In the spirit of to our January 7, 2016 blog, we want to continue with the New Years’ resolution theme by concentrating on other important tasks every Post-acute Long Term Care AR manager should address. The following checklist can be helpful in steering your accounts receivables in a cash-positive direction for 2016:

• Contract Management – Perhaps this is a good time to blow the dust off those payer contract file folders. Get to know the details and the impact they will have on cash flow for the next year. Do they include changes for 2016, such as reimbursement rates and contractual write-offs? Being familiar with and responding to such details can help AR managers more reliably predict payment requirements, amounts, and timing.
• Co-insurance and deductibles – The ruleof thumb is if insurance is going to change, it will be at the beginning of the year. Specifically, check each payer’s copayments and deductibles. They typically seem to parallel Medicare guidelines which went into effect January 1^st. The following table highlights some of these changes:

• Patient liability – Not many states have fiscal years beginning on January 1, but in the event the states your facilities operate in do, then knowing what the patient liability rates will be and communicating them to Medicaid residents’ responsible parties will be helpful to collections. Even if the Medicaid fiscal year end is later, now may be a good time to review anticipated changes.
• Contract folder and tickler file - If you haven’t already, we highly recommend that you set up a tickler file to effectively manage and track your payer contracts. Whether the tickler file is a traditional binder with physical folders or an electronic version, this is a good time to bring them up to date and to calendar critical changes and negotiation/renewal dates.

This list is small, but important. It will help you address not only these important revenue cycle management tasks, but also other tasks tied to your 2016 billing and collection goals.

You’re driving down the freeway, heading home from a busy day at work. Remembering the many conversations you had today, you are somewhat preoccupied. You appear to be going with the flow of traffic, but you fail to notice that traffic’s pace is considerably above the posted speed limit. However, your attention is instantly snapped to the here-and-now when you see flashing lights immediately in the rearview mirror. With a statement of frustration (censored, of course), you realize you’ve just been tagged as the bad-boy poster child of speeders and are about to have a one-on-one interview with law enforcement. Now, yes, you have a speedometer. But when was the last time you looked at it?

Having a working speedometer in your car doesn’t prevent you from getting a traffic ticket. It’s only useful if you use it. Likewise, Business Intelligence (BI) is only as good as it is intelligently used. For today’s blog, let me summarize how some of your peers are intelligently using BI.

A vital routine – it’s a matter of culture

We have discovered among our primeVIEW[1] customers that the common thread of success is that BI is an integral part of their corporate culture. Let me quote from a recently-published case study about Health Services Management and how it uses BI, “Today with primeVIEW conspicuously displayed on a large monitor in his office for group discussion, Ray Tyler, HSM’s Chief Operating Officer, and team can observe and examine such Key Performance Indicators (KPIs) as census, labor, RUG levels, and accounts receivables throughout the day.”

In another case study, Greg Seeger, Health Care Management’s Chief Operating Officer, reports, “Since the system is so intuitive, the learning curve was short and our staff could just run with it….We train our team to use primeVIEW as their go-to KPI information source to track census, labor, 5-star, length of stay, clinical quality, receivables, cash flow, and more. It’s a tremendous resource.”

We have also learned from another COO of a large multi-facility, multi-state operation[2] that from the time a new decision maker is hired, the use of Business Intelligence is ingrained into her or his daily routine and reinforced regularly.

Daily - facilitating meaningful conversation and accountability

It’s one thing to have the information; it’s entirely another to know what to do with it. Data mining and business intelligence foster communication and meaningful conversation. From the corporate to the division to the region and facility levels, BI is the reference point for clinical, cash flow, labor, and compliance-related conversations. Because the information is timely, decision influencers and decision makers are able to address issues before they reach critical mass.

Further, HSM’s Tyler reports that “primeVIEW’s flexible reporting features related to date ranges and formats are also very valuable to us, because primeVIEW enables us to quickly prepare and submit reports to key stakeholders, such as REITs. We can view and report on actual-to-budget reports, wage rates, OT, etc.’”

Some providers have found that BI-generated information is useful in fostering positive working relationships with referral sources by demonstrating on a regular basis admissions, discharges, and rehospitalization rates along with quantifiable clinical data.

