Long-term care insurance has been available for over thirty years. It is becoming increasingly popular for persons to purchase long-term care insurance as they begin to prepare for their potential care needs in the future. Typically, Long-Term Care insurance is attractive to those with assets over $50,000. Those with assets less than $50,000 would generally spend those assets quickly should a medical need arise and potentially qualify for Medicaid.
It’s that time of year again….time to update patient insurance information.
Lack of accurate insurance information is always a challenge but particularly as we begin a new year. Patients may change insurance carriers at the end of one year in preparation for the next. They often neglect to inform their Hospice or Home Health provider of these changes. In order to help ensure that the billing process is accurate and timely, it is critical that insurance information be correct.
Topics: Home Health & Hospice
DSO is an acronym for Days Sales Outstanding. A DSO is a measure of accounts receivable compared to sales. It is also a measure of the performance of the Revenue Cycle process for a healthcare organization. It is considered part of the KPI or Key Performance Indicators that are reviewed on a monthly basis by management. In long term care, administrators and managers often have enough on their plate and can’t be involved in the day to day operations of the accounts receivable side. That area is left to the business office or billing firm. But administrators, owners and managers need to be confident that their business office is fulfilling their responsibilities and the quickest way to do this is to start with the DSO.
Medicaid is a Federal program that provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. 64 million people are covered, including 4.3 million newly eligible adults, according to the 2015 CMS Actuarial Report Average Enrolled.
Topics: Medicaid Consulting
With an increase in the number of ADRs and medical reviews, it is important for agencies to understand how documentation that is submitted is reviewed.
Topics: Home Health & Hospice
The most important account to reconcile is the cash account. The amount of cash on the “books” should be consistent with the monthly bank statement balance. The Cash Flow statement should always be updated once the bank reconciliation is complete. Cash Flow problems are not fun, you never want cash to be understated or overstated when trying to prepare for the next check run. Bank Statements are prepared and issued the week after the month ends; it is good to start them as soon as received to allow ample time for research on any unknown items.
Corporate Compliance. If you work in healthcare, you have most likely heard the words. Set in a statute as a part of the Patient Protection and Affordable Care Act (ACA) as a condition of Medicare and Medicaid provider enrollment, Sections 6102 and 6401 of the ACA mandate that skilled nursing facilities (SNF), as well as other healthcare providers, adopt Corporate Compliance standards by March 23, 2013.
Patients electing the Hospice benefit can reside at any location, as long as it is a safe environment for the patient and hospice caregiver and within the hospice agency service coverage area. If the patient is located in a Long Term Care (LTC) facility, a written agreement is required between the hospice agency and the LTC facility before services are provided.
Physicians have always been known for having the absolute worst handwriting. Although often the subject of jokes, the illegible scribble of a physician can have dire consequences on the life of a patient if orders or prescription dosages are misread, and on an agency’s revenue if claims are denied as a result of an illegible signature. Medicare has adopted precise guidelines on what are acceptable and unacceptable signatures on medical records and documents. Failure to follow these guidelines can lead to claims being denied and payment recoupment.
Effective October 1, 2016, Skilled Nursing Facilities (SNF) are required to submit additional functional and quality measure data via patient assessments to the Centers for Medicare and Medicaid Services (CMS). This information will be gathered from the revised Minimum Data Set (MDS) 3.0 Section A and a new Section GG. Along with these revisions, a new MDS assessment type of an SNF Medicare Part A PPS discharge assessment for when a Medicare Part A stay ends, will be implemented.
An ADR (Additional Development Request) is a request for medical documentation to ensure proper payment for Medicare services provided. Claims are randomly selected based on specific edits and parameters set by the Medicare Contractors. This documentation must be received on or before the 45-day due date. Failure to do so will result in denial code 56900 which indicates documentation was not received or was not received in a timely manner.
The newest update from the Centers for Medicare and Medicaid Services (CMS) was just released in August and I want to share some specifics about the upcoming changes to the Resident Assessment Instrument (RAI) Manual. The RAI Manual changes are effective for October 1, 2016. Most of us have heard about the new section GG, but there are some other notable changes as well: