2 min read

Parkinson suggests I-SNPs as a managed care strategy in senior care

By Prime Care Tech Marketing on Fri, Jun 11, 2021 @ 10:19 AM

In Feds to deliver ‘positive news’ on Provider Relief Fund in coming days: Parkinson, McKnight's LTC News summarized recent comments from AHCA President and CEO Mark Parkinson at the Synergy Summit in Utah.

Among other things, Parkinson stressed managed care is not going away and encouraged senior care providers to embrace it by:

Naturally, you may want to know more about I-SNPs and if/how you might take advantage of them. The below Q&A may be of help to you in assessing this.

What is an I-SNP?
I-SNP stands for Institutional Special Needs Plan and is designed for those who will live in a long-term setting for 90 days or more with no immediate plans for discharge

How does it fit within Medicare?
An I-SNP is a Medicare Advantage plan focused on the care of specialized populations. It replaces traditional Medicare to cover inpatient and outpatient services, plus prescription drugs (as a Part D service).

Who is eligible for an I-SNP?

  • Reside in a long-term care facility with no anticipated discharge
  • Currently enrolled in Medicare A/B
  • Live in a county where I-SNP is licensed

*Check CMS' Special Needs Plan (SNP) Data to see who is operating in your state.

What are the highlights of an I-SNP?

  • Nurse practitioners provide preventative and proactive care
  • RN case managers coordinate care according to the Model of Care (MOC) required by CMS
  • Residents are assigned a 'Risk for Hospitalization' level, which determines care plan and a schedule for proactive rounds
  • Rounds occur as often as weekly or can be more frequent for high-risk residents
  • Provider visits are not subject to medical necessity requirements of traditional Medicare, so they can be more proactive and frequent

How do I-SNPs benefit SNFs/residents?

  • Increased provider visits; faster identification of conditions/treatment
  • Treatment-in-place advantage – visits can happen in the nursing facility
  • Proactive and preventative care; prevents unnecessary hospitalizations
  • Reduce risks and stress associated with hospital stays

How can technology help facilities with I-SNPs?

  • Case-to-contract management is essential to following an ISNP
  • Our Managed Care MASTER software brings contracts online, PLUS pairs them with best-practice workflows and alerts
  • With this automation, you can easily train anyone to act as a case manager and ensure reimbursement

If our Managed Care MASTER can help you 'manage' your managed care, including I-SNP contracts and care, let's connect.

Get in Touch

Topics: managed care Managed Care MASTER medicare advantage ISNP Institutional Special Needs Plan SNP
1 min read

Mcknight's recaps points from  managed care PDPM webinar

By Prime Care Tech Marketing on Fri, May 07, 2021 @ 11:12 AM

In a May 5 article, 'CMS let the cat out of the bag, but it’s managed care that’s ready to pounce,' McKnight's Long-Care News recapped critical points from our recent Managed Care Webinar: Goodbye PDPM, Hello Levels! with Mix Solutions.

  • Webinar poll: 42% of attendees said they’d already had to convert at least some contracts from PDPM to levels.
  • Susie Mix: "They (the plans) are very aggressive in not only cutting our rates 30% to 40%, but they’re also very aggressive in starting this right now."

If you missed advice offered during our webinar, there's still time to tune in.

On-Demand Webinar

Topics: Webinar managed care Mcknights PDPM newsmention
1 min read

[Event] LTC 100 Conference Recap

By Prime Care Tech Marketing on Wed, May 11, 2016 @ 11:46 AM

We enjoyed serving as a host to this exciting event and the many great connections along the way. If you missed our participation in the "50 Shades of Data: Your Most Under-Leveraged Asset" panel, stay tuned to news

We'll soon follow with a revisit of these best practices for mining/integrating data to affect care delivery, procurement, human capital, managed care, bundling and risk. Thanks to Quantum Age, Vintage Senior Living, Cardon & Associates, Mix Solutions and our VP of Technical Services Russ Hertzberg, for making this panel a success.

You also may have heard about our PBJ solution – visit www.primecaretech.com/PBJReporting to learn more. If we didn't get a chance to catch up...

LET'S CONNECT

Topics: mining data revenue cycle management PBJ procurement bundled payment managed care patient care human capital
2 min read

Spotlight on March's Revenue Cycle Management Blogs

By Prime Care Tech Marketing on Thu, Mar 31, 2016 @ 06:45 PM


Revenue-Cycle-Management-Blog-Spotlight-322x221.jpgThis month’s revenue cycle management blogs explored a number of topics, including the basic concepts of a claims clearinghouse, how to ensure managed care claims flow smoothly, 3 ways to help your back office runs smoothly, and 8 ways to avoid False Claims Act pitfalls. Here are some highlights from each and links to access each blog in full.

Clearinghouse 101 – a re-introduction to automated claims processing

“Clearinghouse 101” – an introduction to the some of the critical features and benefits of a claims clearinghouse. Whether you are using one today or not, take a peak. You may find some of the tips useful.

Back to the basics.

Ensure Managed Care claims flow smoothly

Partnering with a clearinghouse with connections to thousands of payers makes submitting claims easier and revenue moving.  Keeping cash flow in a steady stream means understanding how managed care works – knowing the systems, procedures, and requirements are critical. A clearinghouse, like primeCLAIMS, has the ability to connect with multiple Managed Care payers, helps to ease the transition into Managed Care and your revenue cycling.

Learn how.

3 ways to make sure the back office is running smoothly during absences

Interruptions, urgent requests, and unanticipated call-ins, even scheduled absences can be disruptive. But retreat is not the answer. Substitute is the better option - making sure that others are trained to cover the important aspects when needed.

Discover how.

The False Claims Act: 8 ways providers can avoid penalties and fines

Periodically, you will see settlements or court decisions rendered for False Claims Act violations. Claims may be subject to false claims accusations for treatments or services provided that are not deemed medically necessary, do not meet coverage qualifications, or medical record indicates they were not provided as ordered.

How to avoid them.

Moving the Revenue Needle with Secondary Claims

CALCULATE REVENUE

Topics: clearinghouse False Claims Act managed care claims back office managed care