3 Common Healthcare Admissions Mistakes

 

These 3 Common Healthcare Admissions Mistakes May Be Occurring Daily in Your Skilled Nursing Facility:

 

1. “Skilled” Patients Being Admitted as “Custodial” Following a Hospital Stay

 

When the hospital needs to authorize the return of a previous resident of your facility, you may feel that you should do whatever it takes to allow the patient to return. After all, your facility has been his/her home for the past few months (or years) and it is where he/she has been most comfortable. However, it’s imperative to check your facility’s HMO contract prior to admitting anyone, even a long-term resident of your facility, to ensure that it includes a “skilled” benefit.

If the patient is classified as needing “skilled” treatment, you cannot admit him/her on a Custodial plan, regardless of whether you may plan to provide the “skilled” level of treatment.

As per CMS regulations, billing someone under a level different than what they are actually receiving (whether higher or lower) is illegal. If you don’t have the “skilled” contract, you will have to refuse the admission.

 

2. Rejecting Admissions Unnecessarily: High-Cost Admissions Can Still be Profitable

 

You want to admit as many referrals as you can and fill your facility’s beds; but many times, the projected expenses of the patient’s care seem to outweigh your room and board rate. You may feel that it will be more profitable to deny an admission based on high cost needs, be it  expensive drugs or wound therapy.

However, it’s important to do due diligence before denying any admission. Research each case and never take the numbers at face value. Are there carve-outs you can utilize to offset some of the high expenses? Does your contract with this specific payer allow for any exclusions for high-cost drugs or lab? Pre-negotiating good contracts with each payer that include the common carve-outs and exclusions will allow you to accept even high-expense patients.

 

3. Mistaking an HMO Community Medicaid Admission with an HMO MLTSS Admission (Even if they are both Long Term)

 

Be on the lookout for Community Medicaid admissions, as you’ll need to be prepared to stay on top of many aspects of the patient’s billing process. Many times, a facility will automatically admit a Medicaid member and make the mistake of assuming they can easily obtain an authorization, as with an MLTSS member. The authorization process for Community Medicaid is a bit more time consuming .

You’ll also need to make sure your facility is contracted properly with the payer for Community Medicaid as opposed to LTC Medicaid. And of course, make sure you have a plan in action to move the patient to a Long-Term product so there will be no lapse in coverage.

 

A substantial percentage of admission mistakes are potentially avoidable. Being aware of these small details can go a long way in increasing your daily census and overall reimbursement.

 

LTC Contracting’s specialists are trained to assist your newly acquired SNF in obtaining and negotiating a favorable deal with the insurance company, whether it be a Commercial, Managed Medicare, or Managed Medicaid plan. For a professional review of the Medicaid/Medicare billing options for your newly acquired SNF and for any other related information, contact us at LTC.  

What you need to know about the 02/01/2020 NY MLTC changes for Skilled Nursing Facilities.

Hey Everyone!

I want to let you know that we are so proud of our New York skilled nursing facilities! Amazing what you guys pulled off!

If everybody is not familiar, in New York there’s a safety rule – “If you see something say something” – and that’s exactly what New Yorkers did in skilled nursing facilities.

They said that it doesn’t make sense for MLTC’s to be required to cover long-term patients in a skilled nursing facility, so they pushed back. The skilled nursing facilities pushed back, the associations in New York pushed back, and they got what they wanted.

As of February 1st, there is no longer going to be a requirement for MLTC’s to cover a patient that is long-term in a skilled nursing facility in New York.

How is that going to affect you? In three ways.

Before I get to that, I want to give a quick thank you to Jacob Friedman for giving me this information so clearly and understanding how it affects every facility in New York.

So the 3 scenarios are if somebody is already in a skilled nursing facility for 90 days, that is enough determination that they’re going to be long term, and therefore as of February 1 they will move to Medicaid fee-for-service.

So, if you’re familiar with epaces, that means they’ll be moving from an N to an NH on New York Medicaid.

If somebody is in a skilled nursing facility under a MLTC, but have not been there yet for 90 days, they will remain under the MLTC for the 90 day period and then move over to Medicaid fee-for-service at that point.

The last category is someone who is applying for long-term Medicaid. Once they’re determined to be eligible for Medicaid and determined that they are long-term, will move directly onto Medicaid fee-for-service not even getting enrolled in a MLTC at all.

So this is a major change for New York and it’s really exciting!

