2 min read

Documentation Critical to CMS Claims, Patient Care and Medical Reviews

By Prime Care Tech Marketing on Thu, Jun 17, 2021 @ 04:10 PM

As outlined by the Centers for Medicare and Medicaid Services (CMS), Complying with Medical Record Documentation Requirements remains critical to senior care success.

Proper documentation:

  • Helps patients get reasonable and necessary items/services
  • Facilitates proper claim payment
  • Supports favorable medical review decisions

Specific to claims reimbursement, CMS identified the top five reasons for errors. Note, two are related to documentation. 

Top-5-cms-claims-errors-primeclaims-snf-revenue-cycle

So, what does insufficient documentation mean?

  • It does NOT mean documentation doesn’t exist.
  • It means something was incomplete or missing at claim submission.

And, what are the consequences of improper documentation?

Improper documentation disrupts the revenue cycle, which results in loss of financial revenue. CMS claim denials also cost your staff time, requiring them to:

  • Complete forms
  • Submit additional documentation
  • Send a letter explaining why the claim should be paid
  • Resubmit claim

Secondarily, if your order for item/service is illegible, your patient care suffers.

What are some tips for improved documentation?

  • Send ALL associated documentation supporting the item/service billed
    • Some information may come from a prior claim or test
    • If you're not sure if certain documentation is required, send it anyway
  • Send the documentation by the deadline indicated in the request
  • Review documentation to make sure it:
    • Answers who, what, when, why, and how
    • Verifies item/service was performed
    • Verifies medical necessity

Where can I get more information regarding CMS claims errors, including documentation?

Lastly, senior care and skilled nursing facilities (SNFs) can greatly simplify claims revenue management by employing a system customized for this industry, and supported by seasoned claims professionals. Get in touch if we can help.

Learn More

Topics: revenue cycle management SNF CMS primeCLAIMS denial management
1 min read

LTC 100: Helping you reinvent your roadmap to success

By Jim Hoey on Thu, Apr 25, 2019 @ 10:26 AM

LTC100 Banner

Prime Care Technologies is pleased again to help sponsor the LTC 100 Leadership Conference. This year’s theme Carpe Diem - Roadmap to Reinvention  reflects the changing LTC landscape and your need to provide quality, value-based outcomes, while also succeeding as a business.

As a 15+ year post-acute technology provider, we know the ropes. Join us to see how we are solving operational pain points with our comprehensive post-acute claims and managed care reimbursement solutions. You'll see how our technologies are evolving with PDPM and Five Star, too. 

If it's easier, pick a time to connect!


 

Topics: cloud computing technologies primeCLAIMS claims processing automation post-acute claims clearinghouse Managed Care MASTER managed care reimbursement managed care software post-acute technology solutions managed care optimization IT strategy LTC 100 Leadership Conference improve patient care
1 min read

Let's talk technology at AHCA/NCAL Spring CEO Conference May 1-3

By Jim Hoey on Tue, Apr 23, 2019 @ 02:08 PM

MultiCEO

We’re heading to AHCA/NCAL 2019 Spring CEO Conference with innovative tech solutions that help post-acute execs prepare for value-based care.

Our new Managed Care MASTER solution is getting rave reviews from customers who are increasing their Managed Care revenue, while decreasing therapy costs and improving outcomes. It’s designed to handle complex level and Medicare RUG/PDPM reimbursement drivers, so your teams can be PDPM-ready by October.

Connect with us to learn more about our suite of applications that can solve your most difficult operational challenges.

Topics: reduce procurement costs automated procurement process primeVIEW primeCLAIMS claims processing automation post-acute claims clearinghouse e-procurement Managed Care MASTER managed care reimbursement managed care software primeVIEW business intelligence dashboard post-acute business intelligence dashboard primeCOMMERCE managed care optimization 2019 AHCA/NCAL Spring CEO Conference
1 min read

Let's connect at OHCA Convention and Expo April 29-May 2

By Rusty Zosel on Mon, Apr 22, 2019 @ 12:11 PM

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I’m excited to once again join my colleagues at Prime Care Technologies in exhibiting at OHCA. Stop by Booths 127 and 129 to discover our latest advances in post-acute technologies. Our experts will demonstrate how we integrate and accelerate data to optimize business intelligence, claims and managed care reimbursement, as well as purchasing automation from Procurement Partners. We have much to share to address your operational pain points, so let's connect over a break!

Topics: primeCLAIMS claims processing automation post-acute claims clearinghouse Managed Care MASTER managed care reimbursement primeVIEW business intelligence dashboard purchasing automation primeCOMMERCE OHCA
1 min read

[Event] 2018 National Investment Center (NIC) Fall Conference

By Prime Care Tech Marketing on Thu, Oct 11, 2018 @ 11:14 AM

Join Jim Hoey, President and CEO, Prime Care Technologies, with executive team members at the NIC Fall Conference October 17-19. As a post-acute technology innovator, we continuously respond to industry trends and requirements to improve operational efficiencies and revenue opportunities. Schedule here for breakfast, lunch or dinner on how we are leading the way!

  • primeCLOUD – Managed IT services that increase security and efficiency
  • primeVIEW – Post-acute performance dashboard that improves operational outcomes
  • primeCOMMERCE – 100% purchasing control and automation that saves you money 
  • primeCLAIMS – Comprehensive claims clearinghouse that provides total visibility and control
  • primeFORCE Resident Telehealth – 24/7 virtual provider networks that elevate quality of care from your facility
  • Managed Care MASTER  – Patient care syncs with payer contracts to optimize managed care reimbursement

We look forward to seeing you in Chicago.

   

 

Topics: centralize purchasing primeCLAIMS primeCLOUD Managed Care MASTER case management for managed care managed care revenue primeVIEW business intelligence dashboard primeFORCE Resident Telehealth purchasing automation managed IT services primeCOMMERCE

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