1 min read

[On-Demand Webinar] OIG Workplan: Your Key to SNF Compliance

By Prime Care Tech Marketing on Fri, Apr 21, 2017 @ 03:37 PM

In our recent webinar, "OIG Work Plan: Your Key to SNF Compliance," we partnered with Pathway Health Chief Marketing and Strategy Officer, Lisa Thomson to offer advice on how best to comply with the 2017 Officer of Inspector General (OIG) Work Plan. 


  • Identify 3 top compliance concerns related to Affordable Care Act (ACA)
  • Highlight 5 OIG Work Plan items that impact SNFs
  • Define 3 strategies to prevent Fraud, Waste and Abuse

If you missed it, be sure to take advantage of these resources:

 If you feel unprepared for OIG compliance, get in touch with our experts!

  • Prime Care Technologies – Elevate security, expedite IT needs and empower yourself to automate and oversee financial performance, claims processing, managed care, purchasing and workforce.
  • Pathway Health – Bring in the experts as consultants, educators or interim managers to assist with your post-acute care requirements. 
Topics: real-time reporting compliance SNF reporting and analytics OIG Office of Inspector General
1 min read

[Webinar] OIG Workplan: Your Key to SNF Compliance

By Prime Care Tech Marketing on Fri, Apr 07, 2017 @ 12:01 PM

Prime Care Technologies and Cheryl Field (our Chief Product Officer) are excited to partner with Pathway Health Chief Marketing and Strategy Officer, Lisa Thomson, for our webinar – OIG Work Plan: Your Key to SNF Compliance – offering advice on how best to comply with the 2017 Office of Inspector General (OIG) Work Plan.  

During the webinar, we'll:

• Identify 3 top compliance concerns related to Affordable Care Act (ACA)
• Highlight 5 OIG Work Plan items that impact SNFs
• Define 3 strategies to prevent Fraud, Waste and Abuse

You won't want to miss this great educational session!


Topics: compliance SNF CMS post-acute care providers
2 min read

So You Think You're Compliant? What's Keeping You Awake?

By Prime Care Tech Marketing on Wed, Dec 23, 2015 @ 01:27 PM

CompliantRest 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.

Business Intelligence

Topics: business intelligence Data Mining clinical KPIs Losing sleep KPI benchmarks data warehouse compliance
3 min read

How Well is Your Claims Management Solution Moving Cash Flow?

By Prime Care Tech Marketing on Fri, Dec 11, 2015 @ 06:58 PM

Claims Management Cash flowThat claims management has an impact on cash flow cannot be denied. But is your solution really working for you? First, let’s identify in what ways a claims management solution helps cash flow by converting into statements the questions found in our recent primeCLAIMS quiz, entitled, “Is Your Claims Clearinghouse a High Performer?”

Cash Flow


With your current solution you should be seeing cash flow improvements quarter over quarter. We suggest setting specific goals tied to claims-to-cash improvement and review progress at least quarterly. Contributing directly to cash flow improvement is measured improvement in your claims acceptance rate. The clearinghouse you choose should be able to help your AR team significantly reduce claims rejections conveniently. Occasionally, payers may request changes to the claims your team submits. A clearinghouse should help you turn those claims around quickly.

Take a close look at your clearinghouse and the middleware[1] it uses. We have learned from providers who use other clearinghouses that critically-needed application upgrades can take an unreasonably long period of time. Why? Because some clearinghouses do not own the middleware their application relies on and must wait for such changes. Owning the middleware certainly contributes to a quicker response to upgrade requests. 

We’ve mentioned this before, but with a clearinghouse experienced with post-acute payers and their claims processing technicalities providers are more likely to see improved claims processing and fewer frustrations. Such a clearinghouse is more responsive to LTC provider needs and in some cases the clearinghouse can anticipate needs and be ahead of the upgrade curve.

Productivity & Labor Savings

Considering turnover issues, the automated claims management solution needs to be intuitive - easy to learn and use for newly-hired and less-experienced billers. Further, with customized train-the-trainer programs and implementation, the clearinghouse helps providers to get new-hires up and running quickly while reducing orientation and training costs.   

The clearinghouse application must be robust with simplified reimbursement workflows and the users’ ability to manage claims submissions, denials, remits, DDE access, and HETS inquiries in a single portal. Further, being able to submit claims in batches reduces inefficient and costly steps. Should a payer reject a claim, the clearinghouse should be able to isolate the rejected claim and not reject the entire batch. Another example of possible key clearinghouse capabilities is the automatic identification and release of secondary claims. Secondary claims are a significant part of revenue to be collected yet are likely most at risk for non-payment.

Near and dear to any CFO’s heart are reports. Being able to view a dashboard of claims-related KPIs has proven valuable to provider management teams which can reinforce accountability throughout the entire claims management process.


From a strategic standpoint, having a clearinghouse partner that keeps up with LTC-specific regulatory changes across the senior care continuum and communicates them to its provider partners is important. In primeCLAIMS, customers are able to view updates and notices in their dashboards – a convenient way to anticipate and prepare for changes.


Being in total control of who has access to which features, functionalities, and reports gives providers the control they want over the claims flow process. Such security capabilities give corporate, region, and facility managers the flexibility they need to view all locations for which he or she is responsible in aggregate and individually.

Enterprise Effectiveness

Sometimes the term “enterprise class” is overused, but in the case of claims processing, this term is meaningful. With some clearinghouses, management can only view claims’ status one facility at a time. Being able to aggregate (at the corporate or region level) and drill down to specific facilities in one portal gives managers both a high-level and, if they choose, an in-depth view of pending, outstanding, and paid claims.

A clearinghouse should not only upgrade its application and best-practice recommendations based on regulatory and payer-specific changes, but also listen to current customer needs and requests to improve customer productivity. If the clearinghouse appears to be unresponsive or slow to respond, that should be a concern.


We recommend that you carefully evaluate your current claims management solution to see if it is effectively helping you move cash into the bank. It just makes cents.

[1] “Middleware is a general term for software that serves to "glue together" separate, often complex and already existing, programs. Some software components that are frequently connected with middleware include enterprise applications and Web services.” TechTarget, http://searchsoa.techtarget.com/definition/middleware, Margaret Rouse

Claims Process

Topics: automated claims management cash flow clearinghouse Medicare claims claims middleware claims submissions secondary claims reimbursement workflows application upgrades compliance security


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