And for my Illinois friends, yes, you guys pulled off months ago that the managed Medicaid do not require the authorizations, but you’re still working with the managed Medicaid.

It’s exciting to see in New York that the managed Medicaid for long-term skilled nursing facility is completely going away!

So, if I gave an example, I would say that New York is kinda like quitting smoking cold turkey while Illinois is still vaping. You guys are still kind of hooked but hopefully you’ll get there and hopefully all states will get there soon. And as the industry shifts of course everyone is shifting along with that.

If anybody has any questions for New York facilities about how this is going affect your facility and how this is going to affect your case management, your staff, and your contracting, feel free to reach out to me.

I’d be happy to answer your questions and help out.

Have a great day!

Steve Shain
steves@ltccontracting.com
732-961-8466

LTC Contacting
www.ltccontracting.com
Contract Smoothly!
Contracting • Case Management • CHOW’s

How a SNF Change of Ownership Affects Medicare/Medicaid Billing

Image by <a href="https://pixabay.com/users/Capri23auto-1767157/?utm_source=link-attribution&utm_medium=referral&utm_campaign=image&utm_content=3100563">Capri23auto</a> from <a href="https://pixabay.com/?utm_source=link-attribution&utm_medium=referral&utm_campaign=image&utm_content=3100563">Pixabay</a>How a SNF Change of Ownership Affects Medicare/Medicaid Billing

 

You recently acquired a skilled nursing home where rehab and/or nursing services are provided. Here’s what you need to know about how this will affect your reimbursement with Medicare and Medicaid during Change of Ownership (CHOW).

Nursing homes that recently changed SNF management should be aware that it will take some time following the acquisition before becoming certified and approved to begin billing for the services it provides. While the delay can prove quite problematic for cash flow, certain states may allow a viable solution that a new skilled nursing facility owner should be informed about.

The answer for you may be including a provision in the operations transfer agreement that allows the provider to bill and get reimbursed through the seller in the crucial first few months of operation.

Does Your State Allow Billing through the Seller?

Prior to negotiating a contract with the seller about billing facilitation, it’s important to understand that rates often change and the varying state laws about Medicare and Medicaid billing can be complicated.

LTC Contracting provides the following summary highlighting the different billing allowances in the 9 key states we deal with.

  • New York allows a SNF to bill through the seller.
  • New Jersey does allow billing through the seller for fee-for-service, however, most of the MLTSS MCOs will only provide a new contract once you are certified with Medicaid.
  • Maryland, Connecticut and Pennsylvania do not allow billing through the seller.
  • Massachusetts does not allow seller billing, nor does it allow you to apply for a Medicare number until you are approved.
  • Georgia requires you to be approved prior to applying for a Medicare billing number, but you can bill through the seller.
  • Wisconsin does not allow billing through the seller; however, you can bill Medicare before Medicaid is approved and then tie it in once you have been certified.
  • Florida does not allow billing through the seller and approval is a long process, often up to 9 months. Moreover, the HMO utilizes its own agreement based on rate changes that generally go into effect after a sale, prompting many new SNF owners to forgo the seller billing process and swallow losses to circumvent the snags involved in the aftermath of lower rate adjustments.

LTC Contracting’s specialists are trained to assist your newly acquired SNF in obtaining and negotiating a favorable deal with the insurance company, whether it be a Commercial, Managed Medicare, or Managed Medicaid plan. Constantly keeping abreast of changing state laws, we are experienced in helping you navigate and procure a reasonable contract with the seller so that your nursing home will benefit from the best possible billing scenario during the Medicaid and Medicare certification wait-time.

For a professional review of the Medicaid/Medicare billing options for your newly acquired SNF and for any other related information, contact us at LTC.

 

LTC Contracting Helps Strengthen Providers’ Businesses; NJAMHAA

NJAMHAA Winter 2020 News

Council Members help Strengthen (Mental Health) Providers’ Businesses

 

LTC Contracting

 

The LTC Contracting staff guides mental health providers through licensure and business setup procedures and ensures compliance with all regulations, whether the providers are opening new organizations or adding new service lines to their existing businesses.

“We have helped many providers set up their businesses. They often come back to us when they want to add other service lines,” said Steve Shain, COO.

“The integrated license is very exciting. We don’t often see licensing reform in health care,” Shain said, referring to single licensure that will soon be available for providers to offer mental healthcare, substance use treatment and primary healthcare services. “We anticipate it will be a smoother process for providers: a streamlined process with everything managed under one roof.” He noted that LTC is already working with its clients to prepare for the integrated license.

