With all that we’ve been reading about alleged LTC Medicare fraud, overbilling, claiming more services than that which were actually provided, giving incorrect treatments, or up-coding Medicare claims, it’s hard for providers not to feel like a target. Therefore, on behalf of those who are trying to do their best in a world of changing rules, retro reviews, and the dramatic expansion of diagnostic codes, we cry, “Enough already!” We want to speak out for all providers who are doing their best and are NOT trying to rip the system. We believe that the majority of providers operate with integrity and with the intent to provide service consistent with each resident’s needs. Personally, I take exception to any outcry that providers are gaming the system before all the evidence is in place – makes good headlines, but poor policymaker/provider relationships and certainly LOUSY policy.

ProClaim Partners has the opportunity to work with LTC providers managing numerous facilities across the country. Because we work directly with their billing staff and AR managers, we believe that they are doing their best to meet the real needs of their residents and are striving to make sure that the bills are clean and accurately represent the care given.

Having said that, do errors occur? Certainly. Years ago as an adult Boy Scout leader, I, along with others, maintained that scouting would be great…if it weren’t for the boys. Well, providers are in the people business employing people – fallible people. Operating a people business without the messiness of working with people would be great, but unreasonable and illogical. Despite providers’ best efforts with triple checks and even with their clinical applications screening the claims, we’ve discovered extra digits in Medicare numbers, invalid ICD-9 codes, etc.

My advice? Tell your story with claims that accurately reflect the care given and which are properly screened and scrubbed by members of your team (triple check), your clinical application, and a third-party automated claims management solution like ProClaim Partners. And tell your PR department to get off its duff and shout from the rooftops every day the wonderful things your facility and company are doing for the residents you serve, particularly if you are providing services to higher acuity residents. Tell your story. NO, tell your residents’ stories. It’s great press and a great buffer to the possible regulatory scrutiny and bad press that you could encounter in the future.  

Procurement automation has opened the door to opportunities not only to reduce costs, but to improve efficiency and to ensure quality consistency. Think of it this way, as the one responsible for your company’s purchasing practices, you have a lot on your plate. It’s one thing to negotiate purchasing contracts with vendors for all your food, medical supplies, office supplies, housekeeping supplies, and other supplies purchases. It’s another to make sure that those of your organization who place the orders actually receive the benefits from all your hard work. This is where Order Guide Management (OGM) comes in. In short, OGM is the ability to control which products your users have access to according to the terms negotiated.

Because of automated OGM,

• You can ensure that purchasing complies with the contracts painstakingly negotiated, because the users only see what you want them to see when they are preparing their orders.
• Users can more readily find the products they need whether they order them on a recurring basis or only occasionally.
• Users will purchase products that are of the quality you expect and insist upon.
• Your company can also maximize product rebates that your vendors may offer.

OGM is not new, but Procurement Partners is taking this principle to the next level with an enhanced Order Guide Management tool which will be released in the fall of 2012. Our automated and configurable procurement portal is like no other in the industry.

The key benefits of our new OGM tool:

• It can be used for all vendors from food, to medical supplies to office supplies and more.
• Flexibility – a single guide can be used for multiple ordering locations, multiple vendors, and/or multiple job roles.
• Multiple guides can be assigned with priorities defining which order guide attributes take precedence. 
• As the application administrator you have complete control. You don’t have to contact us to make changes.

To learn more, visit us during the AHCA/NCAL 63rd Annual Convention and Expo, booth #1319 or during the 2012 LeadingAge Annual Meeting and Exposition, Prime Care Technologies booth #530. We can introduce you to this outstanding tool and other features of our exceptional automated procurement application.

The headlines in the long term care media continue to highlight RACs audits, claims scrutiny, and claims denial. Further, at a time when sequestration threatens to reduce Medicare reimbursement by as much as 1.8%, revenue cycle management needs to have the constant attention of all providers every day. Of course, the first thing to do is to minimize the risk of denied claims as well as rejected claims.

Even if you are able to withstand an audit, assuming the clinical documentation supports the claims submitted, you still run the risk of poor cash flow management if your claims are rejected because of inadequate or outmoded claims preparation and “scrubbing” processes. Just as it’s important to “get it right the first time” by having the documentation to support your claims, you need to get it right when preparing the claims. In our free download position paper, Five Most Common Billing Errors, we offer insights into ways to avoid billing errors, improper diagnosis codes, invalid hospital stay dates, incorrect service dates, and etc. What we’re talking about in this post is taking your claims submission process to a higher level through claims automation. Claims automation can help by consolidating the claims submission and management process through one portal. This is the premise behind the ProClaim Partners clearinghouse. It’s a one-stop-shop for scrubbing, correcting, submitting, and monitoring claims as well as receiving payment notifications all in one place. You no longer have to trouble with multiple portals or applications.

