Improving Financial Vitals of the Healthcare Industry

LTC Consulting Services’ initial focus when first starting out in 2006 was medical billing for skilled nursing facilities, but we’ve grown immensely since then. Our services have expanded to better support our healthcare clients’ day-to-day finance needs and ensure long-term growth and sustainability with dedicated advisory services.

See the case study by CPA.com by accessing it via the PDF below.

LTC Consulting Lens: PBM For Dummies

Watch this clip!

Stay informed with LTC’s outlook on the Healthcare business world, our AR collections, receivables financing and collection of receivables processes. News, upcoming changes, and policy updates. A great way to keep on the pulse of our industry, without searching further than YouTube.

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Transcript:

Steve Shain: Hi everyone and welcome back! So now that the big conferences-HIMMS, The NIC and of course ECAP – who can forget ECAP? – are now over, it’s time to get back to work and try to focus on what’s coming up ahead. A few weeks ago, I was at the AJAS conference, so I was speaking to a crowd there and I showed them a picture of this individual and I asked them “Does anyone know who this is?” No one did. I even said his name; his name is Alex Azar “Does anyone know who that is?” and they didn’t. And this is a group of health care providers in the room.No one did, so don’t feel bad if you don’t know either. Mr. Alex Azar is the Health and Human Services Secretary of the Untied States of America. He’s probably the most influential person in the healthcare industry that there is today. A little while ago Mr. Azar got up and he said that he is looking to disrupt healthcare as we know it. He’s looking to make major changes and he’s looking to do them extremely quick.

What is his focus?
Mr. Azar is looking to get the industry to go into the direction of value-based care. Value-based care does not look at how much care or the level of care that you’re giving to a patient, but rather the outcome.

What are you doing to rehabilitate the patient?
That is the focus and with that is a larger focus of lowering the cost of healthcare in this country.

How does he want to do that?
Well first line of business is to focus on the health insurers and the pharmaceutical industry. Until now, these two industries were really two separate things but lately the health insurers have been acquiring some of the companies on the pharmaceutical side. We have CVS Caremark that now merged with Aetna, we have Cigna that just recently announced that they’re buying out Express Scripts. Express Scripts is not really a pharmacy, it’s actually a PBM. A PBM – no, a PBM is not a proud bald man – no PBM is a pharmacy benefits manager. Pharmacy benefits managers were put in place in order to make sure that the drug makers don’t hike up prices too high. They were kind of like policemen to make sure that the prices would be fair.

But now, the insurers have acquired these PBMs. They could police the drug makers but who’s going to police the health insurers for making sure that they don’t hike prices up? Enter this guy. This is Mr. Scott Gottlieb, he is the FDA Commissioner. He got up last week and gave a fiery speech to health insurers, telling them that they cannot get away with anything like this in the future. He said that this is very, very dangerous. From the three largest PBMs that are out there, they are controlling more than two-thirds of the PBM industry right now. And he said that it’s no lie that when you get these PBMs joining with health insurers, that is making the market much less competitive. Much less competitive is making the prices go up and they are putting a stop to it.

What are their goals?
Basically, what they’re looking to do is bring a lot more drugs to the market quicker. So, they’re going to bring generic drugs at a quicker pace. Drugs that usually would have to go through red tape in order to get FDA approval in order to hit the market are going to get a little bit of a faster pace in order to get the market kind of flooded with a lot of medication, a lot of available medication, which will bring the prices down.

So, focusing on that on the pharmaceutical side and on the health insurer side, and on the healthcare provider side, they’re looking for value-based care, focusing on value and outcomes, and not value and…incomes. This is all going on at the same time as we have the three billionaires from Amazon, Berkshire and Chase that have been scheming together trying to give small hints about a huge disruption that they’re going to bring to the healthcare industry as well. We don’t know what it’s going to be, hopefully it’s going to be good. But come to think of it, Mr. Bezos here, he is definitely a PBM if you know what I’m talking about. So only good things can come from those people, so hold on tight we’ll see what happens from these new players that are in the market that are looking to change it. And until next time, thank you so much for watching and of course if you have any comments, questions, please feel free to reach out to me, that way we can make this better for you. Take care.