Weekly - staff meetings

In this case study, Dean Kiklis, Frontline Management’s Chief Financial Officer observes that “during its Monday morning staff meetings, …primeVIEW plays a large role. ‘We can readily view what is or is not on target. It’s helpful to be able to keep the team focused on what’s important for the coming week with relevant and up-to-date data….It allows us to surgically address challenges as they arise. It’s up to date so we don’t have to wait for someone to create reports for us.’”

Monthly - financial reviews

Tyler’s use of primeVIEW goes beyond daily operations; “he also refers to it during his monthly financial reviews with facility administrators who simultaneously view performance in specific areas of focus. ‘By the time our P&Ls are ready, they are a month or more in arrears,’ commented Tyler. ‘But with primeVIEW, we can discuss what happened last month and examine current KPIs which directly impact financial performance and help us predict month-end outcomes.’”

Conclusion

By making BI a part of the corporate culture, it facilitates timely and meaningful conversation, adds relevancy to weekly planning and goal-evaluation sessions, and breaths relevancy into monthly financial reviews. Now that is a sound way to help executives and their teams achieve their goals on time and on target. Now, that’s the ticket…to success.

[1] PCT’s Business Intelligence tool

[2] It’s case study will be published in the near future.

Ah, yes, it’s that time of year – time to make those New Year’s resolutions. Exercise, diet, vacations, revisit the old “bucket list”, maybe even finances. Finances? Now a financially-focused resolution or two should resonate with any AR Manager. Maybe we can help you kick off 2016 right with some helpful resolution hints. They may not be earth-shaking taken independently, but together, they can certainly have a positive impact for you and your team.

Resolution #1 - Make sure that pre-admissions screening covers all the financial bases before the admission. This may sound overly simplified, but it is so essential with numerous moving parts. It is a time not only to be informed, but to inform not just once, but regularly after the admission.

• To be informed – All members of the admissions team must know who the payer is and the proper billing procedure - how much, how long, and for what services. Not only immediately after admission, but should the length of stay outlast such coverage as Medicare or private insurance, the team, the family, and resident must know who will pay. You might say that you want to make sure all your “bucks” are in a row.
• To inform – This is something that some providers forget to proactively pay attention to and communicate. Communicate to whom? The rest of the team, the party (private or third party) who will be paying the bill, and the family. Providers need to keep in mind that placing a loved one in a facility is traumatic and unavoidably new. Prior to and on admission, family members/responsible parties encounter so much information. Your team needs to compassionately and frequently remind them of expectations and their loved one’s status. Changing from one payer to another should never be a surprise. Fostering a positive relationship with responsible parties throughout each resident’s stay will pay big dividends in the long run.

Resolution #2 - Make sure the census is correct, up to date, and entered correctly in the billing software. Whether your facility or facilities are still laboring under a manual census tracking and recording process or you are enjoying the benefits of electronic charting, knowing who is in what bed each midnight is critical. Even electronic charting still requires the personal touch, that is, someone has to make the rounds to confirm the beds are occupied, on hold, or vacant.  

Resolution #3 - Make sure to conduct a triple check before submitting any bills or claims. We are not going to elaborate on the triple check process at this time, but stay tuned for helpful tips in future blogs.

Resolution #4 – Stay informed by attending seminars and webinars. Medicare, Medicaid, Bundled Payments, ACOs, VA, etc. are changing and unless you and your team are informed about what has changed or is about to change, you may be a day late and a dollar short. State and Federal agencies, your state and national trade associations, industry media publishers, and others conduct education sessions throughout the year to help you effectively manage the revenue cycle. Plan on attending as many of these as possible.

Resolution #5 - ICD10 training and updates. Although you and your team are usually not the initial coders, you still have to be ICD10 savvy. The key here is specificity – the highest level of specificity. You have our permission to review those codes and if you are uncertain about the codes specificity, push back on admission and during the triple check. At primeCLAIMS, we have seen many claims rejections since the ICD10 implementation due to a lack of specificity.

