A critical component of Revenue collection is the initial discussion of payment terms with residents and their family members at the time of admission to your SNF/AL/CCRC. For many people, discussions about financial issues are considered "private" and reserved for relationships of trust with other family members or advisors such as bankers, attorneys, etc. Certainly not a topic to be discussed with strangers. However, all continuing care providers need to initiate a discussion regarding payment in order to help ensure that the expectations are clear for both the resident/family and the provider.

Try to have financial conversations in person when possible, finding a quiet space free of interruptions and distractions. Be sensitive to the perception of residents and family members who are tentative and may perceive the inquiry/admissions process intrusive and uncomfortable. The goal is to position your community as having a desire to offer a service to the resident by helping to discern any programs or benefits for which the resident may qualify. Communicate the message that you want to help ensure that the resident will be able to receive any benefits available. Follow these guidelines for discussions by pay type:

Private Pay

• Private Pay charges for room and board are billed thirty (30) days in advance. Charges such as beauty shop, laundry, pharmacy, therapy, etc. are billed after the services are provided.
• A payment for the number of days remaining in the current month is expected at the time of admission
• Statements are mailed by the 25th of each month and are due by the 5th business day of the next month.

Medicare

• Medicare is a federal insurance program. There are guidelines for provision of Medicare in a skilled nursing facility. Part A covers in-patient care such following a qualifying hospital stay. Part B covers charges for therapies, physician care, some supplies, etc. (Facility staff can provide a guide from the www.cms.gov website to better explain Part A & B coverage. Be specific about the expectation for the resident as to the current stay and whether or not it is expected to be a Part A stay or not. Be sure to review any co-insurance expectations.)
• Statements for any Medicare charges under Part B as well as Co-insurance charges will be billed on the 25th of each month. Payment is expected by the 5th business day of the following month.

Medicaid

• Residents who have Medicaid coverage may have a Personal Liability amount that is due to the facility each month. That amount is determined by the local Medicaid Office. If that amount has not yet been determined, the state agency should have a worksheet that allows the facility to estimate the amount that will be owed to the facility each month as "Personal Liability."
• Personal Liability charges will be billed in a statement sent on the 25th of each month. Payment is due by the 5th business day of the following month.
• Medicaid applications that have not yet been approved/denied are considered "pending." They are billed as Private Pay.
• The facility may work with the resident to request to be named Rep(resentative) Payee to receive the monthly Social Security check. That check will be deposited into a Resident Trust Fund account. The resident may retain the amount of money allowed for personal use by the state in which the facility is located. Typically this amount is $45-70 per month.
• If the facility is located in a state that required Medicaid Managed Care for Medicaid recipients, you will need to provide the information about the options available if the resident has not already made a choice.

Managed Care/Private Insurance

• The facility will bill the Managed Care/Private Insurance on behalf of the resident for care and services provided. There is no guarantee that the managed care/private insurance carrier will pay for that care. The facility will honor the requirements for notification, certification and/or authorizations to the carrier.
• There may be a coinsurance by the insurance carrier that is the responsibility of the resident.

LTC Insurance

• The facility does not bill LTC insurance companies directly. The resident's charges for care will be billed privately. There is no guarantee that the LTC company will pay for services rendered. The facility will be happy to provide additional copies of the monthly statement and assist in providing any necessary support for review of the charges by the LTC insurance carrier.
• Statements for room and board are billed in advance. Charges such as beauty shop, laundry, pharmacy, therapy, etc. are billed after the services are provided.
• Statements are mailed by the 25th of each month and are due by the 5th business day of the next month.

It is most helpful to residents and family members if information regarding community payment terms is in writing, perhaps in a Welcome packet or handout during the admissions process. The facility may find it helpful to include a copy of a blank statement so that it can be reviewed as part of the admission paperwork process. Information about Resident Banking services, the Resident Trust account, payment via credit card or ACH should also be included in the Welcome packet or discussion.

Lastly, it is very important that the resident/family member view the facility Business Office as friendly and accessible. The hours of the Business office should be posted and scheduled to accommodate some evening and weekend hours, if only on alternating days. Business office staff should work closely with the Admissions and Social Service staff to invite questions about payment sources such as Medicare, Medicaid, etc. and to schedule Family Nights to offer presentations on the particulars. Staff should offer to assist families in completing forms, making copies, etc. If possible, staff should be available to accompany or represent residents in the Medicaid application process. Each month that a Medicaid application continues to remain in "pending" status, the facility does not collect payment. If the volume of Medicaid pending cases escalates, there can be a negative impact on cash flow for the operations of the facility.

While the topic of payment may be a sensitive one for staff and resident/family alike, it is a topic that must be brought forward as part of the admission to a SNF/AL. Education regarding payment options may help to alleviate most concerns and dispel any myths or misinformation. Staff who are supportive, accessible and willing to be supportive to the resident/family will open the lines of communication and use that beginning relationship as a foundation for continued communication and cooperation regarding payment issues going forward during the stay and beyond.

Discuss: How do you get the conversation started at your center? Share your best practices with us via the blog. Need more hints on getting the conversation started? Contact This email address is being protected from spambots. You need JavaScript enabled to view it. for a few scripted conversation starters.