The 2018 Proposed Federal Budget and Medicaid

On May 23rd , the 2018 proposed federal budget was released by the White House. Since then, there has been a flurry of news about what this means and how it will affect US citizens. Let’s focus on the planned changes to Medicaid, which is an important topic for our readers.

Perhaps you heard about the “$600 billion cuts to Medicaid over 10 years.” As stated, this is a fact – well, the actual line item is $616 billion. Here’s the section taken from pages 9 and 10 of the budget document:

Reform Medicaid: To realign financial incentives and provide stability to both Federal and State budgets, the Budget proposes to reform Medicaid by giving States the choice  between a per capita cap and a block grant and empowering States to innovate and prioritize Medicaid dollars to the mostvulnerable populations. States will have more flexibility to control costs and design individual, State- $610 billion over 10 years.

Basically, Medicaid would fully be managed at the State level. The Federal Government would provide a fixed amount of money to each State. Medicaid services include nursing home and institutional care as well as personal care, occupational therapy, and work support for the disabled and elderly to allow them to live on their own. Providing a health facility is required by law, but the programs to keep people on their own are considered optional.

What is not reflected in the $616 billion is the $800 billion cut to Medicaid funding that is in the House-passed version of the American Health Care Act. There is overlap between these two numbers, but there is not yet a consensus on how much that is. According to NPR, Medicaid’s growth would be cut over time because healthcare costs grow faster than the economy.

Medicaid currently provides healthcare support for 75 million low income, elderly, and disabled people.

Here’s a link to the full proposed budget, if you’re interested in reading more.

#HealthcareSummit17: What You Need to Know

This year’s Healthcare Summit is bigger than ever. It’s on June 19 – 20 at The Coaches Club at MetLife Stadium. We had a Q&A with Ovadyah Stavsky, Director of Marketing at SPS and LTC, to find out what you need to know to get the most out of the packed agenda.

Q: This is the sixth annual Healthcare Summit. What’s new this year?

We’ve taken the learnings from each of the previous Healthcare Summits and have built them into this year’s event. The Healthcare Summit started out fairly small, but due to overflowing classes and increased success year after year, we’ve scaled the program to a full two-day event. We are offering attendees up to three CEUs per day for a total of six, and all workshops are approved LNHA’s, CALA’s, DON’s and SW’s, and for all states.

The Healthcare Summit is all about appreciation and learning opportunities for our clients and healthcare professionals. I’m sure attendees won’t be disappointed.

Q: Can you tell us about the informative CEU sessions?

On Monday, June 19th, there are two sessions on “Utilization Review Today – Everything You Need to Know…And Then Some!” The UR process controls costs and quality of care, which protects both patients and facilities. Each session earns 1.5 CEUs, for a total of 3 CEUs for the full course.

Tuesday’s two-part program is on a topic that doesn’t receive enough attention: “From High School to Old School: Elders Who Bully and Strategies to Intervene.” Some seniors in facilities undergo the same unfair treatment as high school students. Again, each session earns 1.5 CEUs.

Attendees do not have to go to all sessions to get credits. New Jersey social workers should be aware that they must attend part one and two of a course for three credits. They can’t receive 1.5 for half of a course.

Q: Who are the platinum sponsors?

We are very excited about our platinum sponsors! They are:

Mobilex USA, America’s leading provider of mobile imaging services. Mobilex brings x-ray and sonogram technology to your facility. For over 35 years, they have been serving patients in over 7000 facilities throughout most of the United States.

Brian Patten and Associates specializes in assisting organizations in the explanation in enrollment of core and ancillary employee benefits. Their management team has over 54 years of benefit and rolling and consulting experience, and the service over 1.5 million employees throughout all 50 states.

