Revenue cycle management (RCM) lies at the heart of a long-term post-acute care (LTPAC) provider’s operation. Without the proper processes in place, cash flow slows down, bad debt increases and customer satisfaction declines. So how can your LTPAC organization optimize its RCM function? We recommend starting with the five strategies outlined below.
Since the inception of the Medicare program in 1965, beneficiaries have been identified by a Social Security number-based identifier known as the Health Insurance Claim (HIC) number. This unique identifier has been used to determine the beneficiary for all Medicare transactions such as eligibility, billing and claim status inquiries.As a means to help fight identity theft, The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires the Centers for Medicare and Medicaid Services (CMS) to remove the beneficiary’s Social Security number from all Medicare cards by April 2019 and replace it with an identifier that will help to secure the integrity of the beneficiary health data. This new number will be known as the Medicare Beneficiary Identifier (MBI).
With reimbursement rates and profit margins shrinking and unfunded mandates and regulations increasing, home health agencies must look for ways to diversify services all while increasing revenue. One home health service that agencies can offer is home health outpatient therapy, despite it not always being provided in a clinic, hospital or private practice.
Topics: Home Health & Hospice
For long-term post-acute care (LTPAC) providers, budget season is here! In fact, most organizations are already in the midst of finalizing their numbers for approval in the upcoming year.
Every industry approaches budgeting differently, but when it comes to long-term care, there are certain areas that require special attention. The most frequent budget-related questions I receive from clients have to do with comparisons between actual expenses and what was originally projected. There are certain areas that seem simple, but if they are missed can cause frustrations and large variances when the time period comes.
To some in the skilled nursing facility (SNF) arena, documentation can seem unnecessary and overly time consuming. However, when documentation isn’t completed, there is no proof that what happened, happened. In SNF settings, documenting resident care is required from not only the licensed staff, but also nurse assistants.
On January 1, 2015, the Centers for Medicare & Medicaid Services (CMS) required home health agencies (HHAs) to obtain documentation from the certifying physician's and/or the acute/post-acute care facility's medical record for the patient. This served as the basis for the certification and eliminated the face-to-face encounter narrative as part of the certification of patient eligibility for the benefit.
Did you know that in 2016, 20% of Medicare residents are hospitalized within 30 days of discharge? Nearly 90% of these hospitalizations were classified as unplanned. Early identification of a resident’s change in condition is paramount to managing and preventing unnecessary transfers. The eINTERACT™ program is a PointClickCare® module that was developed to help decrease hospital readmissions and improve quality of care. It consists of several parts including:
The Level of Care (LOC) in the PointClickCare® Census and Rates resident tab is used for the management of No Pay and Exhaust claim billing for residents, after a Medicare Part A skilled stay. The LOC has no other function but to drive this process. Skilled Nursing Facilities (SNFs) are required to submit claims to Medicare for residents to report the benefit period even though no benefits may be payable. The Centers for Medicare & Medicaid Services (CMS) maintains a record of all inpatient services for each beneficiary, whether those services are covered by Medicare or not.