ltc-consulting-specialists

[ltc-consulting-specialists]

Skilled Nursing Home Billing Services

When it comes to Skilled Nursing Home billing and collecting money for our clients, we are relentless; and have been since 1982

We understand the challenges of providing care and generating revenues, you should have minimal challenges collecting your payments for this work. This is where LTC can help. We have teams and systems that are ready to proactively engage to the benefit of your operations and cash flow. We view ourselves as a partner in your success and we look forward to connecting with you. Contact us today for a free trial!

[ltc-consulting-specialists]

$32.5B Value in Medicare Advantage

Medicare Advantage delivers $32.5 billion, or $123.36 per member per month, in additional value to beneficiaries, according to a report released Thursday by the Better Medicare Alliance (BMA).

Hospital and physician services are 24% less expensive per month: $709.66 for MA plans per month and $935.67 for Medicare FFS. These statistics exclude administrative expenses and profits, according to the report.

“Even with 5% lower FFS Medicare costs for Medicare-covered services, MA is still less expensive in total program costs than FFS,” the report said, referencing a sensitivity analysis which adjusted FFS comparator population costs +/- 5%.

The 5% margin accounts for unadjusted coding and different eligibility statuses for which data was not available.

MA plan benefits are “at least as generous” as what Medicare fee-for-service (FFS) provides for less cost, the report said, thanks to lower out-of-pocket costs and additional benefits to choosing from, compared to Medicare FFS.

The advocacy group’s research arm — the Center for Innovation in Medicare Advantage — commissioned the report, which was conducted by management consulting company Milliman.

“At a time when lawmakers are weighing important policy considerations for seniors’ health care, Milliman’s findings speak to the value that Medicare Advantage delivers not only for seniors, but also for the health care system,” Mary Beth Donahue, president and CEO of BMA said during the organization’s second day of its MA Summit event on Thursday.

Donahue refers to the Biden Administration’s Build Back Better legislation currently being discussed by Congress. Advocates for Medicare Advantage are concerned the bill’s expansion of Medicare FFS to include vision, dental and hearing needs would come at a cost for MA beneficiaries.

“We’re not opposed to adding new benefits in fee-for-service Medicare, but there’s particular interest in ensuring that it’s not paid on the backs of Medicare Advantage beneficiaries,” Donahue said during an MA Summit session yesterday.

Congressman Darren Soto (D-Fla.), a speaker at BMA’s event today, said that MA will continue to be the “high quality program” it is right now. No new fees or taxes will be tied to the expansion, Soto said.

“We want to make sure we create options for everyone, but I suspect we’ll see a still remaining strong preference for Medicare Advantage in Florida, given its popularity,” added Soto.

Soto’s Central Florida district has one of the highest MA penetration rates in the country — 60% of Medicare-eligible seniors choose Medicare Advantage, according to BMA data.

“There’s a lot of retirees in Florida, more in South Florida, but still a fair amount in places in my district, like in Poinciana or in some of the others like Championsgate … you combine all those factors and Medicare Advantage is a popular ticket in Central Florida,” noted Soto.

Still, one in five seniors don’t know the difference between Medicare Advantage and Medicare FFS, according to a poll conducted by BMA.

https://www.ltcconsulting.com/articles/value-in-medicare-advantage

[ltc-consulting-specialists]

Administrator Losses are ‘Critical Issue’ for Nursing Home Workflow, Morale

https://www.ltcconsulting.com/articles/nursing-home-administrator-losses

#nursinghomebilling #nursinghomecollections #ltcconsulting #ltc #nursinghomes

[ltc-consulting-specialists]

Nursing Home Staffing Problems

Of 1,183 nursing home and assisted living providers surveyed by the American Health Care Association and National Center of Assisted Living (AHCA/NCAL), nearly every nursing home is currently asking staff to work overtime or extra shifts and more than half are limiting new admissions due to staffing shortages.

While the long-term ramifications of the current shortage remain to be seen, 78% of the nursing homes surveyed admitted to being concerned about having to shut down their facility due to workforce challenges with 35% of that group describing themselves as “very concerned.”

The survey also showed that 86% of nursing homes said their workforce situation has gotten worse over the last three months, with 57% of that group describing it as “much worse.”

“Too many facilities are struggling to hire and retain staff that are needed to serve millions of vulnerable residents,” Mark Parkinson, president and CEO of AHCA/NCAL said in the press release. “Lawmakers across the country must prioritize long term care and that begins with providing resources to address workforce challenges.”

Parkinson believes that when facilities have the means to offer competitive wages and training programs, workers will follow.

However, without help from Congress and state legislators, boosting the industry’s workforce will not be possible, he said.

Restricting admissions has become an increasingly widely used strategy for nursing homes to handle staffing shortages with 58% of nursing homes admitting to limiting admissions due to staffing shortages, according to the survey.

Parkinson said in the press release that he felt the Care For Our Seniors Act would be an “appropriate vehicle” for Congress to fund a long-term solution to addressing chronic staffing shortages in nursing homes and other long-term care facilities.