APS Marketing Group is a full-service marketing agency. They help companies make a good first impression and work with brands on reputation control.

Tech-Keys is your one-stop destination for everything IT. From IT Consulting through system design, implementation and ongoing maintenance, Tech-Keys provides all the technological support your facility or organization needs to stay relevant in today’s digital world.

We encourage Summit attendees to visit with our platinum sponsors during the event.

Q: Bo Dietl is your guest speaker this year. What can attendees expect from his address?

With Bo, one thing I’m sure we can expect is the unexpected. Bo is a force of nature and is always memorable. He is one of the most highly decorated NYPD detectives in the history of the NYPD and he runs one of the most successful private investigation firms in the country. He’s quintessentially New York, and he’s currently running for mayor of New York.

Q: Who should attend the Healthcare Summit?

The daytime courses are designed for healthcare professionals, such as administrators of nursing homes and assisted living facilities, social workers, and directors of nursing. Others in the industry, such as BOM’s etc., will enjoy and benefit from the networking events. We look forward to seeing you there!

To Register for this event visit www.njhealthcaresummit.com.

Register for #HealthcareSummit17!

June 19 – 20 2017

The Coaches Club at MetLife Stadium

Open Bar • Buffet Dinner
Up to 6 CEUs for Administrators, SWs and DONs
Approved for all States

Registration is open to LNHAs, CALAs, DONs and SWs, or members of facilities and organizations that have a relationship with LTC Consulting Services.

To register please visit www.njhealthcaresummit.com.

What You Need To Know

This year’s Healthcare Summit is bigger than ever. It’s on June 19 – 20 at The Coaches Club at MetLife Stadium. We had a Q&A with Ovadyah Stavsky, Director of Marketing at SPS and LTC, to find out what you need to know to get the most out of the packed agenda.

Q: This is the sixth annual Healthcare Summit. What’s new this year?

We’ve taken the learnings from each of the previous Healthcare Summits and have built them into this year’s event. The Healthcare Summit started outfairly small, but due to overflowing classes and increased success year after year, we’ve scaled the program to a full two-day event. We are offering attendees up to three CEUs per day for a total of six, and all workshops are approved LNHA’s, CALA’s, DON’s and SW’s, and for all states.

The Healthcare Summit is all about appreciation and learning opportunities for our clients and healthcare professionals. I’m sure attendees won’t be disappointed.

Q: Can you tell us about the informative CEU sessions?

On Monday, June 19th, there are two sessions on “Utilization Review Today – Everything You Need to Know…And Then Some!” The UR process controls costs and quality of care, which protects both patients and facilities. Each session earns 1.5 CEUs, for a total of 3 CEUs for the full course.

Tuesday’s two-part program is on a topic that doesn’t receive enough attention: “From High School to Old School: Elders Who Bully and Strategies to Intervene.” Some seniors in facilities undergo the same unfair treatment as high school students. Again, each session earns 1.5 CEUs.

Attendees do not have to go to all sessions to get credits. New Jersey social workers should be aware that they must attend part one and two of a course for three credits. They can’t receive 1.5 for half of a course.

Q: Who are the platinum sponsors?

We are very excited about our platinum sponsors! They are:

Mobilex USA, America’s leading provider of mobile imaging services. Mobilex brings x-ray and sonogram technology to your facility. For over 35 years, they have been serving patients in over 7000 facilities throughout most of the United States.

Brian Patten and Associates specializes in assisting organizations in the explanation in enrollment of core and ancillary employee benefits. Their management team has over 54 years of benefit and rolling and consulting experience, and the service over 1.5 million employees throughout all 50 states.

APS Marketing Group is a full-service marketing agency. They help companies make a good first impression and work with brands on reputation control.

