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.

Rest assured. LTPAC Clinical executives can know rather easily.

What keeps you up at night? When I ran SNFs, many things would intrusively leap onto the stage of my dreams, stealing the limelight. Their discordant presence would dash the quiet and restful performance currently playing, causing me to start into a sudden and unwelcome wakefulness. It was one thing to steal the limelight, it was another to completely take over the show and lock the stage door to my more sedate and slumber-inducing dreams. Stifling a cry, I would sit bolt upright in bed, beads of sweat on my furrowed brow. One of those frequent limelight-stealing imps was a nagging doubt about my facility’s compliance.

Compliant to what? Federal and State regulations? Fire and safety? The Fair Labor Standards Act? Safe Harbor? HIPAA? Corporate standards and objectives? The list goes on and on, each list member competing animatedly for my attention. “No sleep tonight,” I’d groan. But times have changed and so has technology potentially barring the stage doors to unsolicited dream disturbers.

In the days before automated data mining and business intelligence (BI)-generated dashboards and reporting, I would have to make a mental note to investigate if and how compliant we were, recognizing that the research alone would take quite a lot of time, assuming no interruptions (silly me), sorting through charts, files, and printouts. But today WITH BI at a manager’s fingertips, those with compliance concerns, including clinical managers, have ready access to critical Key Performance Indicators (KPIs). With Business Intelligence, clinical managers can conveniently view a variety of KPIs which they can make their own. (I’ll get to that shortly.)

Let’s take a look at some of the KPIs clinicians can view to discover in measurable terms if their areas of concern are compliant. With regular input either directly from the data which resides within their clinical application automatically “pumped” into the data warehouse or keyed in directly, clinicians have access to frequently refreshed information. This information can include such KPIs as in-house-acquired or community-acquired pressure ulcers with the number of residents with pressure ulcers at what stages and at what percent of the average daily census over a month’s period of time or trended over a 12-month period.

Restraints? Weight loss? Anti-psychotic use? Infections? Readmissions? Falls/Accidents? Sentinel events, such as dehydration or fecal impaction? Indwelling catheters? Pain management? Hour per patient/resident day compared to state standards and to budget? Overtime usage? And more. If the data exists, the information can be viewed in the BI dashboard.

Now, I referred earlier to managers making KPIs their own. How about comparing the KPIs against benchmarks the clinical team has created based on regulations and company/facility-established standards, usually set to exceed the regulatory requirements? It’s all in one dashboard. No longer do clinicians have to wait for reports to be researched, compiled, published, and distributed. Log in and find out. No more uncertainty. Just discover. Take action. Get results.

With BI, this potentially sleep-disruptive concern can be put to rest. It’s called peace of mind. Take a dose of BI every day and sleep well.

With a Claims Management Solution - The gift that keeps on paying

Admittedly, the reimbursement process is complicated. Not only must billers identify who is to pay the bill, they have to know how to bill the payer and get paid as quickly as possible. This is especially the case when billing third party payers, such as Medicare, Medicaid, Managed Care, and private insurances. Each has its own requirements as far as coding, bill timing, and claims processing quirks are concerned which seem to change frequently. If billers are having to prepare, process, track, and follow up with claims manually using spreadsheets, phone calls, emails, letters, logs, and on and on, it is no wonder that billers are stressed and overwhelmed, that dollars are left on the table and claims are lost or misplaced. Reimbursement, or revenue cycle management, does not have to be complicated, however. In fact, it can be relatively simple with an automated claims management solution through a claims clearinghouse. But, buyers beware. Let’s take a closer look.

Keeping it simple – clearinghouse musts

Let’s assume that the strengths of automating claims management are a given. Specific clearinghouse features can considerably contribute to claims management simplicity. To help simplify and accelerate converting revenue to cash, a clearinghouse, like primeCLAIMS, should be able to do the following:

• In the event a claim is rejected, the clearinghouse should be able to isolate specific claims, not reject the entire batch of claims.
• The solution should give billers the ability to edit, scrub, monitor, and manage claims throughout the process.
• The clearinghouse must be able to stay on top of the almost daily changes to submission requirements, even the most obscure.

Visibility and control – an AR manager’s dream

Visibility and control with an enterprise-class claims solution also contributes to process simplification. With one log-in:

• Billers can connect directly to all Medicare payers via CMS-approved NSVs (Network Services Providers)
• Billers should have access to tools needed to manage claims, DDE, ADR status tracking, eligibility, secondary billing, and claims denied.
• AR managers can view each facility’s claims status and provide assistance where necessary.

Such simple tools to help speed cash flow with fewer rejections and cleaner claims. They also reduce costs by:

• Eliminating unnecessary paperwork
• Reducing transaction fees
• Reducing labor through elimination of such labor-intensive inefficiencies as:

• Log-ins to multiple systems to view all locations, determine eligibility, edit, and track all claims
• Manually compiling and submitting secondary payer claims

Simplicity in claims processing and managing also delivers peace of mind with:

• HIPAA checks
• Up to 10 years of data stored online

The bottom line

Using a clearinghouse to process, submit, and monitor claims yields numerous cost savings and improved cash flow. It’s much simpler and it just make cents.

In our more recent blogs, we have pushed the benefits of business intelligence (BI). We have especially emphasized its timeliness. With BI, you can know what’s happening practically in real time. Just open the dashboard and you see Key Performance Indicators (KPIs) important to you. But are you aware that you can be alerted via email when certain KPIs are significantly above or below targeted benchmarks?

Let’s say you and your management team have identified specific census benchmarks with given parameters which, when exceeded or fallen short of, the BI tool immediately sends you an emailed alert notifying you that certain regions and facilities are at risk. With that information in hand, you can immediately contact and troubleshoot the situation with the appropriate staff.

This is just as valid with labor KPIs. How about overtime? You are sitting in your office preparing for the next meeting when your email notifies you of an incoming message. You navigate to the message to see that it’s from the Business Intelligence tool alerting you which facilities have exceeded overtime parameters today.

Cash management? Near and dear to any executive’s heart is making sure that collections are keeping pace with targeted collection goals. Let’s say your team has identified that certain private-pay collection benchmarks are achieved by the 10^th. On that day, you receive an alert that specific facilities are falling short of their collection goals for private-pay with resident-specific contact and balance information. Because of this alert, your team can address the issues now.

Business Intelligence generated alerts not only deliver timely information, they also reinforce accountability. I don’t think it’s so much of matter of “Big Daddy” is watching. Rather, it’s an opportunity. When facilities are falling short of their goals, they may be distracted by other matters. Receiving an alert-generated call from your team can be helpful and supportive.

If you have a Business Intelligence tool like primeVIEW, that generates alerts, use them! It’s one more benefit available to help your team to effectively manage that which really matters.