Prime Care Technologies announced today the addition of Michelle Burdette as Vice President of Operations. Michelle now oversees operations for the primeCLAIMS post-acute claims revenue management application and the primeVIEW analytics dashboard for skilled nursing/senior living facilities (SNFs/SLFs). She is responsible for driving adoption, utilization, and retention across the two product lines.

With more than 25 years of experience serving the healthcare/skilled nursing industry as a financial leader, Burdette has overseen multiple software implementations across billing, accounting, and operations groups. Most recently, she was the Chief Financial Officer at Prema Financial Solutions, a back-office consultant to SNF and other healthcare organizations.

Said Prime Care Technologies Chief Operating Officer, Carl Mickiewicz, “Michelle's knowledge of both the operational and financial needs of senior living organizations positions her to meet our ongoing goal of providing senior care operators with decision-driven data applications.”

Added President and CEO, Jim Hoey, “We are pleased to add a highly experienced and qualified team member like Michelle to our operations team. We look forward to her ideas for growing the software and delivering operational efficiency to more senior care clients.”

About Prime Care Technologies

For nearly two decades, Prime Care Technologies has provided senior care operators with integrated business intelligence and software solutions, driving proactive decision-making and the highest quality care. Based in Atlanta with 175 employees and 200+ healthcare/IT partnerships, its technology-driven solutions have been leveraged in 10,000+ facilities. With deep multi-vendor interoperability expertise, including the integration of 70+ healthcare applications and 3,500+ EDI payers, Prime Care Technologies offers the leading data warehouse in post-acute care. Learn more at http://www.primecaretech.com.

Are you a small or midsize business (SMB)? Most skilled nursing and senior living organizations find themselves in this category and like all other SMBs, cyber security should be a top concern given that 60% of companies impacted by cyber attacks go out of business. If that gets your attention, you'll be interested to see these related stats.

The onus is on business owners to create a culture of cyber security across the workforce. Make staff feel part of the team when it comes to blocking out attackers -- train them to recognize and avoid threats. Many companies now offer phishing resistance training, which is a great tool to have in your belt.

Lastly, we can't stress enough the importance of password management. It's estimated that 60% of employees use the same password across multiple work and home applications. Educate them on creating better ones, automate your password expiration policy and consider multi-factor authorizations (MFAs).

If you're feeling vulnerable, take our cyber security self-audit to see if you've got cyber security basics in place. If you've got weaknesses, we can help.

• IT Assessment Service
• Bait & Phish Employee Training
• primeCLOUD IT Service Suite

COVID's toll on senior care, unfortunately, extends beyond precious lives lost to the loss of valuable staff, according to the AHCA/NCAL Survey on Workforce Challenges. It's a headache for administrators and an energy suck for staff working more days or longer shifts to fill the gap. If you're facing these challenges, we've got some ideas!

Rebuilding Staff

Incentives and support

• Consider bonuses and extra time off (e.g., mental health days, extra PTO)
• Partner with nearby child care providers on discounted programs
• Build support groups for common challenges – parenting, child/pet care, transportation, fitness, emotional health, etc.
• Foster a collaborative environment where opinions are heard
• Communicate often and using various channels – posters, emails, text, chat, meetings
  
  

Adaptive hiring and training

• Streamline hiring/onboarding – 'there's an app for that!'
• Consider RMTs and HHAs as fill-ins in for CNAs
• Recruit/incent EMTs for nurses aid positions
• Provide tuition assistance and continuing ed
• Offer work/practice programs for nurses/others
• Offer mentor program for new hires
• Build growth tracks and leadership opportunities
  
  

Supportive workforces

• Partner with telehealth providers
• Consider travel nurses
• Build volunteer programs/relationships

Combating Fatigue

Increased Check-Ins and Communications

• Conduct more all-hands calls and use them to recognize staff efforts
• Consider random check-ins with communities 2-3 times a week
• Support efforts with staff newsletters and websites
  
  

a Culture OF FUN AND FAMILY

• Welcome staff to work; thank them as they leave
• Offer virtual breaks, include games and contests
• Host parking lot events/parades with food, buttons, leader drop-ins (even virtual)
  
  

SHOWS OF APPRECIATION

• Offer 'hero' pay, extra PTO, flexible schedules
• Increase employee appreciation budgets and keep rewards flowing
• Follow-up with personal notes and certificates from leadership
  
  

Diversity and Equality

• Drive diversity and equality to recruiting and development
• Offer active listening sessions for employees to share experiences
• Create employee-led diversity, inclusion, and belonging council
  
  

SIMPLICITY IN TIMES OF CHALLENGE

• Shelve non-priority tasks and assignments
• Offer employee webinars for stress, parenting, protecting self/family/residents, etc.
• Partner employees up for 'listening with empathy' or 'staff buddy' programs
  
  

The Light at the End of the Tunnel

It's been a challenging time for senior caregivers, but just remember how far you've come. The pandemic has brought previously overlooked challenges to light, empowering advocates to drive more focus to strengthen the workforce in SNFs and ALFs. 