Tech-Keys is your one-stop destination for everything IT. From IT Consulting through system design, implementation and ongoing maintenance, Tech-Keys provides all the technological support your facility or organization needs to stay relevant in today’s digital world.

We encourage Summit attendees to visit with our platinum sponsors during the event.

Q: Bo Dietl is your guest speaker this year. What can attendees expect from his address?

With Bo, one thing I’m sure we can expect is the unexpected. Bo is a force of nature and is always memorable. He is one of the most highly decorated NYPD detectives in the history of the NYPD and he runs one of the most successful private investigation firms in the country. He’s quintessentially New York, and he’s currently running for mayor of New York.

Q: Who should attend the Healthcare Summit?

The daytime courses are designed for healthcare professionals, such as administrators of nursing homes and assisted living facilities, social workers, and directors of nursing. Others in the industry, such as BOM’s etc., will enjoy and benefit from the networking events. We look forward to seeing you there!

To register for this event visit www.njhealthcaresummit.com.

EVENT SCHEDULE

Monday, June 19
1:00 – 3:30   Utilization Review Today – Everything You Need to Know…And Then Some! Part 1
1.5 CEUs for administrators, SWs and RNs
3:00 – 3:30   Light refreshments
3:30 – 5:00   Utilization Review Today – Everything You Need to Know…And Then Some! Part 2
1.5 CEUs for administrators, SWs and RNs
5:00 – 7:00   Eat, drink and network
7:00 – 7:15   Platinum presentations
7:15 – 8:45   Eat, drink and network
8:45 – 9:05   Guest speaker
9:05 – 11:00   Dessert bar, stay and play!

Tuesday, June 20
8:00 – 10:00   Breakfast with the Plats
10:00 – 11:30   From High School to Old School: Elders Who Bully and Strategies to Intervene. Part 1
1.5 CEUs for administrators, SWs and RNs
11:30 – 12:00   Grab-A-Lunch
12:00 – 1:30   From High School to Old School: Elders Who Bully and Strategies to Intervene. Part 2
1.5 CEUs for administrators, SWs and RNs

PLEASE NOTE
NJ SWs will need to attend parts 1 & 2 of a course to receive 3 credits. They cannot receive 1.5 for any half.

PARKING IS FREE
Park in Lot A and enter through the BudLight Gate.

HOTEL INFORMATION
Hilton Meadowlands
To take advantage of our event rate, please contact info@silverwingtravel.com
(732) 905-8888

Event Sponsors:

PLATINUM:
Mobilex  Brian Patten Associates  APS Central   Tech-Keys

Gold:
Allstate Medical  Fischer Roofing   MobileCare

Silver:
Patterson Design   Specialty RX  Tender Touch  Towne NursingAll State Pest Management

 

To register for this event visit www.njhealthcaresummit.com.

The One Thing You Should Never Do When Faced With A Collections Issue

LTC collections director Chaim Cohen observes that the pressure to file claims in a timely manner – and the need for healthcare businesses to constantly move forward — often leave any lingering collection issues in the dust. That, of course, means perfectly collectible money uncollected.

Collection questions like, “What shall we do now?” or “How do we proceed from here?” are often asked too far into the collection process – sometimes after 120 days or more — rather than right at the start.

The unfortunate result is lost money that could have been collected months ago.

So the one thing you should never do when facing a Aging receivable issue: wait. Don’t put it on the back burner.

How is your company’s Aging receivable health? Is it all that it can be, or do you sense a need for improvement? Chaim says that in many cases, collection issues are more resolvable than most people expect.

Here are a few examples:

When the initial claim or the rebill fails to be processed in a timely fashion, the works get gummed up. Timing is everything.

Another red flag that slows down or roadblocks collections are claims that were processed incorrectly. You may have crossed your t’s and dotted your i’s, but insurance companies are used to denying claims. Whether the answer is justified or not, you may not have the time or the knowledge to follow through.

