Post-Acute Care News

Get News via Email

[Webinar On-Demand] Best Practices in LTPAC Revenue Cycle Management

By Prime Care Tech Marketing on Thu, May 18, 2017 @ 02:18 PM

If you missed it or want to review it again, our Best Practices in LTPAC Revenue Cycle Management Webinar replay and slides are now available. This webinar offers top tips from our 25+ year veteran, Kimberly Sturm, and our seven years of helping post-acute care clients get claims paid faster and with less hassle.

If it's time to streamline your claims processes, be sure to schedule a demo with us for help. Our clients report that our primeCLAIMS  solution cuts processing time by up to 50%, helping them recover revenue faster.

Topics: revenue cycle management, MSP, Medicare Secondary Payer, secondary claims, claims processing automation, post-acute claims clearinghouse

Spotlight on April’s Revenue Cycle Management Blogs

By Prime Care Tech Marketing on Thu, Apr 28, 2016 @ 02:00 PM

Revenue-Cycle-Management-Blog-Spotlight-322x221.jpgRevenue Cycle Management is constant, a year-round effort, but periodically worth occasional scrutiny and cleaning up. Likewise, if you bill Medicare for services and need to file secondary claims, then taking a look again at automation through a clearinghouse may result in cleaning up those outstanding AR balances. This month’s blogs offer useful insights to help AR managers refresh revenue cycle best practices and remove the clutter of uncollected revenue.  

Spring clean your revenue cycle

This 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”.
  2. Check the aging.
  3. Revisit your pre-admission screening procedures.
  4. Make sure the census is correct.
  5. Stay on top of your Days Sales Outstanding (DSO).
  6. Conduct a thorough claims triple check.
  7. Engage the right clearinghouse.

Learn how these steps can help you freshen up your revenue cycle management practices.

 

Secondary payer claims – finding ROI (Reducing Outstanding Income)

The ROI of automating secondary claims through a claims clearinghouse is potentially huge. Traditionally billers completed paper forms and mailed them to the payer. Sounds simple, but it wasn’t and, some providers are still submitting claims in this way. Phone calls and error-generated resubmittals contribute to a complex, cumbersome, costly, and prolonged payment process. With electronic claims automation, providers can securely submit and track claims to multiple payers all in one portal. In this blog, we highlight some of the advantages a claims clearinghouse can offer and the potential ROI when doing so.

Discover the benefits and ROI of automating secondary claims submission. 

 

Are you collecting all your secondary claims and
how much does it cost to do so?

pCL_Calculator_Webpage_Trimmed.jpg

Check it out!

 

Topics: automated revenue cycle management system, revenue cycle management, Medicare Secondary Payer, secondary claims, revenue cycle, secondary payer

3 unique ways to shorten revenue cycles

By Prime Care Tech Marketing on Thu, Feb 04, 2016 @ 07:20 PM

iStock_000035332812_Small_2.jpgLTPAC CFOs in the 21st 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.

Topics: revenue cycle management, AR managers, Medicare Secondary Payer, claims processing costs, job satisfaction, Life Plan Community

Taking the Headaches Out of Secondary Claims

By Prime Care Tech Marketing on Mon, Nov 09, 2015 @ 06:55 PM

Secondary ClaimsFor CFOs, the bottom line matters, whether it’s the P&L or identifying what’s in the bank. Occasionally, though, it does help to know within the context of “what’s in the bank,” how the money gets there. Since Medicare Part A is a significant revenue source, being aware that just submitting a claim for Part A-covered days-of-service may not be enough can be helpful to supporting the organization’s efforts to create an impediment-free flow of cash to the bank.

Let’s take a closer look at the obvious. Assuming the resident meets all the Part A eligibility requirements and that he or she receives Medicare-coverable services, the Medicare MAC will pay the entire amount of the RUG-determined per diem for the first 20 days of the spell of illness. The “rub” is who pays for the coinsurance for the remaining days of qualified services from the 21st day onward? This is where the secondary payer comes in and, potentially, the headaches.

Introduction

Secondary claims, if not properly handled (and I mean filed electronically, not manually – more about that in a moment) can slow up cash flow. “A claim is a claim, isn’t it?” Nope. "Well, I’ve got the staff and I am certainly paying enough for them to process the claims. They know what they’re doing.” Yes, but because of the intricacies of submitting the secondary claim after receiving payment from the primary payer, providers can and often do see a delay in payment or no payment at all. “But why?” you may ask.

