To know is to grow.” Yes, as I pondered this week’s blog topic, this quote came to mind – probably not original, but it is apropos and kind of catchy. As the manager of an accounts receivable team at the corporate, region, or facility level, your job is to help your team members grow in knowledge, skill sets, and ultimately productivity. For over ten years, Prime Care Technologies has asserted that knowledge is the power to succeed and to grow. The seed of knowledge is data converted to useful information and transformed into knowledge. Let’s explore five ways you can help your team’s productivity and success through knowledge.

1. Become a part of the admissions team – Know who is to be admitted when, who is to pay, and be able to collect permissable deposits. Office managers have the obligation to remind admissions decision makers that the temptation to admit “warm bodies” just to fill empty beds will certainly drive up direct care costs, but may not contribute to a healthy bottom line. Further, company policy can insist that the administrator/executive director sign off on all write-offs. Bad debt sitting passively on the books is one thing, but a write-off is concrete confirmation that the facility is not going to collect and can serve as a real deterrent to the practice of “heads in beds,” as a veteran AR consultant once stated to me.

On an even more proactive note – become part of the admissions team. We have observed that the more responsible facilities, which happen to have a better bottom line track record, require that each member of the admissions team (comprised at least of the administrator, director of nursing, rehab services, and the business office) must sign off on each pending admission. By doing so, the team members insure that the essential bases are covered.

2. Help the family with the Medicaid application – Figuratively speaking, hold their hands. Once you know that the resident may qualify for Medicaid, at the least, either prior to or on admission have a copy of the Medicaid application ready for the responsible party. Highlight the applicable sections to be filled out. Even include a cover list with simple instructions about how to fill out the form. In some facilities, the business office actually sits down with the responsible party to walk through the form and to complete the form right there and then. The facility makes a copy of the completed application for the responsible party and then mails the original.

3. Collect resident liability up front – For Medicaid-covered residents, some states allow you to collect the resident liability on admission. Check with your state’s Medicaid program to confirm and to determine what the collectible pro-rated amount should be.

4. Ask if the responsible party would like the facility to manage the resident income – The resident trust fund can be a real benefit to responsible parties and families members. Because it is federally insured direct-deposit account that collects interest, the facility business office can pay resident-specific bills. The family does not need to worry about bringing in deposits or paying bills. It can contribute to peace of mind and can strengthen the responsible party/facility relationship.

5. Thank your staff. Regularly let them know how much you appreciate your team. They work hard and in a frequently frantic environment. A “thank you” goes a long way by letting them know you appreciate them and are aware of their successes.

Knowledge about admissions, that the Medicaid application has been filed, that deposits are collected, the resident bills are going to be paid, and that good work is recognized goes a long way to foster success. What other things do you do to fuel your AR team’s pursuit of excellence? Please share it with us. It makes cents.

What makes billers effective? Habitual attention to specific details and consistent execution of routine, yet critical tasks. I’d like to share with you what our team considers to be nine habits of highly effective long term care billers. Caution the resultant success can be addictive. That's a good thing. 

1. Make sure your census is correct. We can’t stress this enough. Work closely with the Director of Nursing to make sure the night shift nurses are indeed taking a midnight census. Here is an example of what could happen if they don’t. Let’s say Mrs. Brown is discharged to the hospital, but the discharge is not correctly noted. Because she is still considered in the census, you may bill for the entire month incorrectly. Daily stand-up meetings are great opportunities to confirm the census count and to review the previous 24 hours’ admissions, discharges, and bed holds. Whatever procedures are in place to track the census, relentlessly encourage accuracy and timeliness.
2. Check eligibility regularly. Do this at least monthly. For example, residents can change from the traditional Medicare model to a Medicare HMO plan at any time. It’s impossible to bill for Part A days when the resident has already exhausted the days available in the Benefit Period.
3. Triple check during the month-end close. We’ve mentioned month-end triple checks before. If your facility or facilities a significant volume of Part A and Part B claims each month, you may be willing to check a random sampling of bills during this meeting. But what should you cover during the triple check?

• Consistency of nursing and therapy documentation – Make sure that the nursing documentation supports the therapy documentation and vise-versa. If the resident needs therapy to learn to ambulate, nursing and therapy documentation needs to support that.
• Verify that the medical record supports the intervention performed – This is, of course, dependent upon the supervising clinician’s judgment. Make sure the team addresses this issue.
• Verify therapy minutes – Confirm that the minutes to be billed are consistent with the RUG level’s requirements.
• Charting – Especially for skilled Part A services, clinicians need to chart as required. Make sure clinical documentation has progress notes, noting that the resident needs skilled intervention.
• Benefit days availability - Communicate available Part A days.
• MDS assessment reference dates - Verify the MDS-assessment reference dates are accurate for the 5 day, 14 day, 30 day, etc.
• Physician orders - Make sure that physician orders have been received and have been implemented.
• Physician certification/re-certification – Make sure the attending physician has certified or recertified the need for skilled services and that the record includes reliable documentation.

4. Know your payer contracts – As we discussed in the last blog, review your payer contracts regularly.
5. Make sure the business office staff is continually learning – Dr. Covey referred to it as sharpening the saw. If you are an AR manager, this is important. The world of claims processing and billing requirements change constantly. Challenge yourself and your staff to learn something new every day. Also, acknowledge that turnover among billing staff exists which means in some cases, you must start over again. Take advantage of the webinars provided by the MACs when available.  They’re free!
6. Get organized and know where to find and plan what needs to be done by when. Remember today’s technology can be your best friend with digital calendaring, automatic reminders and alerts, software-based task lists, and more.
7. Don't be an island to yourself - Be transparent in your billing practices and routines. Just as back-up and failover procedures are critical to IT, so is “cloning” yourself extremely important. Billing must be on time. Train others to pick up where you may have to leave off, just in case.
8. Foster positive working relationships among staff members – An atmosphere of open dialogue and trust contributes to a smooth-running operation. Have a go-to person in each department. Those “insiders” can give you the information you need quickly and accurately.
9. Be the go-to person yourself – Let trust and dependability begin with you.

Okay, I am sure you can add to the list, but we suggest you keep it short and do what matters most in your role as a biller. It just makes good cents.