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

Data is everywhere; it’s pervasive. The challenge as well as the opportunity lie 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.

The challenge

Long Term Care (LTC) providers are sitting on a vast reservoir of data. However, many do not have the resources to tap into that data and to convert it into something useful to solve current problems, to seize emerging opportunities, and to plan for the future. But, where to start?

BI’s purpose

Let’s wrap our arms around what BI’s purpose would, could, and should be. Succinctly put, BI reports, provides online analytics, and delivers Key Performance Indicator (KPI) visualization and monitoring.

BI’s use

As we visit with our BI customers and industry leaders across the country, we’ve observed that decision makers use BI to measure, monitor, and act on clinical quality outcomes, financial analysis, operational performance, cost management, compliance, and market-specific information. Executives use such information to take direct action, as needed, and to work with their teams to better align performance with company and facility-specific benchmarks/goals.

BI drives development and market acceptance

The evidence is clear that no one thing has been the agitator for BI acceptance and growth. Rather, the following factors have each played a contributing role:

• Federal and state health reforms
• Availability of healthcare-related data
• The imperative to identify and control costs
• Quality Assurance and Performance Improvement (QAPI)
• The need to increase customer satisfaction
• The demanding and complex regulatory environment, such as PBJ reporting, HIPAA, etc.
• Cloud-based computing technologies
• The availability of data through IT adoption
• Health Information Exchanges (HIEs)
• New value-based payment models
• And others

BI Stakeholders

Who uses BI? Here is a “short list” of those who rely on and use BI:

• BI software and services providers
• Healthcare providers
• Healthcare payers
• Accountable Care Organizations (ACOs)
• Managed Care Organizations (MCOs)
• Health Information Exchanges (HIEs)
• Investors/lenders
• Federal and state governments
• Researchers

All of these entities and people have a stake in the BI world and they all have some influence on how providers conduct business.

What this means to you

If you haven’t yet fully caught the larger vision of what BI has become and could be, you need to do so now or you will be left behind. In today’s world, the old manual ways of gathering and processing data, responding to the information gleaned, and taking action are too slow and cumbersome. Besides, some stakeholders, such as government agencies, are not giving you a choice. I highly recommend that you conduct an assessment of your organization’s BI needs today and in the future and devise a plan to help you ramp up as quickly as possible. A sure bet, is to look at existing BI tools, like PCT’s primeVIEW, designed for LTC providers, like you.

Discover how easy it is to integrate staffing and census data with PCT's PBJ Reporting Platform

In a recent blog, we highlighted some benefits of automating secondary claims processing through a clearinghouse. The ROI 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 preparation and submittal, providers can securely submit and track claims to multiple payers all in one portal. Here are some of the advantages a claims clearinghouse can offer:

• Single location electronic claims management with real-time electronic claims verifications
• Smooth claims flow to payers with a significantly reduced risk of rejections - since claims clearinghouses are connected to multiple payers and understand the peculiar format and workflow requirements
• Electronic Remittance Advice (ERA) –view all payments and adjustments
• Claim Status Reports
• Rejection analysis in which the system explains error codes in English
• Edit and correct claims online anytime
• Real-time support

ROI - Secondary claims process saves time

Think of time savings in two ways:

1. Billers’ time – The manual workflow of copying, mailing, and filing claims takes time. Even hand keying claims to each payer takes time. Billers have to know the specific submission requirements of each payer. In a manually-generated claims environment, such complexities can result in errors and slower claims turnaround. With a clearinghouse, such as primeCLAIMS, the system prepares the secondary claims automatically. All billers have to do is review the claims in the Secondary tab and click on the button to send them. It’s simple. And our customers love using it. The ROI? A reduction in claims processing and related costs.

2. Claims turnaround time - Office Managers can go right to the Secondary payer tab once they have downloaded the 835 ERAs (Electronic Remittance Advices). The secondary claims are there for review and submission. No delays. And the claims are accurate and prepared automatically to meet payer-specific requirements the first time. The ROI? A reduction of 4-6 weeks in claims turnaround and payment. One of our customers has stated that it has had a major impact on the reduction of Days Sales Outstanding (DSO).

To give you an idea of what’s at risk, if you are not using a clearinghouse to submit secondary payer claims, take a look at our Secondary Claims ROI calculator and see for yourself. The calculator helps you to identify what revenue may be at risk as well as the time and money it takes to manually generate the claims.

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

Check it out.

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 15^th, 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. So, here are 8 steps we recommend you take to fully leverage the PBJ reporting requirement:

1. Go automated. Automated reporting tools, such as primeVIEW’s PBJ reporting tool, takes the data processing and reporting preparation time down to a minimum. It’s a no-brainer. With today’s advanced data processing technology already available, why reinvent the wheel or, worse yet, do it manually? Remember – it must be auditable and mistakes can be costly.
 
2. Know the reporting requirements. Who does CMS consider to be direct care staff? The criteria involves individuals, including agency/pool/registry and contract staff who:
   • Have interpersonal contact with residents or resident care management (This includes medical directors and consultants.)
   • Provide care and services to allow residents to attain or maintain the highest practicable physical, mental, and psychosocial well being
   • Note: Physical plant maintenance and upkeep staff are not considered direct care staff
 
3. The PBJ reporting system set-up requires four items
   • Unique employee ID – avoiding any personally identifiable information (no social security numbers)
   • Hire date – whether directly employed by the facility or under contract, this is the first date of employment by the facility and payment for services delivered at the facility
   • Termination date – whether directly employed by the facility or under contract, this is the last date of employment by the facility and payment for services delivered at the facility
   • Pay type code – identifies whether the staff member is an exempt or non-exempt direct facility employee or a contracted employee

Tracking this can be complicated. An employee’s job responsibilities can change throughout the day. Report hours worked based on each employee’s primary role tied to the employee’s position and shift. To make this somewhat easier, you may want to work with your staff scheduling, time and attendance, and payroll vendor(s) to see if job code assignment can be automated.

4. Know what doesn’t count. Here are some things that CMS identifies that you should not count.
   • Hours paid for any leave or work-related absence
   • Overtime for exempt staff (ex: 40 hours per week hours paid, not hours worked)
   • Hours that are billed directly to Medicare
   • Hours for services provided to residents in non-certified beds

5. Know what counts. This includes hours that your time and attendance application tracks for facility direct staff. You also need to track the following possible scenarios: 
   • Contract and agency
   • Corporate staff who may be filling in for a staff memeber whose roles meet the CMS job categories
   • Salaried staff who don't use the time clock

6. Be reasonable. Now that’s what we would like to say to CMS, but actually that is what CMS is advising how your tracking and allocation systems need to be – reasonable – in accounting for, calculating, and reporting direct care hours. Keep in mind that an audit will likely review payroll and invoices tied to contracts.

7. Plan carefully. Your team can work with the vendors mentioned above to create as audit-proof a set of procedures as possible. The plan should include objectives with a July 1^st deadline for having all components in place.

8. Staff according to needs. Flat PPD direct care budgets are great, but they are not usually responsive to aggregated resident needs. Check staffing levels every day and adjust accordingly to call-offs, time-off requests, no-shows, and the dynamics of census, activities, acuity, and workload.

Decide now on an auditable system to identify and retrieve those hours. Test. Test. Test. And learn. Then implement. This process begs another blog, but you get the idea. It will take time to prepare, but it will be well worth it.

Contact us today about PCT’s PBJ reporting solution - save time, save money, reduce stress.