A little background

Once Medicare pays the claim, the MAC may through a coordination of benefits agreement automatically forward the secondary claim to the secondary payer. But not in all cases. Only if the secondary payer pays a fee for such services. The secondary payer can be a commercial insurance (Medi-Gap) or Medicaid. In some states, Medicaid secondary payer claims will cross over automatically. However, even if the state automatically processes the secondary claim, some states do not pay the entire coinsurance amount.

In those cases where the secondary payer does not pay the fee for Medicare to automatically forward the secondary claim, the provider’s Central Billing Office or AR staff or Billers will have to identify, process, submit, monitor, and intervene as needed to collect the secondary payer payment. They can do this manually (Really?) or electronically (Get with the program, folks.).

Manual or electronic processing – showing our bias

Let’s look at the two alternatives.

Paper-based secondary claims – This process is as old as dirt. Because there are many nuances to the process and opportunities for omissions, errors, and procrastination, it creates delays. The billing department receives notices of payment from the primary payer. Then billers have to print the UB04, attach the claim level, related remittance advice, and mail or fax these papers to the secondary payer. The manual method usually requires a tickler file, likely an accordion file with 30 slots in which to place copies of the submitted documents for follow-up. On the follow-up day, the biller places a call to the payer. Unfortunately, it’s not unusual for the payer to not have a record of the submission. So the biller will have to resubmit the claim again and move the claim documentation further back in the accordion file.

Oh, and here is another possible “...grant me the serenity to accept the things I cannot change…” moment. Some secondary payers require a 15-30-day waiting period before a provider can resubmit the claim. How’s that for taking the starch out of your shirt?

Because preparing, filing, and following up on secondary payer claims can engender procrastination, it's easy to lose track of the secondary payer claims. This can result in further payment delays or no payment at all, if the submission takes place outside the allowable filing window (sometimes 90 days to a year).

Electronic claims – the aspirin of secondary claims processing

Processing secondary payer claims electronically through a clearinghouse is as fast and easy to follow as this paragraph. Because the process of claims preparation to submission to follow-up to payments is automated, it gets the job done faster. It also helps to reduce the staff hours consumed when processing claims manually. Word to the wise, “Use the technology at hand.” 

What can a CFO do?

The bottom line looks much healthier, because the provider electronically processes not only primary payer claims, but secondary claims as well. It’s certainly one less headache.

And that makes cents.

 

Claims Process

Topics: Medicare Part A, clearinghouse, Medicare Secondary Payer, MAC, UB04, Medi-Gap

Medicare Secondary Payer – 5 Steps to win the race to timely payments

By Proclaim Partners on Fri, Apr 12, 2013 @ 01:20 PM

Winning the raceWinning the race to collect your money on time is everything. However, Medicare Secondary Payer[1] (MSP) may cause nursing home billers to trip up in their efforts to get payments as quickly as possible. Tripped too often, and providers may find themselves not quite reaching the monthly collection goal finish line. Worse yet, they may find themselves going backwards due to fines imposed for “knowingly, willfully, and repeatedly providing inaccurate information related to the existence of other health insurance or coverage.” Perhaps it’s time to get in shape regarding MSPs.

But first, what is MSP and why is it so important?

Conditioning exercise – know the terms of the game. Let’s start with primary payers. Primary payers are those which have the primary responsibility for paying a claim. Sounds simple, right?  How does this apply to MSP? Medicare does not pay for services and items that other health insurance or coverage is primarily responsible for paying. In other words, Medicare is the secondary payer when it is not responsible for paying first; when it is not the beneficiary’s primary health insurance coverage. So, remember, only in the absence of other primary insurance or coverage does Medicare remain the primary payer.  Examples include accidents where the auto insurance would eclipse Medicare, workers compensation, a fall whether at home or on public property, etc.

Are there any exceptions to the MSP requirements? No and Yes.

First, no.  Federal law takes precedence over state laws and private contracts. It doesn’t matter what an insurance contract or state law may claim federal law always take precedence.

Second, yes. In the following situations, Medicare may make payment, assuming Medicare covers the services and you file a proper claim.

  • A Group Health Plan (GHP) denies payment for services because the beneficiary is not covered by the GHP;
  • A no-fault or liability insurer does not pay or denies the medical bill;
  • A Workers Compensation (WC)  program denies payment, as in situations where WC is not required to pay for a given medical condition; or
  • A WC Medicare Set-aside Arrangement (WCMSA) is exhausted.

Conditioning note: When submitting a claim to Medicare, include documentation from the other payer stating the claim was denied and/or benefits were exhausted.

OK. With this understanding, you should be in shape and in racing trim. Let’s discuss 5 tactics to completing the collection race in good time.

