Symphony Care Network
increases revenue $1,200/stay

Symphony Care Network

Among the most innovative post-acute providers with over 40 years of experience, Symphony provides high-quality care to multiple locations across Illinois, Indiana, and Michigan.

Challenges

Like many operators today, Symphony wanted to meet the needs of managed care residents while capturing accurate reimbursement. Relying on internal paper-based processes, Symphony’s centralized case managers were spending too much time tracking down updates from its 25 locations.

• Understanding the differences between each state’s managed care partners and contracts was complicated, resulting in unintentional errors and missed revenue opportunities.
• Facility care teams/operators did not understand the managed care contracts, processes, and requirements.
• Concurrent reviews were frequently difficult to read due to messy handwriting and needing to be faxed multiple times.

Symphony used other solutions to maximize revenue, but data was not timely, impacting their ability to act on level adjustments and carve-outs. These systems also did not address the rift between the centralized case management department and facility interdisciplinary teams.

When they searched again, Symphony found Managed Care Master (MCM) from Prime Care Technologies. They saw it as a solution to help navigate contracts and reimbursement and increase transparency across the organization related to managed care.

How We Helped

One of the best advantages was the concurrent review updates generated by Managed Care MASTER. The standardized concurrent review forms combined with the data pulled from electronic medical records enabled Symphony to produce more accurate and legible updates for managed care partners. This eliminated faxes, as well as calls/emails back and forth to clarify handwritten notes. 

"With web-based data at our fingertips, we process updates during morning meetings, which can save up to 30 minutes per update." 

– Erica Mason, MSW, LSW, VP Managed Care

Additionally, Managed Care MASTER's contract integration and patient stay data for real-time alerts and reports took away the need for manual reporting and additional spreadsheets. This created transparency between the centralized case management team and the facility teams/operators, enabling all to quickly and accurately view the authorized levels and the contracted care requirements. 

"Managed Care MASTER's daily alerts to the case management team also identified opportunities for level increases and carve-outs, as well as differences in approved HIPPS codes versus MDS. This reduced the number of retrospective audits and claims corrections."

Beyond time saved, Symphony improved communications through the MCM reviews, enabling them to demonstrate the need for continued stay, continue to meet managed care quality standards, and remain high-performing providers. 

“We also input information on the pre-admission side to check for managed care patients and authorizations going into the tool. Case managers are alerted for the coverage and high-cost medications, which also makes a big difference in terms of quality of updates.”

Results

• Consolidated real-time EHR data with clinical data into a single solution
• Improved census and length of stay with timely electronic updates
• Reduced staff time by 30 minutes per update
• Increased daily revenue by $100/day via therapy alerts.
• Increased managed care revenue by an average of $1,200/stay
  
  

“Our staff was worried about a new learning curve and were skeptical that the software would actually save time. But, Prime Care Technologies’ collaboration has been great and they now find their jobs much easier.”