As more advances in technology force those in the Long Term Post-Acute Care (LTPAC) community to adopt, and adapt quickly to use of technological resources, it is important to ensure that your system(s) are not just set up to meet the needs of the provider, but that the system(s) are maintained appropriately and timely.

More and more LTPAC providers are moving into an Electronic Health Record (EHR) platform – integrating census and reimbursement methodology with the clinical record, including Medication Administration Records (MARs) and Treatment Administration Records (TARs), physician orders, therapy and diagnostic vendor records and in some advanced scenarios, interoperability with acute care providers. It is an exciting time, but precarious. With all of these advances the staff of the LTPAC facility has an increasing burden to learn - and utilize – new technological resources.

Implementing a New Electronic Health Record Platform

Prior to implementing a new EHR package, the LTPAC provider must ensure not only that the proper equipment is available, but that staff have the requisite knowledge and skill set to apply to the process.

For example, when considering the abilities of the Business Office:

• Can staff outline the appropriate process for census maintenance?
• Can staff detail the payer methodologies for room and board and ancillary services?
• Are there outliers, or carve outs for exclusions?
• Does staff understand the relationship between standard charges and contractual allowances?
• Does staff know the impact of Accounts Receivable (AR) on the General Ledger (GL)?
• Do they know the difference between revenue and AR?
• Is staff currently performing month end reconciliations or other revenue tests before closing the AR for the month?
• Is staff well versed in Medicare regulation? Are they knowledgeable enough to detail the information on a claim form?
• Does staff have a standard process for each function performed starting with resident admission through collection?
• Does staff participate in ongoing education on the topics of compliance and payer requirements?

It is important not to take the above for granted. Many implementations have been derailed simply due to the fact that the financial staff does not understand the requirements of their position. Many are performing functions in a way that was originally taught to them – without understanding the whys or wherefores, or the impact. It is the “way we have always done it”.  This of course, does not necessarily mean that it is the way it should be done.

Another factor to consider in the pre-implementation planning is who will be responsible for the system maintenance. Once the conversion is complete, there will be a need for ongoing configuration updates such as:

• Payer Rate updates (annually, bi-annually, quarterly)
• Changes in payer requirements (Levels vs RUGs, revenue code changes, service detail, etc.)
• Fee Schedule updates
• New payers, or sun-setting others
• Charge code maintenance for new services, contractual or bad debt adjustments
• Additions or changes to the Chart of Accounts
• Updates to the flow of clinical information into the financial record
• Software provider enhancements and updates to accommodate the changing regulatory requirements

Setup of the software system is a key to appropriate revenue recognition, and bad setup or upkeep of the system drastically impacts the business office’s ability to complete claim denial management and collection of AR. If staff has to continually adjust balances, or create workarounds to complete a function because the system setup is incorrect, then there is an increased margin of error in the AR and less and less time for actual follow up. In other words, they would be setup to fail.