1. Contact the COBC (Coordination of Benefits Contractor).
You may contact the COBC to:

  • Verify Medicare’s primary/secondary status,
  • Report changes to a beneficiary’s health coverage,
  • Report a beneficiary’s accident/injury,
  • Report potential MSP situations, or
  • Ask questions regarding Medicare development letters and questionnaires

2. Know your responsibilities. 
As a Medicare provider you should obtain billing information prior to providing services.  You will need to:

  • Gather accurate MSP data to determine whether or not Medicare is the primary payer by asking Medicare beneficiaries (or their representatives) questions concerning the beneficiary’s MSP status.
  • Bill the primary payer before billing Medicare.
  • For Part A, submit any MSP information on your Medicare claim using proper condition and occurrence codes on the claim.
  • For Part B, submit an Explanation of Benefits (EOB) form from the primary payer on your claim with all appropriate MSP information. If submitting an electronic claim, provide the necessary fields, loops, and segments needed to process the MSP claim.

3. Gather accurate data from the MSP beneficiary.
You must determine whether Medicare is the primary or secondary payer for each inpatient admission prior to submitting a bill by asking Medicare beneficiaries about other coverage. You should also inquire through HETS (HIPAA Eligibility Transaction System).

The MSP Questionnaire
CMS developed an MSP questionnaire[2] for providers to use as a guide to help identify other payers that may be primary to Medicare. The questionnaire follows a logical step-by-step sequence of Yes/No questions involving whether or not:

  • The beneficiary is receiving Black Lung (BL) Benefits
  • The services are to be paid by a government research program
  • Department of Veterans Affairs (DVA) has authorized and agreed to pay for your care at this facility
  • The illness/injury was due to a work-related accident/condition
  • The illness/injury was due to a non-work-related accident
  • No-fault insurance is available
  • Liability insurance is available
  • The beneficiary is employed
  • The spouse is currently employed
  • The beneficiary has group health plan (GHP) coverage based on his or her own or a spouse's current employment
  • The beneficiary has GHP coverage based on own current employment: does the employer that sponsors or contributes to the GHP employ 20 or more employees or 100 or more employees?
  • The beneficiary has GHP coverage based on his or her spouse’s current employment: does the spouse’s employer that sponsors or contributes to the GHP employ 20 or more employees or 100 or more employees
  • The beneficiary is covered under the GHP of a family member other than his or her spouse whose employer that sponsors or contributes to the GHP employs 100 or more employees
  • The beneficiary has End Stage Renal Disease (ESRD) and has group health plan (GHP) coverage
  • The beneficiary has received a kidney transplant
  • The beneficiary has received maintenance dialysis treatments
  • The beneficiary is within the 30-month coordination period that starts MM/DD/CCYY
  • The beneficiary is entitled to Medicare on the basis of either ESRD and age or ESRD and disability
  • The initial entitlement to Medicare (including simultaneous or dual entitlement) was based on ESRD
  • The GHP is already primary based on age or disability entitlement

Race tactic: You should retain a copy of completed MSP questionnaires in your files or online for 10 years.

4. Avoid submitting a claim to Medicare without providing the other insurer’s information.
Medicare may erroneously pay the claim as primary if it meets all Medicare requirements, including coverage and medical necessity guidelines. However, if the beneficiary’s Medicare record in HETS indicates that another insurer should have paid primary to Medicare, Medicare will deny the claim, unless it may rightly pay conditionally.

5. Avoid the penalties to failure to filing correct and accurate claims with Medicare.
Medicare can fine providers, physicians, and other suppliers up to $2,000 for knowingly, willfully, and repeatedly providing inaccurate information related to the existence of other health insurance or coverage.

MSP is a serious matter you should carefully address BEFORE you file a claim. By following these five steps you will be in good shape to cross the collection finish line successfully and in good time.


[1] The term "Medicare Secondary Payer" is sometimes confused with Medicare supplement. A Medicare supplement (Medigap) policy is a private health insurance policy designed specifically to fill in some of the "gaps" in Medicare's coverage when Medicare is the primary payer. Medicare supplement policies typically pay for expenses that Medicare does not pay because of deductible or coinsurance amounts or other limits under the Medicare program.

[2] Medicare Secondary Payer (MSP) Manual, Chapter 3 - MSP Provider, Physician, and Other, Supplier Billing Requirements, 20.2.1 - Admission Questions to Ask Medicare Beneficiaries.

Topics: MSP, HETS, collections, Medicare Secondary Payer

Recent Posts

Screen_Shot_2016-07-26_at_3.06.07_PM.png

Gain visibility and control over claims operations

See how Prime Care can move the needle across your enterprise

PLAY DEMO