“Congress has the opportunity right now, through budget reconciliation, to include meaningful investments in long term care, which will help address key staffing challenges,” he added. “We cannot allow facilities to close because of these challenges.”

For more articles and expert advice please visit www.ltcconsulting.com 

Resource: https://skillednursingnews.com/2021/09/58-of-nursing-homes-are-limiting-new-admissions-due-to-staffing-shortages/

[ltc-consulting-specialists]

The LTC Lookout Tips and Trends for Business Office Results Managed Medicaid

You remember the old days, when we had a little "HMO" billing? Now Managed Care is everywhere. Remember "Fee For Service Medicaid"? Well now so much of it is Managed Medicaid. Yes, the old days were simpler, but there's no point in nostalgia, we have claims that need to be paid in full.

They key to success with Managed Medicaid is being organized and getting it right from the start. Authorizations, Eligibilities, Dates of Service, Levels of Care, Claims, Codes and deadlines all need to be right, and the whole process needs to stay organized. A couple more tips:

Disenrollment. Some health plans cover for one month and then disenroll to State Medicaid. If you miss the window you could have unreimbursed days. Start the process on day one.

Coding Different health plans want different codes on their claims, even for the same service. Make sure you understand what goes where.

Timely Filing Deadlines can be as short as 90 days, and timely filing is very hard to overcome. If your timeliness window is closing, and you still don't have everything you need, consider billing for a (timely) denial then correcting your claim down the road.

Relationships are Important Put a smile in your voice, get on the phone and make some friends at the health plans. Having people in your corner makes a huge difference

At LTC Consulting, our teams can help you handle Managed Medicaid challenges. We know the systems and the people and we can aggressively pursue and collect money for you. Managed Medicaid payers have been posing challenges for years, but the solutions are out there. Please reach out if we can be of service.

https://www.ltcconsulting.com/articles/skilled-nursing-home-managed-medicaid

[ltc-consulting-specialists]

10 posts!

[ltc-consulting-specialists]

Nursing Home Business Office Consulting

From software setup and training to audits of A/R, policies, and staff.

Our consulting group is available for special engagements:

Software configuration and training

Business office reviews including A/R audits, policy and procedure, and staff knowledge assessments.

Staff training

Temporary business office coverage

Special Payer focus projects

Compliance reviews

visit www.ltcconsulting.com

[ltc-consulting-specialists]

Nursing Home Aged Account Collections

Bad Debts happen fast. If you have aged balances, we advise immediate, proactive steps to protect your revenue and collect your cash.

No one can afford to lose money for services already provided. Our sharp, sophisticated teams have a proven system to collect aged accounts and put the money in your bank.

We collect $Millions of aged, at-risk receivables for providers every year.

Here is what we do:

We conduct an efficient aging review to determine areas of focus and propose a collections action plan.

We establish basic software and information access and immediately launch the collections action plan.

We move quickly and generate the quickest possible results.

We provide monthly reports and updates.

[ltc-consulting-specialists]

Skilled Nursing Billing & AR Management

Accurate billing with timely and diligent Accounts Receivable (A/R) management

Our engagements include the following drivers of success:

Software Systems Setup and Oversight: Assuring correct revenues, clean, timely claims and accurate books. Incorrectly set up software quickly and easily creates bad debts. We always start here.

Census Management: We scrutinize your census every day and take proactive steps to understand possible changes in payers or coverage.

Admissions Management: We confirm and track eligibility and authorization for every admission, every cycle. We proactively address all and pending eligibility and reauthorization cases.

Timely Claims for all Payers: We keep to rigorous timely filing protocols. We generate clean claims and transmit them on time for all payers with no exceptions.

Private Collections: We facilitate friendly and timely communications with private payers to stay on top of outstanding balances.

Month End reports: We provide monthly Key Indicator Reports that include revenues, claims, payments, DSO and cash receipt trends, authorization status, eligibility status and more.

Aging Review: We review all aging balances every month. Visit www.ltcconsulting.com

[ltc-consulting-specialists]

Older adults with dementia half as likely to move to a nursing home if they live with adult children

Researchers at the University of Michigan have found major differences in potential family caregiver availability — and likelihood of moving to a nursing home — based on the gender, race, ethnicity, education level and family structure of older adults with dementia.

The study draws from comprehensive interviews conducted between 2002 and 2014 with a national sample of nearly 5,000 people with dementia. The data come from the Health and Retirement Study, which is based at the university’s Institute for Social Research.

Overall, they found that people with dementia who are women, Black, low-income or have lower levels of education are all less likely than their counterparts to have available spouse caregivers, but more likely to have adult children available to provide care. The study also showed that the immediate availability of adult children is directly associated with the chances that a person with dementia will continue to live at home or move to a nursing home.

