In March and April, we posted Payroll-Based Journal (PBJ)-related blogs to help our readers further understand and prepare for what the Centers for Medicare and Medicaid Services (CMS) will require of them starting July 1^st. In this posting, we’ll take PBJ reporting one step further. But first, we assume you are not inclined to create your own system to input the necessary data and compile it into an XML file. If this describes your situation, then you will need to contract with a vendor to help you automate the process. And we think doing so is well worth the time, effort, and money.

Quick PBJ summary

But first, at a high level, let’s rehash information found in previous blogs about PBJ reporting. In our blog, dated March 15, 2016, we encouraged providers to get started now. Why?

• Submission will be mandatory, effective July 1, 2016. Providers will be required to file both staffing and census data no later than 45 days after the last day of each fiscal quarter (i.e. for the quarter ended September 30, 2016 electronic reporting must be completed no later than 11:59 pm EST on November 14, 2016).
• Every quarter, providers must use the online PBJ system provided by CMS to report the hours staff – AND contractors – were paid to perform onsite services for facility residents, excluding paid time off (e.g., vacation, sick leave, etc.).
• The PBJ system will only allow XML file submission – one per facility – and/or manual data entry at this time.

We warned, “Don’t be lulled by the November 14 3^rd quarter reporting deadline. Collecting this data and preparing it for submission will take time – lots of time (and money) – especially if you are trying to do this manually.” It’s expensive and prone to clerical errors. Automate as much as possible by contracting with a vendor that offers PBJ reporting automation.

Even automated solutions will require some manual data entry

Please be aware that no matter how automated the system is that you select, there will still be a need for some manual data entry particularly for those direct care staff whose time your time and attendance application may not capture sufficient to meet PBJ requirements, such as:

• Salaried and corporate staff
• Contract workers
• Staff who may wear different hats throughout the shift
• Staff attending a training or inservice session
• Exempt nursing staff filling in for a call-in floor nurse
• Allocating hours for the 3^rd shift accountable over a two-day period
• Splitting hours between the certified and non-certified sections or for those facilities with certified residents housed in a facility that does not have a distinct part

Engaging a PBJ reporting solutions vendor

Determine the features each solution offers and confirm that they have been sufficiently tested. For example, is the solution able to?

• Integrate cross-facility data from employee and census systems
• Allow providers to manually enter and append contractor data to the existing file
• Enable providers to view/monitor a summary of employee and contractor hours
• Automate mapping of labor codes to CMS codes
• Retrieve multiple XML files
• Export one all-inclusive XML file per facility for quarterly upload to CMS

There is still time, though short now. Look at offerings, check their features, confirm their compatibility with your organization's intended best practices, check references, and confirm. Then execute and test, test, and test. Don't cut corners.  

If you would like a no-obligation demonstration of our tested PBJ Reporting Platform, call 877-644-2306, or click here to request a demo.

FYI - Here’s a valuable PBJ summary document - https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-16-13.pdf

“By adopting a platform now, they can assure all systems are in place and run test submissions to assure they're in good shape prior to the deadline,” said Jim Hoey, president of Prime Care Technologies.

Revenue Cycle Management is constant, a year-round effort, but periodically worth occasional scrutiny and cleaning up. Likewise, if you bill Medicare for services and need to file secondary claims, then taking a look again at automation through a clearinghouse may result in cleaning up those outstanding AR balances. This month’s blogs offer useful insights to help AR managers refresh revenue cycle best practices and remove the clutter of uncollected revenue.  

Spring clean your revenue cycle

This is the time of year to open the windows, air out the house, deep clean long neglected spaces, and tidy up. For AR managers, it’s also a good time to “spring clean” the revenue cycle in a few key ways.

1. Update and refresh your payers’ contracts “wiki”.
2. Check the aging.
3. Revisit your pre-admission screening procedures.
4. Make sure the census is correct.
5. Stay on top of your Days Sales Outstanding (DSO).
6. Conduct a thorough claims triple check.
7. Engage the right clearinghouse.

Learn how these steps can help you freshen up your revenue cycle management practices.

Secondary payer claims – finding ROI (Reducing Outstanding Income)

The ROI of automating secondary claims through a claims clearinghouse is potentially huge. Traditionally billers completed paper forms and mailed them to the payer. Sounds simple, but it wasn’t and, some providers are still submitting claims in this way. Phone calls and error-generated resubmittals contribute to a complex, cumbersome, costly, and prolonged payment process. With electronic claims automation, providers can securely submit and track claims to multiple payers all in one portal. In this blog, we highlight some of the advantages a claims clearinghouse can offer and the potential ROI when doing so.