LTC’s services also include getting providers credentialed and on the Managed Care Organizations’ (MCOs’) networks, which is especially important now that the MCOs are covering substance use services for special populations (Managed Long-Term Services and Supports clients, individuals served by the Division of Developmental Disabilities and people who are Fully Integrated Dual Eligible for Special Needs Plans [FIDE-SNP]) and additional populations will inevitably be covered by MCOs.

“Providers who have worked with commercial MCOs out of network are realizing that the market is shifting to in network, so they’re trying to get into networks as soon as possible,” Shain stated. “Some are playing it by ear. By waiting, they’re losing their leverage with MCOs and not helping to create adequate networks.

“Providers need to constantly verify and re-verify their clients’ eligibility, not just at admission,” Shain advised.

He explained that if providers are not aware when their clients switch MCOs, they could experience problems in reimbursement and disruptions to delivery of care. For those providers already participating with MCOs’ Medicaid plans, LTC helps with “anything on the financial end,” Shain said. “LTC partners with a company that does the billing and utilization review for LTCs’ client facilities, and LTC looks at this from a financial approach to ensure accuracy.”

 

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.

Watch “The Quid Pro Quo Video” by LTC Contracting

The Quid Pro Quo Video.

Hey everyone!

If you’ll notice this video looks a little bit different.

I’ll get to that in a moment, but I want to talk to you about today are two points that are making a lot of news. That is Medicare for All  – which is pretty easy to pronounce, and something that’s not so easy to pronounce: Quid Pro Quo.

Now, one of them can make you very electable the other one can make you very impeachable. Really they don’t really have much to do with each other – Medicare for All and Quid pro Quo; however, they converge when we’re talking about healthcare. And this is what I’d like to clear the air about.

Medicare for All is really a fundamental argument: the fundamental argument on how healthcare should be provided in this country. There is the concept that maybe Medicare for All is a good model, or maybe we should take the current model and adjust it and tweak it to make it better.

But keep in mind that aside for this argument, there are Political Action Committees (called PACs). These PACs are on the Medicare for All side that is a deep pocketed well-funded organization that is coming from companies as well as other organizations that will benefit in a quid pro quo style from Medicare for All and therefore they’re pushing to influence that.

On the other hand, the anti-Medicare for All, there is a Partnership for Americas Healthcare Future which is a huge PAC that is trying to go against Medicare for All. Again, they’re company backed organizations that will benefit from not having Medicare for All.

Aside for this fundamental argument about Medicare for All being the right choice or not, there is really another argument  through corporations and organizations that would like to influence the decision here. So keep in mind that policy is often driven by politics.

And when you’re dealing with politics, nothing is ever just black and white.

Thank you so much for watching we’ll see you next time!

 

Steve Shain, COO

LTC Contracting

Watch “The PDPM Rap” by LTC Contracting

PDPM, the rap. As being danced to at SNF morning meetings everywhere.

Lyrics by Steve Shain, COO LTC Contracting

Watch on You Tube.

3 Must-Haves in an AR Specialist

LTC Collections

 

3 Must-Haves in an AR Specialist

 

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.

1. Expert Knowledge of your particular state’s CMS, Medicaid/Medicare and MCO rules

 

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.

 

2. Strong Relationships with HMOs and MCOs

 

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.

3. An Emphasis on Technology; Software and Support

 

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.

Follow these 4 Essential Tips to Minimize Uncollectible Receivables

Follow these 4 Essential Tips to Minimize Uncollectible Receivables

 

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:

 

1 – Stay on top of accounts receivable deadlines.

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.

 

2 – Don’t let problems snowball.

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.

 

3 – Look at the big picture.

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.

 

4 – Take a proactive, predictive approach.

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.

Medicare For All, Explained

There’s been a lot of hype about “Medicare for All” with the upcoming 2020 presidential elections.

How will Medicare changes affect healthcare as we know it? What about the insurance companies?

No one is completely sure, but here is what we know:

  • There are many interpretations of “Medicare for All” but most explain it will pay for everything; dental and vision included.
  • Funding this program will be complicated; as of now Bernie Sanders’s plan is taxing the wealthy to provide funding.
  • Insurance companies aren’t going anywhere. Watch the video (1:00) to understand why.

In this video, Steve Shain breaks down the facts to clearly explain all you need to know about “Medicare for All”.

 

LTC Contracting works to establish relationships between facility operator and payers to negotiate competitive contracts for your facility as well as many other services.