Ever receive a bill you didn’t quite understand? Was it more than you anticipated, or list charges of which you had no prior knowledge? Did that bill get paid right away, or did it go into a bottomless stack of papers or a list of to-dos? As consumers, we are more inclined to pay a bill on time when it is accurate and we have agreed upon the terms upfront. The same could be said for health insurance payers when they receive reimbursement claims from providers.
For a skilled nursing provider, any billing confusion that results in payment delays or non-payment can have a tremendous impact on the entire revenue cycle. When patients understand their copays, deductibles and coverage before services are rendered, there are fewer surprises and increased patient satisfaction. When payers receive claims that are free of errors, providers are more likely to be reimbursed on time and in full. The process of checking a patient’s insurance is payer verification, and it is the first—and most critical—step in a skilled nursing facility’s revenue cycle.
How can your skilled nursing facility prevent verification errors from impacting revenue?
When insurance information is verified upfront at the time of service, providers are in a better position to estimate a patient’s financial responsibilities. To verify existing coverage, the business office manager or admissions staff will collect the patient’s demographic and insurance information. This information is plugged into the PointClickCare® (or another platform) eligibility platform, and a result will indicate in real-time the effective date of coverage and details about their plan. The provider’s reimbursement on future claims depends on the accuracy of information at this critical step.
Some individuals may have more than one active health insurance policy. Admissions staff should always confirm whether there is a secondary payer. This could include a Medicare supplement or coverage under the spouse. Documenting this information will help ensure the appropriate parties are billed, and that the provider is reimbursed at the highest rate possible.
Payer eligibility must be verified during initial admissions and for patient returns, as skilled nursing facilities have unique eligibility requirements that must be followed to receive reimbursement from The Centers for Medicare & Medicaid Services (CMS). Different payers have different requirements, which will impact the way a patient’s clinical paperwork is treated. Medicaid patients require an MDS admission assessment, and providers have 14 days to complete it. However, the MDS assessment process is different for Medicare beneficiaries. Medicare beneficiaries must be actively enrolled, have benefit days available, and meet the 3-day qualifying hospital stay requirement. If any one of these requirements are not met, the patient may be considered ineligible and the provider will not be reimbursed. Managed care beneficiaries must be enrolled and providers must receive a prior authorization for treatment to be covered.
If a patient experiences a change in status, certain actions must follow to avoid payment delays and denials. If a Medicare Advantage patient elects hospice, for example, the patient reverts to the traditional Medicare plan. This payer change must be reflected in the system for billing purposes, and a clinical assessment must be completed to meet reimbursement requirements under the new plan.
Administrative staff at skilled nursing facilities have a lot on their plate at any given moment, and any manual process increases the chances of errors or omissions. PointClickCare® users can easily (for a nominal fee) take advantage of the eligibility verification tool, which provides real-time validation of patient insurance information. Not only does this tool verify coverage at initial admissions; it will identify changes in a patient’s eligibility status and alert users through a report available on the dashboard. This report should be run and reviewed monthly at minimum, so that any denied, failed or errors in eligibility can be identified and resolved in a more expedient manner.
While technology can eliminate much of the guesswork and tedious data entry, providers must also prioritize open communication between departments. When communication between clinical and administrative staff breaks down, changes in patient status can become overlooked, and billing errors become imminent. To bridge the communication gap, many skilled nursing providers utilize a daily (usually morning) team meeting, which can be conducted in as little as 15 minutes. The agenda for this meeting should include changes to a patient’s payer, as well as updates on new admissions, discharges and hospice elections.
Admitting and treating a patient without proof of insurance is a risky move for any skilled nursing provider. The revenue leakage that will inevitably result will have a trickle-down effect on the entire facility, impacting cash flow, staffing, reputation and more.
Implementing a verification process that includes these six elements will help eliminate billing errors, payment delays, denials, and non-compliance. To learn more about how to prevent verification errors and optimize revenue in your skilled nursing facility, request a free consultation here.
A business office manager in a skilled nursing facility wears many hats, and should therefore be competent in a variety of skills including administrative/customer service, accounting, compliance, and multitasking so much more. Below we break down these four broad skills that are essential for a healthcare business office manager:
Essential Skills for a Skilled Nursing Facility Business Office Manager
Customer Service
Many skilled nursing business office managers are responsible for managing the phone lines and assisting everyone who comes through the door—and it is those interactions that set the tone for the entire facility. Any unpleasant experience can cause residents and/or their family members to be dissatisfied, which could easily result in losing their business. Excellent customer service should always be a priority, but this is especially true for front line leadership positions such as the business office manager. Understanding the needs of the resident and effective communication are imperative.
Accounting
Billing and collection are complex tasks that require knowledge of your systems, insurance payer contracts, regulatory guidelines, billing codes, denial trends and more. In facilities where the primary skilled nursing business office manager is responsible for billing, they must work to ensure charges, claims and statements are accurate, or reimbursement will be delayed or forfeited. They must pursue and correct denials in a timely manner, or significant revenue will be lost. Business office managers may also oversee resident trust funds, which is highly regulated and should be properly handled with safeguards to protect against theft and fraud.
Compliance
Ongoing changes in healthcare laws and regulation means that providers need someone focused on policies, procedures, auditing and monitoring. Providers are constantly faced with new risks, and any kind of misconduct can result in fines or penalties. Skilled nursing business office managers are an important party of the interdisciplinary team, and need to employ training and best practices to minimize risks.
Multitasking
With so many responsibilities to balance, a skilled nursing business office manager must learn to adapt to the demands and priorities for the day. In one moment, they may be assisting a resident with their Medicaid eligibility paperwork, and the next addressing a complaint or preparing an insurance claim. Interruptions throughout their day should be expected, yet they must remain organized, flexible and focused on efficiency.
As if recruiting candidates for this office-based administrative position was not challenging enough, a business office manager must also have knowledge of the skilled nursing industry, insurance payers and government regulations—all of which must be learned in time. This combination of skill and industry experience is unique, which is why so many providers continually struggle to hire and retain the right talent.
Luckily, there is a solution.
Enhancing Outcomes with Richter
A skilled nursing business office manager plays an integral role in an organization’s ability to thrive financially. When they are inexperienced or feel unsupported, the effects will be felt companywide. As the industry’s leading skilled nursing and long-term care consultants, Richter can deliver customized solutions to help you achieve your goals. Whether you are in the market for a new business office manager or seek to further educate your staff, our team of professionals are here to assist.
To learn more about comprehensive solutions for skilled nursing facilities, contact us here or call us at 866.806.0799.
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