As always, technology can help. If you don't know how your staffing stands on a weekly basis, or if you're trending toward overtime or not enough nursing hours, talk to us about our SNF/ALF analytics dashboard, primeVIEW.

As outlined by the Centers for Medicare and Medicaid Services (CMS), Complying with Medical Record Documentation Requirements remains critical to senior care success.

Proper documentation:

• Helps patients get reasonable and necessary items/services
• Facilitates proper claim payment
• Supports favorable medical review decisions

Specific to claims reimbursement, CMS identified the top five reasons for errors. Note, two are related to documentation. 

So, what does insufficient documentation mean?

• It does NOT mean documentation doesn’t exist.
• It means something was incomplete or missing at claim submission.

And, what are the consequences of improper documentation?

Improper documentation disrupts the revenue cycle, which results in loss of financial revenue. CMS claim denials also cost your staff time, requiring them to:

• Complete forms
• Submit additional documentation
• Send a letter explaining why the claim should be paid
• Resubmit claim

Secondarily, if your order for item/service is illegible, your patient care suffers.

What are some tips for improved documentation?

• Send ALL associated documentation supporting the item/service billed
  • Some information may come from a prior claim or test
  • If you're not sure if certain documentation is required, send it anyway
• Send the documentation by the deadline indicated in the request
• Review documentation to make sure it:
  • Answers who, what, when, why, and how
  • Verifies item/service was performed
  • Verifies medical necessity

Where can I get more information regarding CMS claims errors, including documentation?

• Complying with Medical Record Documentation Requirements
• Complying with Medicare Signature Requirements

Lastly, senior care and skilled nursing facilities (SNFs) can greatly simplify claims revenue management by employing a system customized for this industry, and supported by seasoned claims professionals. Get in touch if we can help.

In Feds to deliver ‘positive news’ on Provider Relief Fund in coming days: Parkinson, McKnight's LTC News summarized recent comments from AHCA President and CEO Mark Parkinson at the Synergy Summit in Utah.

Among other things, Parkinson stressed managed care is not going away and encouraged senior care providers to embrace it by:

• Becoming a top provider in a given market
• Improving demographics
• Becoming part of a network
• Taking advantage of institutional special needs plans (I-SNPs)

Naturally, you may want to know more about I-SNPs and if/how you might take advantage of them. The below Q&A may be of help to you in assessing this.

What is an I-SNP?
I-SNP stands for Institutional Special Needs Plan and is designed for those who will live in a long-term setting for 90 days or more with no immediate plans for discharge

How does it fit within Medicare?
An I-SNP is a Medicare Advantage plan focused on the care of specialized populations. It replaces traditional Medicare to cover inpatient and outpatient services, plus prescription drugs (as a Part D service).

Who is eligible for an I-SNP?

• Reside in a long-term care facility with no anticipated discharge
• Currently enrolled in Medicare A/B
• Live in a county where I-SNP is licensed

*Check CMS' Special Needs Plan (SNP) Data to see who is operating in your state.

What are the highlights of an I-SNP?

• Nurse practitioners provide preventative and proactive care
• RN case managers coordinate care according to the Model of Care (MOC) required by CMS
• Residents are assigned a 'Risk for Hospitalization' level, which determines care plan and a schedule for proactive rounds
• Rounds occur as often as weekly or can be more frequent for high-risk residents
• Provider visits are not subject to medical necessity requirements of traditional Medicare, so they can be more proactive and frequent

How do I-SNPs benefit SNFs/residents?

• Increased provider visits; faster identification of conditions/treatment
• Treatment-in-place advantage – visits can happen in the nursing facility
• Proactive and preventative care; prevents unnecessary hospitalizations
• Reduce risks and stress associated with hospital stays

How can technology help facilities with I-SNPs?

• Case-to-contract management is essential to following an ISNP
• Our Managed Care MASTER software brings contracts online, PLUS pairs them with best-practice workflows and alerts
• With this automation, you can easily train anyone to act as a case manager and ensure reimbursement

If our Managed Care MASTER can help you 'manage' your managed care, including I-SNP contracts and care, let's connect.