Sometimes the problem is not even collecting the money at all; it’s actually more about not posting the payment correctly. For instance, on the books, it may look like there is an outstanding balance, but it could be that the payment was posted in the wrong place or perhaps it was not posted at all. Technically, the aging receivable was paid, but it was not recorded. This is a basic “cleaning up” solution that Chaim tackles often.

Incorrect coding also presents a typical collections obstacle. The bill may contain the wrong code, which prevents the claim from going through. A simple fix, but often an overlooked issue.

The reason why aging receivables are often so difficult is because the original issues that caused the problem (listed above) are not addressed. Even if the fix is easy, they don’t go away or resolve themselves — they are still going to be there as time goes on. You need to address them stat.

Of course, you may not have the time, the staff, or the resources to tackle those issues, as well as the knowledge of what actually went wrong.

Here are a few tips that Chaim recommends in order to get your aging receivables  in order:

Categorize all claims. There are many reasons for collection troubles, including claim denials, filing timing or authorization complications. LTC regularly points out issues that may be the weak link in the aging receivable  chain, and can even keep you from needing collection services in the future.

Have your collections evaluated by an outside source. Sometimes it takes a second set of eyes to catch the problem or a collections professional who knows what to look for. LTC examines your collection issues from all angles and offers solutions that will prevent similar problems in the future. Chaim says that it’s a beneficial “two-for-one” deal: get your collection issue resolved and, at the same time, learn how to deal with that issue if and when it happens again.

It helps that LTC is well connected in the industry, with a large network of contacts (in both low and high places) that may help facilitate the collection in an efficient way. LTC takes the time that you may not have to dig into the problem.

Chaim adds that most businesses focus on fires that are right in front of them, in the present moment. They are often too busy with current balances to spend too much time on last year’s balances. In most cases, businesses often write them off as a loss.

However, LTC shows that the quicker you act on a collection, the sooner you’ll resolve it so that you can move on with a more balanced aging.

With that in mind, remember this: even with the right collection skills and the right connections, the longer you wait, the less likely it can be successful. Make collection a top priority, and as soon as possible.

Time is money, so don’t leave any on the table.

Click here to find out how LTC can offer you collection solutions.

These Nurses Are the Best At New Technology

Experience isn’t always an advantage. A new report reveals the group of nurses who are most likely to know their way around new technology: the younger, less experienced ones.

The embrace of new technology is usually generational both at home and in the workplace. However, the report by the University of California – San Francisco, raises less obvious concerns about the way new technology is implemented.

The study, released in December 2016, suggests that many facilities don’t have a seamless process for training staff in new technology, and that staff education may be considered a lesser priority.

After conducting small-group interviews at 15 nursing homes, it was found that younger, less experienced nurses were most interested in learning new technology, and were most likely to become “point people” for helping other, older staff members.

Generally, the factor that made the difference in training comprehension: the presence of younger, less experienced nurses, rather than the nurses with years of experience.

The study rated overall levels of satisfaction with new-technology training as well. The result: not much satisfaction. The feedback was even more negative when it came to IT trainers with non-clinical backgrounds who could not converse in nurse speak.

The barrier to learning cited by most interviewees is wireless connectivity within the facility. In other words: bad WiFi.

Conclusions from the research team for nursing homes to consider when implementing new technology:

  • Develop a toolkit that prepares staff for changes or upgrades.
  • Develop a best practices training document.
  • Boost funding incentives for training.
  • Increase compensation for staff with advanced IT skills.

 

 

Repeal, Replace, Re-mind me why I care?

Ok, you’ve seen it flashing on the news and in your emails. President Trump is doing away with ObamaCare and they’ve created a brand spanking new healthcare plan. Who cares? Well actually, after reviewing the proposed changes there are a couple of points you should know about if you are a healthcare operator.

So, instead of you having to read the Plan details yourself, we figured we’d give you the highlights here briefly, then you can get back to work!