Discover the benefits and ROI of automating secondary claims submission. 

Are you collecting all your secondary claims and
how much does it cost to do so?

Check it out!

In this month’s BI-focused blog postings, we delved into the basics of Business Intelligence (BI) and its impact on today’s long term care provider. PBJ reporting is definitely coming. Read how about the eight steps you can take to be ready for the July 1^st launch.

Back to BI’s Basics – the challenge, the purpose, and its use in LTC

Data is everywhere; it’s pervasive. The challenge as well as the opportunity lies in retrieving the raw data and converting it into useful and actionable information. In the past, we have posted a number of blogs on a wide range of Business Intelligence (BI)/data mining-related topics - from Payroll-based Journal (PBJ) reporting to data-driven decision making, from BI’s role in helping providers stand out in the ACO crowd to how BI helps providers demonstrate value, and so on. But let’s step back and reexamine what has driven BI to become what it is today. Read on.

8 things you can do now to get ready for PBJ reporting

90 days, give or take, may sound like a lot of time, but when tackling something like PBJ reporting, it’s actually just around the corner. This blog will help you to identify the 8 tasks providers need to complete in order to be ready.

In the recent blog, published March 15th, we highlighted PBJ reporting requirements. We emphasized that reporting automation is vital to help providers, like you, not “waste critical time building reports and checking data.” However, automation is only as good as the data collected. In this blog, we offered 8 steps you and your team can take to fully leverage the PBJ reporting requirement. Read on.

PBJ is just around the corner.
Will you be ready? We can help. Learn how.

This is the time of year to open the windows, air out the house, deep clean long neglected spaces, and tidy up. For AR managers, it’s also a good time to “spring clean” the revenue cycle in a few key ways.

1. Update and refresh your payers’ contracts “wiki”. Likely, payer requirements have changed. Know the nuances. Reviewing the contracts and the summary sheet you’ve created for each to make sure your knowledge is current. Make sure your billing practices are consistent with payer expectations. You may think, “But my billing software should be up to date with all changes.” Not necessarily. You will discover that it’s always a good idea to check and to communicate disparities with your vendor. Some areas to focus on: 
   • Levels of care by RUG scores or service levels
   • The level of ICD-10 code specificity required
   • How many days are considered co-pay days
   • Which ancillaries are covered in the base rate and which may be billed separately or not at all
   • If a pre-authorization and re-authorizations for a stay are needed

2. Check the aging. Ask yourself, “Are our payers paying correctly?” Are they paying the contracted rates for ancillary services? The billing software may have it right, but does the payer? Reconcile what you are billing with the actual payments. If you don’t the ripple effect could be significant. A credit on your aging may not really be an overpayment. It may mean you are not tracking payments carefully. This involves more than just answering the question, “Did we get paid?” Instead, you should ask, “Did we get paid correctly and are you recording the payments correctly?

3. Revisit your pre-admission screening procedures. Confirm that the pre-admissions screening procedures cover all the financial bases before admission. This may sound overly simplified, but it is so essential because of the numerous moving parts.

4. Make sure the census is correct. This seems so obvious, but it is so critical. Make sure the census is up to date and entered correctly in the billing software.

5. Stay on top of your Days Sales Outstanding (DSO). Discuss DSO with your team. Evaluate your progress towards reducing it to an acceptable level – ideally around 30 days. Realistically identify what is in your control. For example, Medicaid in some states pay much later than others. Consider DSO carefully, set goals thoughtfully, collect aggressively, and review regularly.

6. Conduct a thorough claims triple check. This should be a multi-disciplinary review of all claims prior to submission. While it may not be practicable to review all claims, identify what could be a reasonable random sampling. You may want to target claims forwarded to a certain payer with which you have had problems in the recent past.

7. Engage the right clearinghouse. Reassess your clearinghouse. You need to be sure that:
   • It knows your business and post-acute payers
   • You see cash flow improvements quarter over quarter
   • Its application is robust with simplified, intuitive workflows
   • It generates accurate and actionable reports
   • That the application is truly enterprise class with single sign-on for ease of access to multiple facilities, especially for designated region and corporate staff
   • The clearinghouse support team listens and promptly responds to your concerns and requests

It’s time to open those windows and let the fresh air in.  Spring clean your revenue cycle. It just makes cents.

Bonus: Discover 5 tips for maintaining your revenue stream in 2016