Designed for long term care providers, the ideal enterprise-class portal will enable you to centrally monitor and manage all claims before and after they are submitted. From a central home page or dashboard, depending on the permissions/security levels you configure, you can review information and take action at a corporate, regional, or facility level. You can check for errors and clean them up before submitting the claims. The system’s scrubber, which constantly updates itself through its evolving database, can search for errors and omissions according to each payer’s rules. Within the portal you have the opportunity to make corrections in a number of ways according to your preferred workflow and internal policies. You can use the Search function to research claims and where they are in the submission-payment cycle.

You even have access to DDE and multiple MACs log-ins through this portal. While you can make corrections in the DDE, our clearinghouse lets you correct errors within the portal itself.

Other features allow you to stay on top of the revenue cycle for all payers. For example, your claims can be loaded into the system conveniently either via FTP or frequent data sweeps determined by you. Once the system receives the 835 payment notices, it sends emails to those you’ve designated to receive them.

To avoid unnecessary delays in payment, getting the claims submission process right the first time is critical for long term care providers. Visit us at our booth, #1418, during the AHCA/NCAL 63^rd Annual Convention and Expo or during the 2012 LeadingAge Annual Meeting and Exposition, Prime Care Technologies, booth #530, We can show how you can accelerate payments, increase collections, and reduce DSO. It’s the right thing to do.

I would like to introduce Rand Johnson as the author of this, our latest blog. With over 33 years in Long Term Care serving in such roles as administrator in facilities ranging in size from 35 beds to 388 beds, consultant, Senior Vice President of a prestigious LTC-focused reimbursement consulting firm, and Marketing Director for Prime Care Technologies, Rand contributes a broad as well as deep perspective to our team of bloggers. In today’s blog, Rand focuses on how automated invoice processing saves time and money. While he addresses LTC in particular, the content can readily apply to any business.

With a slow economy compounded by increasingly restricted reimbursements, cash flow management for LTC providers is a must. To accurately manage cash flow, executives must be able to accurately track spend to date in order to reliably forecast future spending. Automated invoice processing enables providers to manage cash flow to the vendors/suppliers and to accurately track their spend in real-time.

I’ve been in the LTC business for a good looooonnnnng time starting in the days when expense management was disjointed and departmentalized. Everything was by hand - the creation of purchase orders, the weekly calls to the vendors to place orders, the creation of endless forms and reports, the weekly spend-to-budget “fudge-it” reports (Really, how many actually reconciled these reports with the general ledger? Who had the time?), the handling of reams of POs attached to the invoices, the batching of same to be shipped to the corporate office, etc. Every link in the chain was under such a strain that a break was not an “if,” but a “when.” It was laborious at best and rife with risk for errors and unpleasant surprises. (I’m sure some administrators remember finding a batch or two of invoices which had yet to be processed in the former Business Office Manager’s desk drawers. That’s the stuff sleepless nights are made of.)

Those days are and should be long gone – a necessary evil in the evolution of business office workflow management. There is hope and it’s called automatic invoice processing. And it’s available today. The IT revolution has become more than data processing. In reality, it is a useable and useful tool especially in the form of procurement automation. Here are some of its features with their explicit and implicit benefits. Automated invoice processing:

• Automatically tracks spending for proper accounting, real-time reporting, accountability, and spend forecasting
• Affords complete control of invoice processing – you set the rules, such as approvals, contract compliance, workflow, etc.
• Delivers time and money savings - because the process is fully automated, it requires little to no manual steps in the workflow
• Reduced processing errors – the less humans are involved, the fewer the errors
• Automated processing of all types of invoices

Automated invoice processing also facilitates and reports on reconciliation of invoices to purchase orders and contract terms. It also aids in the tracking of back-ordered items and only paying for what you receive.

As I mentioned earlier, the automated payment process is not dependent on human intervention with its inherent distractions and shifting priorities which are too often moving targets. Invoice processing is automatic, reliable, and - through its reporting features - actionable as needed.

You should really look into and consider automated invoice processing to save time and money, to reduce errors, and to get some much-needed restful sleep. You owe it to yourself.