 

  1. There are a few things NOT changing.

Here they are:

  • Insurers will still have to cover preexisting conditions
  • Insurers will still have to cover Adult children until age 26
  • Insurers will still have to give out of pocket limits
  1. Introducing Medicaid Per Capita Caps.

This means the Federal Government will give a grant, sort of like an allowance to each state. This cap amount would be based off how many Medicaid qualified individuals are in the state for the year. It would then increase annually based off the medical inflation rate. Many provider advocates feel this will not be sufficient to cover the gap that Medicaid rate increases and increased provider assessment may have offered previously.

  1. Who is eligible for Medicaid?

ObamaCare allowed for anyone under the 138% poverty level to be included in the Medicaid program. The new plan reverts back to limiting this to children, pregnant women, elderly, and disabled. Anyone already on the program will be grandfathered in, and remain covered.

  1. What are the big changes for insurance?

So, good news/bad news, we’ll start with the bad. The new plan allows for insurers to raise the premiums by 5x, for older customers. On the bright side, older customers will get twice the amount of tax credits annually of $4,000 per year.

  1. If Insurance and Medicaid are both changing, Managed Medicaid definitely is.

That’s correct. The EHB (essential health benefits) that were mandated that Managed Medicaid plans must offer, is now being removed. Some of these required benefits were mental health and substance abuse treatment, pediatric services including vision and oral care, and rehabilitative services and devices.

  1. Anything Else?

Yup. In December, the plan is to roll out some more significant changes. An important one being the allowance for insurers to expand over state lines. This would lead to much more competitive market, and less control by insurer over providers.

 

Trump Administration Will Increase Crackdown on Nursing Home Fraud

The Department of Justice (DOJ) will continue to aggressively investigate skilled nursing facility fraud under President Trump, according to Bloomberg BNA’s legal, tax and compliance site.

The new administration will likely preserve several policies held over from the Obama era, which include the use of data-analysis in investigations. This analysis is culled from data mining, a method of finding patterns in large amounts of data that may help detect fraud. Data mining software tools can predict future behavior based on the knowledge of past events. It’s used to help investigators identify and analyze billing patterns and Medicare criminals, and stop fraudulent claims before they’re paid.

In 2015, Deputy Attorney General Sally Quillian Yates proposed The Yates Plan, which holds more individuals – as opposed to corporations — responsible in fraud cases. These offenders can range from nursing home management executives to facility personnel. Civil and criminal prosecutors will also commit to increased cooperation in bringing these individuals to justice The goal of this plan is to encourage more self-regulation and self-disclosure. The government provided 20 specific examples of Medicare claims for what it said were unnecessary therapy services administered to patients.

In September 2016, a settlement cost a skilled nursing facility $28.5 million due to allegations of unnecessary billings at its locations.
Owners and operators of three Miami skilled nursing facilities were charged criminally in a $1 billion nursing home fraud scheme. According to the DOJ, this was “the largest single criminal health-care case ever brought against individuals” The owner, a hospital administrator and a physician’s assistant were charged in an indictment with conspiracy, money laundering and health-care fraud, according to the U.S. Attorney’s office in Miami.

As part of the DOJ’s Elder Justice Initiative, a top priority will be combating fraud in post-acute care. The department’s ten regional nursing home task forces will focus on nursing homes that provide “grossly substandard” care. This plan includes members of the U.S. Attorney’s offices, state Medicaid Fraud Control Units, state and local prosecutors offices, the Department of Health and Human Services, state Adult Protective Services agencies, long-term-care ombudsman programs and law enforcement.

The goal: to resolve concerns about under-performing and fraudulent nursing homes in a timely manner.

“All too often we have found nursing home owners or operators who put their own economic gain before the needs of their residents,” said Acting Associate Attorney General Stuart F. Delery. “These task forces will help ensure that we are working closely with all relevant parties to protect the elderly.”

Also on the DOJ radar in the new administration: fraud in the pharmaceutical and medical device industries.