LTPAC CFOs in the 21^st century have to be concerned about many things. But in reality, much of what CFOs do revolves around getting paid on time in the amounts anticipated. Perhaps paying attention to the not-so-obvious factors influencing payment may be worth investigating.

Does this CFO job description for a Life Plan Community (LPC) sound familiar?

• Ensures corporate financial processes and systems, including overall financial controls
• Oversees accounting and financial reporting, financial planning & analysis, and budgeting
• Establishes financial systems and investment accounting and reporting
• Assures all financial operations function efficiently and effectively in compliance with all applicable policies and procedures and statutory/regulatory guidelines (Italics added)
• Strong participation in strategic planning and initiatives, project management

To accomplish this, the essential duties involved include:

• Providing proactive and sound guidance regarding management of assets, investments, and financial trends
• Overseeing a system of responsible accounting including budget and internal controls
• Developing and leading the finance team to maximum productivity and responsiveness (Italics added)
• Ensuring that monthly financial statements are provided on a timely basis
• Acting as a trusted counselor regarding development of new sources of revenue

Although each of these are specific to this LPC, they are for the most part what CFOs are responsible for no matter how many locations the company operates. They have one thing in common – responsible oversight of all income, expenses, and investments. For the purposes of this blog, let’s focus on three ways to shorten the revenue cycle by “developing and leading the finance team to maximum productivity and responsiveness” – specifically by addressing A/R team job satisfaction, claims processing costs, and secondary claims payments.

1. A/R Team Job Satisfaction

In previous blogs, we have addressed such job-satisfaction drivers as empowering the AR team through participation in the admissions process, direct involvement in helping residents apply for Medicaid, sharpening the blade of job skills through recurring education and best-practice updates, employing successful billing habits, making sure the census is correct, checking eligibility regularly, participation in regularly-held billing triple checks, familiarity with key aspects of payer contracts, and getting back to the billing basics. Competence, education, and good, old-fashioned appreciation and positive feedback contribute significantly to reduced turnover and job satisfaction. A happy team is a productive team and a productive team collects money owed.

2. Claims Processing Costs

Does it matter how much it costs to process claims? Yes. Let’s just take a simple example. An operator of 40 facilities in the western US used to process claims at the facility level. But with the advent of all-in-one claims clearinghouses, centralizing the billing function in the corporate office became doable and resulted in cost-saving efficiencies. Much of the claims preparation, submission, corrections as needed, follow-up, and payment receipts could be performed on line and for the most part automatically. Fewer billers were needed, resulting in a reduction in labor costs. Just as importantly, they collected money more quickly.

3. Medicare Secondary Payer (MSP) Claims

In the case cited in the previous paragraph, the provider in question was able to automate the processing of MSP claims resulting in an accelerated payment cycle with a reduction of 30 days between secondary claims filing and payment receipts. 

Is your company getting paid on time in the amount anticipated at lower costs? We suggest that with your AR manager(s) you take a hard look at these three productivity contributors and determine what initiatives need your support. Because, really, it all makes good cents.

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.

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.