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.

If you would like to learn more about our primeVIEW and primeCLAIMS SaaS applications, get in touch for a demo or 30-minute consult. 

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. 

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?

• 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.

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.