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




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

What Billers Should Know to Help Jumpstart 2016

By Prime Care Tech Marketing on Wed, Dec 23, 2015 @ 01:48 PM

Billers 2016 ClaimsValuable 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:


Related blogs


ICD-10 – It’s here. Now what?

Maintain a solid financial footing through the quagmire of ICD-10 implementation

Secondary claims

Taking the Headaches Out of Secondary Claims

What you’re wasting by processing secondary claims manually

The Importance of Using a Clearinghouse for Secondary Claims


How to handle claims rejections


Mitigate shrinking margins with revenue cycle management

Do yourself a favor - Simplify the reimbursement process

Simplifying the Managed Care Claims Process

It’s the Holidays! How to have financial Peace of Mind at this busy time.


How well is your claims management solution moving cash flow?

Clearinghouse support – is it there when you need it?

Clean claims

Giving Payers a Clean Claim – 11 tips to getting paid faster

Happy Holidays! May this season bring you and yours joy.

Claims Process

Topics: revenue cycle management claims management clearinghouse LTPAC, Long Term Post-Acure Care, ICD-10 claims rejections secondary claims clean claims LTPAC providers billers managing claims
3 min read

ICD-10 – It’s here. Now what?

By Prime Care Tech Marketing on Mon, Oct 05, 2015 @ 06:56 PM

ICD-10 Implementation is a journey not necessarily a destination – at least for the foreseeable future.

What's Your Plan for ICD-10Remember Y2K? The proverbial sky was predicted to fall. It didn’t. Will the long-anticipated ICD-10 implementation be similarly anticlimactic? Probably not. ICD-10 has been dubbed the “complexification of healthcare” in the Washington Post, which also predicted that “the resulting confusion and inconsistency in claims processing would create unnecessary administrative costs and take resources away from patient care.” Texas Medical Association President, Dr. Tom Garcia, has been quoted as saying, “It’s the countdown to a perfect storm.” Whether the financial firmament will come crashing down on providers’ heads due to ICD-10 will depend not only on their preparations, but what they do after implementation.

It may well prove helpful to consolidate insights, tips and best practices submitted by experts around the country.

Let’s first address the Challenges. Despite all the training and preparation, providers still may encounter the following:

  1. Productivity decrease. As coders attempt to employ ICD-10, decreasing productivity and inaccuracy-induced delays will have an impact on cost and the bottom line.
  2. Financial impact. Cash flow disruption from increased denials and underpayment may also occur.
  3. Resources. You’ve allocated required resources to prepare for implementation. Now it’s time to determine the resources needed to keep the implementation on track.
  4. Technology-related challenges. These may include data transmission issues and unscheduled vendor updates. You may need to retest critical application or system functionality.

What should you be doing?

  1. Create, implement, assess, and continuously correct a post ICD-10 implementation strategy. Take into account that this has not only impacted procedures, policies, and skill sets, but also people—including employee morale. Any change is threatening until employees can acknowledge what practices they need to let go of, deal with the sense of loss of the familiar, can understand and envision what ICD-10 competency can do for the organization and for them personally, and fully embrace the new best practices and skill sets. Tip: Involve your staff in troubleshooting through problem and resolution identification.
  2. Assess demands on resources. Address effective allocation of the most impacted resources.
  3. Set goals from the top down and the bottom up. Setting goals goes hand-in-hand with tracking key metrics. Involving ICD-10 stakeholders at all levels within your organization is critical.
  4. Monitor net revenue and cash trends. Identify, understand, and mitigate the root cause(s) of any cash flow disruptions or revenue declines.
  5. Assess documentation quality. Experts emphasize the need for specificity in clinical documentation.
  6. Prepare to defend code assignments. Make sure that the documentation is consistent with the ICD-10 coding demands and supports the classification information details. Notwithstanding their inherent differences, learning a coding/classification system and understanding the clinical factors of a diagnosis are related…and important. Tip: Audit coding productivity and accuracy.
  7. Training, training, and more training. Training will never stop. Tip: Develop a formalized on-going training program for clinicians and coders.
  8. Hire coding help in the short run. Experts can help you assess where you are by conducting audits and working closely with coders and clinicians alike.
  9. Review the Q&A document before submitting claims and MDS assessments that include October 2015 dates of service (include SNF clinicians, MDS coordinators, and billers in the review process)
  10. Track key preparation and processing metrics. Rome wasn’t built in a day...nor will your process be built over night. If you have not already done so, identify key preparation and processing metrics and track them. Set benchmarks for the near and long term.
  11. Acknowledge that it's an on-going process and accept it.


Taking steps throughout the ICD-10 implementation process will prevent the cash flow and bottom line storms from raining on your financial parade. Several resources are available to help you make the transition to ICD-10 successful. For example:

Additional thoughts from CMS

The Centers for Medicare and Medicaid Services have recently offered the following:

  • The ICD-10 Ombudsman will be available to help answer nursing facility questions and can be reached at ICD10_Ombudsman@cms.hhs.gov.
  • Minimum Data Set (MDS) assessments with Assessment Reference Dates (ARDs) on or before September 30, 2015 must contain a valid ICD-9 code in Section I if a diagnosis code is necessary.  SNF MDS assessments with ARDs on or after October 1, 2015 must contain a valid ICD-10 code.  CMS will reject MDS assessments if a Section I diagnosis code version does not apply for the ARD entered.

Business Intelligence

Topics: ICD-10 cash flow disruption bottom line net revenue cash trends ICD-10 coding


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