Resolution #6 – Stay on top of your Days Sales Outstanding (DSO). Discuss DSO with your team and set goals to reduce it to an acceptable level – ideally around 30 days. However, realistically identify what is in your control. For example, Medicaid in some states pay much later than others. Consider that carefully, set goals thoughtfully, and collect aggressively.

Making and successfully achieving resolutions specific to your department’s and business’s needs can make 2016 truly a Happy New Year at least financially.

It just make cents.

In a recent McKnight’s Senior Living article, the leaders of Argentum, NCAL, and LeadingAge responded to the question of their respective associations’ agendas for 2016. As I read their responses, I opportunely observed that Business Intelligence (BI) can help them effectively address these. For James Balda, President and CEO of Argentum (formerly the Assisted Living Facilities of America [ALFA]), the top issues are workforce development, quality care, operational excellence, and consumer choice. National Center for Assisted Living's (NCAL) Executive Director, Scott Tittle, reports that his organization’s top priorities involve state regulatory issues, workforce development, and, most significantly, “new tools that will help members accumulate data they can use to communicate the quality of care that they provide and to compare themselves with peer providers” with emphasis on quality outcomes. Katie Smith Sloan, President and CEO of LeadingAge, emphasized payment model changes, “whether it's ACOs or bundled payments or creating a network to negotiate with health plans.” A further concern, according to Ms. Sloan, is the lack of unit inventory, creating long waiting lists, and workforce development needs as well.

Taking license to read between the lines, all would likely agree that effective strategies require further research and that further research requires actionable information from reliable and timely data sources. This requires a robust data mining and business intelligence solution. Such a solution not only allows for the storage of critical data in data warehouses, but the retrieval, aggregation, and dissemination of such data converted to useful Key Performance Indicators (KPIs) which can be used internally or shared with other healthcare stake holders and investors.

Let’s take operational excellence, for example. Whether you call it “operational excellence” or “quality of care” perhaps, or positioning facilities to “negotiate with health plans”, having fresh, up-to-date information about the quality of clinical services, the costs to provide the services, and the labor required creates an advantage. Providers can respond to today’s issues today with an eye on the future. It also fosters the sharing of information that providers and their respective associations need to address these issues effectively. With BI, the information is already available and easily digestible.

How do you eat the elephants of workforce development, compliance, operational excellence, and payment model changes? One “byte” of data at a time. Accumulated and properly served, BI-generated KPIs can sustain such initiatives with energy and focus over the long haul.

Make Business Intelligence part of your 2016 strategic plan! 

Valuable highlights from 2015 blogs to prepare for 2016

Hard to believe that 2015 is rapidly passing into history. Another year, but what a year it has been for Long Term Post-Acute Providers (LTPAC) providers especially considering the incredible number of claims billers have had to prepare, submit, monitor, and manage. We congratulate billers across the country for what they have been able to accomplish in converting claims to cash in the bank.

The primeCLAIMS team works just as hard to provide an excellent clearinghouse service and also to communicate worthwhile tips and advice to help make billing tasks easier to complete. Looking back on our blogs in 2015, we have covered such topics as ICD-10, processing secondary claims, dealing with claims rejections, principles of successfully Revenue Cycle Management, tips for submitting clean claims, and what to look for in a LTPAC clearinghouse.

Regarding secondary claims, one of our recent blogs, entitled, “What you’re wasting by processing secondary claims manually,” discusses the why’s of automation. The days of manually identifying, preparing, processing, and tracking secondary payer claims is long past. If they haven’t already, we suggest billers retire such costly practices forever and start the new year right.

Managing claims does not have to be complicated we argued in the blog, “Do yourself a favor - Simplify the reimbursement process,” if billers automate the process.

Not all clearinghouses are created equal. In “How well is your claims management solution moving cash flow,” we share some insight into what a clearinghouse, processing LTPAC claims, should offer. Further, because no matter how automated the process may be, claims is still about people. And people and machines need support. In another blog, we ask the question, “Clearinghouse support – is it there when you need it?”

These blogs represent the kind of information billers and their managers should know to be successful not only in 2015, but also in 2016. We look forward to continuing to share our insights and the experiences of your peers in future blogs. After all, it just makes cents.

For your convenience, we’ve grouped the recent blogs by category:

Happy Holidays! May this season bring you and yours joy.