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5 Tricks to Stay Ahead of the LTPAC Reimbursement Curve

Posted by Bobbie Tiedt Donohew, Associate Director of Consulting Services on May 5, 2016 11:46:48 AM
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Topics: Clinical Consulting

medicaid-application.jpgWork as a trainer has some inherent obstacles – especially when that training is done remotely via an online meeting center. The first challenge, of course, is that it’s hard to capture and keep the attention of trainees without them being able to see me move about or wave my arms to indicate the importance of a significant piece of Medicare compliance. Then, there is the chance that the trainee may have limited or outdated computer experience – or just may be new to the job or industry.

Believe it or not, in 2016 when such a huge part of our population is seemingly glued to their mobile devices and other techie gadgets, I still encounter some folks who have been in the LTPAC business for a very long time and have somehow stayed below the radar of gaining technical experience!  My coworkers chuckle in the background as they hear me say “find the big long white box at the top of the screen, that’s where you type in a web address” or my personal favorite “click on the button in the top left hand side of your screen… (pause)...no, your other left”.

Embrace Technology and Change in LTPAC

I’m not sure why, but many folks have a fear of personal “system upgrade” – learning to use new tools or making the commitment to keep up to date on industry requirements and legislation. This knowledge and skill deficit becomes really apparent when I am asked to add a value code to someone’s software that CMS discontinued 5 years ago. Or when I try to discuss electronic claims submission with a client and they tell me that they’ve always billed on paper. When I ask why, when there are so many electronic options to be used the response is usually the very scary phrase “We’ve always done it that way!”

On March 23, 2010 President Obama signed the Patient Protection and Affordable Care Act (ACA) into legislation. The ACA has changed and will continue to change the face of LTPAC reimbursement for the foreseeable future. Now more than ever, every single worker in the LTPAC field needs to stop saying “we’ve always done it that way” and embrace as much new technology and industry knowledge as possible! Face it – the one constant in LTPAC now is that the changes are coming at us swiftly!

Here are 5 new tricks that you can learn today to keep yourself relevant in our ever-changing reimbursement world:

  1. Learn what “Innovation” means in CMS terms. Learn as much as you can about the different “Innovation” models that are currently open for enrollment in your region. Has your facility applied to participate in one of the models available in your area?  
  2. Learn about “Partnerships”. Have you approached your local hospital and asked to partner with them in a Bundled reimbursement model?  Have they gone to your neighbors instead of you to begin that valuable partnership?
  3. Learn about the OIG 2016 Work Plan. Identify their focus and how it pertains to your billing. Are bad billing practices putting your organization in jeopardy for audits or recoupments?  Be able to name all the government agencies that are data mining and studying your paid claims and the focus that each and every one of them has.
  4. Learn what “Accountability” means as it pertains to the Affordable Care Act (ACA). Facilities that learn how to effectively manage their costs while still providing excellent patient care are those who will rise to the top of the list for preferred partnerships with hospitals and other LTPAC providers.
  5. Don’t check your claims once before billing…TRIPLE CHECK them!  Whether you are mailing a claim or sending it to a provider electronically, you are attesting to the fact that your data is compliant with all current billing guidelines.

Set 15 minutes aside each and every day to read…study…research every new topic regarding LTPAC billing and compliance and how it is going to – and it surely will – affect your job. You can’t afford not to!!!


Need help keeping up with technology and change in the LTPAC industry? Contact Richter Healthcare Consultants to request a free consultation to learn how we can help.