3 min read

Catching up on the state of senior care at OHCA

By Prime Care Tech Marketing on Mon, Aug 30, 2021 @ 03:49 PM

Last week, our team attended the annual Ohio Health Care Association (OHCA) convention. Our Senior Customer Success Director Debi Damas also lead a session on the state of senior care. She discussed pandemic challenges and encouraged the exchange of strategies to mitigate change. The following is a recap of this valuable session.

Where does senior care stand and what the heck happened?

  • Nursing home staffing shortages only worsened as 2020 came to a close
  • 48 states saw occupancy of 80% or less, with some as low as 56%

What can senior organizations do right now?

  • Develop purpose-driven, compassionate staff
  • Adopt technology to increase connectedness, efficacy, and optimal health
  • Embrace telehealth
  • Develop a culture of positive aging framed by wellness
  • Establish trust by being prepared for emergencies and unexpected events

What happened with senior living census?

  • Increased push to home health care
  • People wanted no part of facility-based care
  • Long-term care (LTC) facilities were not admitting
  • Skilled nursing facilities (SNFs) turned beds/halls into COVID units
  • Senior care providers are now seeing slight increases in census

How can senior organizations build census?

  • Marketing value-adds to prospective residents:
    • Amenities
    • Telehealth
    • Wellness focus
  • Sharing positive performance data with hospitals:
    • Vaccination rates
    • Infection control
    • Outcome data, readmission rates
  • Identifying an ideal niche based on ICD code(s)

How does revenue look in senior care?

  • 55% of SNFs are operating at a loss
  • Significant increases in claims denials, resulting in more reviews
  • Some managed care is moving from PDPM to levels
  • Per Mark Parkinson (CEO of AHCA/NCAL), long term success comes down to: 
    • State Medicaid rates
    • Payer mix
    • Financing
    • Operational excellence

What staffing trends emerged among senior care employers?

  • Rigid schedules/Inflexible call off policies
  • 23% of nursing homes had direct care staff shortages in May
  • 96% received some government assistance
  • 47% received funds from Paycheck Protection Plan (PPP)
  • 82% received funds from CARES Act/Provider Relief Fund
  • 52% received Medicaid add on or increase from state government

What can senior care organizations do to improve staffing?

  • Increase the ways you make staff feel valued
  • Change your pay structure
  • Offer bonuses – sign-on, working all scheduled shifts, etc.
  • Revise staffing policies to benefit employees
  • Increase flexibility to accommodate child/eldercare challenges
  • Provide a career path; demonstrate benefits of added skills and education
  • Be attentive and thorough with screening and hiring

To reiterate one of Debi's earlier points, technology can help. Here are three senior care providers who are benefiting right now from our software.

 

Topics: census primeVIEW revenue cycle labor Managed Care MASTER staffing post-pandemic
1 min read

PDPM Webinar Follow-Up: Technology can help; ask about primeVIEW

By Cheryl Field on Mon, Mar 11, 2019 @ 02:23 PM

Thanks your interest in last week's Patient Driven Payment Model (PDPM) Webinar for C-suite executives. You may recall my mention that our technologies can help. Don't Put Off PDPM Prep!

For example, primeVIEW delivers an easy-to-navigate interface that automatically refreshes in near real time with consolidated data from various systems.

  • Census
  • Labor
  • Revenue cycle
  • Satisfaction scores
  • Five-Star Quality Ratings

So, get in touch if you'd like to hear more!

Topics: census readmission rates PDPM LOS length of stay readmission
2 min read

7 ways to spring clean your revenue cycle

By Prime Care Tech Marketing on Thu, Apr 14, 2016 @ 07:35 PM


iStock_000076598221_Small.jpgThis 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
  1. 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?
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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

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DOWNLOAD NOW

 

Topics: DSO clearinghouse ICD-10 days sales outstanding RUG scores census revenue cycle AR aging pre-admission screening claims triple check
3 min read

9 Effective Habits Every Biller Should Adopt

By Prime Care Tech Marketing on Thu, Jan 21, 2016 @ 03:00 PM

iStock_000050766304_Small.jpgWhat makes billers effective? Habitual attention to specific details and consistent execution of routine, yet critical tasks. I’d like to share with you what our team considers to be nine habits of highly effective long term care billers. Caution the resultant success can be addictive. That's a good thing. 

