PDPM, the rap. As being danced to at SNF morning meetings everywhere.
Lyrics by Steve Shain, COO LTC Contracting
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Your staff is working hard to ensure smooth admissions and proper care for each patient. The billing department is continuously receiving new claims and is finding it difficult to process them with the constant onslaught of looming deadlines. You have come to terms with the fact that it’s time to hand off some of the workload to a competent new hire or third-party so your receivables team can focus on the current; making sure each patient is receiving the care they need.
However, while you understand that this is an essential step in enabling your facility’s success, how does one go about finding an individual or company qualified enough to handle one of the most integral aspects of your business? After all, the wrong hire can disrupt your entire cash-flow!
As a company that has been working with hundreds of SNFs over the last decade, here at LTC we’ve seen it all. We’ve put together this list of the top three must-haves facility operators should check for when considering handing off a facility’s AR to specialists.
Look for an individual/ company that is familiar with your state and its various regulations/laws. Being that Medicaid rules vary, sometimes very subtly, per state, specialists that are familiar with the nuances and requirements are per region, will not only help things get processed, but may allow for a lower margin of denied claims.
As in every industry, positive and well-rooted relationships are important. An individual or company that has strong relationships with the various insurance companies can help you get better contracts, better timely filing – time allowances for filling a claim and are key when issues arise.
A technologically advanced company that can integrate with your billing software (most billing software doesn’t have the capabilities to track follow-ups properly) and that can properly track day to day workflow will ensure that nothing falls through the cracks and all claims are followed up. And when cleaning up aging AR, proper technology can provide analytics and help pinpoint what caused these claims to fall behind.
Keep this checklist in mind when considering a receivables specialist for your skilled nursing facility to ensure a smooth transition.
LTC Consulting Services is the long term care industry’s premier medical billing service and off-site central business office. LTC’s custom business management packages for health care facilities offers peace of mind while substantially increasing and maximizing their revenues.
Everyday demands on busy accounts receivable departments make it all too easy for collections to fall behind. Here are some tips on minimizing uncollectible receivables:
Insurance companies have very strict rules on timely filing. A best practice is to check a week after submitting a claim to make sure that the claim is on file with the insurance company. After confirming that your claim is on file, make sure to check back on its status within three weeks. This will ensure that none of your claims are denied for “timely filing” issues, and that you catch all denials that need to be corrected. Once a claim has been denied because a payor’s deadline has been missed, a formerly simple recovery can become much more difficult.
If claims don’t get corrected and fixed as soon as you catch them, they will build up month-to-month and your outstanding AR problem will only get worse. You may push it off thinking, “I don’t have time now, I’ll get to it when I can,” but there will always be new work building up.
Dealing with each crisis as it arises won’t solve the problem. A detailed, overall assessment may reveal common causes or systemic issues with a specific payor, process, communication breakdown or inefficiency. Always try to identify why your claims aren’t naturally paying, and try to fix those problems globally so they don’t repeat every month.
At minimum, schedule a monthly review. Regular reporting—and follow-through—is essential to tracking trends over time and solving problems while they are still manageable.
You don’t have to go it alone.
For a full suite of long-term care facility support services, talk to the experts at LTC.