Market opportunities continue to expand for skilled nursing facilities (SNFs), senior care facilities and long-term care facilities around the U.S. as more and more baby boomers seek residence and care. Yet, increasing numbers of residents means added pressure to meet Medicaid challenges—particularly as Medicaid rules and regulations continually change and evolve.

In order to adequately serve residents and help ensure optimal outcomes while remaining profitable and compliant, it is more important than ever to meet every Medicaid challenge your long-term post-acute care (LTPAC) facility knows about—as well as those you may not be aware of, or don’t fully understand.

Today, more and more LTPACs are turning to outside Medicaid specialists for insights, expertise, training and customized solutions for a variety of Medicaid challenges.

Outside Medicaid Consulting Services – Proactive and Strategic Help With Medicaid Challenges

The Centers for Medicare and Medicaid Services (CMS) requires nursing facilities to be in compliance with the requirements in 42 CFR Part 483, Subpart B, to receive payment under the Medicare or Medicaid programs.

At Richter, our Medicaid Consulting Services specialists have worked with skilled nursing, senior care facilities and long-term care facilities for more than 20 years to implement processes built around Medicaid regulations and train staff on the latest billing and reporting requirements. In our work, we’ve identified four service competencies that every exceptional Medicaid consultant should possess:

• Application and appeals management. Consultants should manage the application process completely; work with the resident or their responsible party; work with the county/caseworkers to ensure timely turnaround; and escalate cases for state hearing when needed.
• Medicaid program education. Experienced and respected Medicaid consultants should help your facility meet Medicaid eligibility requirements under established processes; help you manage pending cases; and provide leadership and direction for Medicaid managed care.
• Adjudication resolution. Consultants should be equipped to perform a comprehensive analysis of the accounts listed on the adjudication order to ensure proper disposition—they will refute the findings with solid documentation and will work closely with state auditors to ensure appropriate repayments are made.
• Program compliance audits. Audits performed by exceptional Medicaid consultants comprise a comprehensive review of the active Medicaid cases at a facility to ensure that documentation is in place to support the facility’s billing—from levels of care to appropriate application of patient resources. The analysis can provide insight into risks for recoupment and help the facility compile the necessary documentation to refute adjudication orders from the state auditors.

Beyond Core Medicaid Consulting Services, Expertise and Industry Involvement Make the Difference

Certainly, the Medicaid consulting specialist you hire for your SNF should offer the four key service competencies we listed above. Yet, Medicaid consulting is a highly specialized field; it takes more than academic study – and even field experience – to deliver the highest level of consulting services. Accordingly, your Medicaid specialist should be an active participant in the Medicaid arena in order to gain the insights and advance knowledge of Medicaid developments—and how that can impact your facility.

At Richter, our Medicaid consultants attend industry events throughout the year, year in and year out, to help ensure we are 100% up-to-date on Medicare rules, regulations, trends and training protocols. Our consultants serve on multiple trade association committees and work closely with key players in county, state and national agencies. You should expect nothing less from the Medicaid consultant you hire to help you meet your facility’s Medicaid challenges.

Consider Intangible Qualities of SNF Medicaid Consultants As Well

Beyond the experience, capabilities and resources that Medicaid consultants offer, there are three essential intangible qualities that you should look for when considering an outside Medicaid consultant for your facility:

• Successful Medicaid consultants should instill confidence and trust by virtue of their experience, demeanor and personal qualities.
• A track record of results. Highly capable consultants have tangibly moved the needle for clients in a variety of LTPAC settings. When evaluating them, be up front in asking about their work on different project scopes, and the results they achieved.
• A willingness to invest in relationship building. Yes, your Medicaid consultants should be laser-focused on addressing the defined work scope; but they should bring a strategic mind-set to the table, be naturally inquisitive, ask questions that give insight on additional areas of potential improvement and show genuine interest in growing the relationship over time.

Contact Richter’s Medicaid Consultants

Do you have questions about hiring a Medicaid consultant for your skilled nursing facility, or other Medicaid challenges? Call Richter’s Medicaid Consulting Specialists at 866-806-0799 to schedule a free consultation.

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