  1. Make sure your census is correct. We can’t stress this enough. Work closely with the Director of Nursing to make sure the night shift nurses are indeed taking a midnight census. Here is an example of what could happen if they don’t. Let’s say Mrs. Brown is discharged to the hospital, but the discharge is not correctly noted. Because she is still considered in the census, you may bill for the entire month incorrectly. Daily stand-up meetings are great opportunities to confirm the census count and to review the previous 24 hours’ admissions, discharges, and bed holds. Whatever procedures are in place to track the census, relentlessly encourage accuracy and timeliness.
  2. Check eligibility regularly. Do this at least monthly. For example, residents can change from the traditional Medicare model to a Medicare HMO plan at any time. It’s impossible to bill for Part A days when the resident has already exhausted the days available in the Benefit Period.
  3. Triple check during the month-end close. We’ve mentioned month-end triple checks before. If your facility or facilities a significant volume of Part A and Part B claims each month, you may be willing to check a random sampling of bills during this meeting. But what should you cover during the triple check?
  • Consistency of nursing and therapy documentation – Make sure that the nursing documentation supports the therapy documentation and vise-versa. If the resident needs therapy to learn to ambulate, nursing and therapy documentation needs to support that.
  • Verify that the medical record supports the intervention performed – This is, of course, dependent upon the supervising clinician’s judgment. Make sure the team addresses this issue.
  • Verify therapy minutes – Confirm that the minutes to be billed are consistent with the RUG level’s requirements.
  • Charting – Especially for skilled Part A services, clinicians need to chart as required. Make sure clinical documentation has progress notes, noting that the resident needs skilled intervention.
  • Benefit days availability - Communicate available Part A days.
  • MDS assessment reference dates - Verify the MDS-assessment reference dates are accurate for the 5 day, 14 day, 30 day, etc.
  • Physician orders - Make sure that physician orders have been received and have been implemented.
  • Physician certification/re-certification – Make sure the attending physician has certified or recertified the need for skilled services and that the record includes reliable documentation.
  1. Know your payer contracts – As we discussed in the last blog, review your payer contracts regularly.
  2. Make sure the business office staff is continually learning – Dr. Covey referred to it as sharpening the saw. If you are an AR manager, this is important. The world of claims processing and billing requirements change constantly. Challenge yourself and your staff to learn something new every day. Also, acknowledge that turnover among billing staff exists which means in some cases, you must start over again. Take advantage of the webinars provided by the MACs when available.  They’re free!
  3. Get organized and know where to find and plan what needs to be done by when. Remember today’s technology can be your best friend with digital calendaring, automatic reminders and alerts, software-based task lists, and more.
  4. Don't be an island to yourself - Be transparent in your billing practices and routines. Just as back-up and failover procedures are critical to IT, so is “cloning” yourself extremely important. Billing must be on time. Train others to pick up where you may have to leave off, just in case.
  5. Foster positive working relationships among staff members – An atmosphere of open dialogue and trust contributes to a smooth-running operation. Have a go-to person in each department. Those “insiders” can give you the information you need quickly and accurately.
  6. Be the go-to person yourself – Let trust and dependability begin with you.

Okay, I am sure you can add to the list, but we suggest you keep it short and do what matters most in your role as a biller. It just makes good cents.

Topics: triple check census payer contracts effective billers eligibility business office staff get organized daily stand-up meetings
3 min read

Six Resolutions Every AR Manager Should Make

By Prime Care Tech Marketing on Thu, Jan 07, 2016 @ 07:23 PM

iStock_000081689631_Small.jpgAh, 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.

Business Intelligence

Topics: DSO AR managers ICD-10 days sales outstanding triple check private pay Medicaid census billing software ICD-10 training pre-admissions screenings Medicare private insurance