What's top of mind for senior care operators in Ohio this year? Working smarter to achieve desired outcomes. And technology can help. As we illustrate in the infographic below, our customized software for senior care – primeVIEW and primeCLAIMS – can help with the top five priorities discussed at OHCA.
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As outlined by the Centers for Medicare and Medicaid Services (CMS), Complying with Medical Record Documentation Requirements remains critical to senior care success.
- 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.
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?
- 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?
- Complying with Medical Record Documentation Requirements
- Complying with Medicare Signature Requirements
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.
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We're heading to CAHF Annual Convention and Expo to showcase technologies that will help improve your operational and quality outcomes in 2019. Stop by Booth 1004 to see our advances in revenue cycle management, SNF business intelligence and managed care optimization.
Join Susie Mix, President/CEO of Mix Solutions and our partner in the development of our Managed Care MASTER application, will present Making the Most of Your Managed Care Contracting on Tuesday, November 13, at 10:00 a.m.
Schedule a meal or meeting with us to talk about 2019 game changers!
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Prime Care Technologies is heading to the NIC Spring Investment Forum March 7-9 to meet with skilled nursing operators, care coordinators, financial leaders and other healthcare professionals who are looking to improve outcomes and reduce costs in post-acute and long-term care.
Our exec team will be onsite to provide expertise and discuss best practice strategies through technology solutions such as primeCLAIMS and primeVIEW – each designed specifically for the LTPAC environment. We look forward to hearing specifically what is top of mind for your organization in 2018 and how investment in the right technology can change the game.
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Join us for Prime Care Technologies' August 2-3 Virtual Tradeshow. This show features seven strategic sessions with top post-acute providers and vendors who will discuss highly-efficient solutions for meeting your operational demands in purchasing, regulatory, staffing, revenue, claims and more.
Wednesday, August 2
10:30-11:30 a.m. ET
Executive Decision-Making: Leveraging Facility Data as Business Intelligence
Speaker: Kim Sonderegger, Pinnacle Quality Insight
Panel: Samantha Broussard, Plantation Management; Eric Rivard, Plum Healthcare Group, Cheryl Field, Prime Care Technologies
12:30-1:30 p.m. ET
E-Procurement: Innovative Management of Healthcare Spend
Speaker: Jessica Spencer, Medline Industries
Panel: Pam Mink, Foundation Health Services and Rusty Zosel, Procurement Partners
2-3 p.m. ET
CMS Requirements for Participation: Need-to-Know Compliance Tips for Long-Term Care
Speakers: Clifton Porter, AHCA; Clint Maun, Maun-Lemke, LLC
Panel: Cheryl Field, Prime Care Technologies
Thursday, August 4
10:30-11:30 a.m. ET
Revenue Cycle Management; Cash is King
Speaker: Clint Maun, Maun-Lemke, LLC
Panel: Becky Yocum, American Healthcare, Patti Bolen, Southern HealthCare Management and Kimberly Sturm, Prime Care Technologies
Cybersecurity: Protecting Your Critical Points of Access
Speaker: Fred Layfield, Prime Care Technologies
Panel: Jim Hoey, Prime Care Technologies
2-3 p.m ET
Attracting and Retaining Staff in a Competitive Market
Speaker: Lisa Thomson, Pathway Health
Panel: Diane Harrison, Magnolia Manor; Barbara Wilkins, Kindred Care/Rehab-Greenbriar; Joe Stone, Prime Care Technologies
3-4 p.m. ET
Healthcare Risk Management: Employee Safety Practices to Prevent Liability
Speaker: David Mathog, USI Insurance Services
Panel: Joe Stone, Prime Care Technologies