In all, 62% of people with dementia didn’t have a spouse or partner living with them. Another 13% lived with a spouse or partner who needed help with daily living activities themselves. Only 24% lived with a spouse who had no limitations on their abilities. In addition, one-quarter of older adults with dementia lived with an adult child, and an additional 42% had at least one adult child living within 10 miles. But 23% had no adult children living with them or close by.

Based on follow-up interviews done two years after the first, data showed that an older adult with dementia was half as likely to move into a nursing home if they lived with an adult child. Nearly one-third of those with no adult children were receiving nursing home care by the two-year followup, as were one-quarter of those without an adult child living within 10 miles of them. By comparison, 11% of those who had an adult child living with them at the first interview point had moved to a nursing home by the end of two years.

“Given the prevalence of dementia and the high cost of in-home and long-term care, finding ways to support family caregivers and better understand the challenges they face is timely and important,” said Cathleen Connell, Ph.D., senior author of the study and professor at the University of Michigan School of Public Health Department of Health Behavior and Health Education.

For more news and tips visit us at our website.

[ltc-consulting-specialists]

Managed Medicaid Tips & Trends

​Once upon a time, we did a little "HMO" billing, now Managed Care is everywhere. ​ ​​Once there was mostly "Fee For Service Medicaid", and now this payer is Managed. Those were the good old days, but there's no point in nostalgia, we have work to do, and claims that need to get paid at 100%. The key to Managed Medicaid is being organized and getting it right from the start. Authorizations, Eligibilities, Dates of Service, Levels of Care, Claims, Codes, and deadlines all need to be kept straight. ​​When you work with LTC Consulting, we help you handle Managed Medicaid challenges. We work the systems and aggressively pursue and collect money for you. We have overcome the challenges posed by Managed Medicaid payers for years, and we are ready to share our knowledge with you. Our teams are standing by and can't wait to work with you! ​ ​​Also remember: Disenrollment – Some health plans cover for one month and then disenroll to State Medicaid, but you need to get the ball rolling on Day One! Coding – Different health plans want different codes on their claims, even for the same service. Make sure you know what goes where. Timely Filing – deadlines can sometimes be as short as 90 days. Better to bill for a denial and correct down the road than try to overcome timely filing limitations Relationships are Important! – Get on the phone and make some friends at the health plans. If push comes to shove, you always want people in your corner. ​ ​​When you work with LTC Consulting, we help you handle Managed Medicaid challenges. We work the systems and aggressively pursue and collect money for you. We have overcome the challenges posed by Managed Medicaid payers for years, and we are ready to share our knowledge with you. Our teams are standing by and can't wait to work with you!

https://www.ltcconsulting.com/articles/managed-medicaid-tips-trends

[ltc-consulting-specialists]

Zimmet President: Delaying PDPM Adjustments Could Make Problem Worse

When the U.S. Centers for Medicare & Medicaid Services (CMS) announced it would delay adjustments to the Payment-Driven Payment Model (PDPM) until next year, some in the skilled nursing industry felt they were getting some breathing room. ​ ​But Marc Zimmet, president of consulting firm Zimmet Healthcare Services Group, said he believes that delaying the inevitable could result in an even larger rate recalibration in the near future. ​ ​ Zimmet discussed the topic and others on Wednesday at the company’s annual conference in Mohegan Sun, Conn. ​ ​“We see PDPM rates going up as providers get better at capturing and at the end of the day, this is only going to end one way … We’re going to have a bigger recalibration next year, we have to,” Zimmet told Skilled Nursing News Thursday. ​ ​“It was not the 5%; it was the way [CMS] did it that I took exception with,” he added. “The entire logic behind it was ill-conceived.” ​ ​Adjustments were expected to be made to the payment structure after CMS determined that the model increased payments to nursing homes by about 5% in fiscal 2020, for a total gain of $1.7 billion. ​ ​The new system for Medicare reimbursement, which was implemented in October 2019, was intended to be budget-neutral, meaning that CMS would not spend more money on PDPM than they had under the Resource Utilization Group (RUG) system. ​ ​Zimmet also said the foundation of SNF economics is “broken” and noted during his presentation that federal policy and legislation impacts every state differently. ​ ​“Things are so different state-by-state that when laws are being made or rules are being implemented, there has to be some consideration about how it’s going to trickle down to the local and state level,” Zimmet told SNN. ​ ​He said there needs to be a consideration on how policies and regulations will impact providers at the local level “without mandating and really disadvantaging some operators.” ​#healthcarebilling #accountsrecievablecollection #nursinghomebilling #nursinghomeconsulting

[ltc-consulting-specialists]

The LTC Lookout Tips and Trends for Optimal Business Office Results

Current Medicare Issues:

We know how COVID has complicated Medicare billing and reimbursements for facilities. There are new waivers and codes and processes, and reimbursements are easily held up. We are helping clients collect on aged Medicare balances, and we have observed some trends that may be of interest. It's easier than ever to miss one small thing on a claim and hold up months of cash flow. For example: Sequencing Individual residents with multiple claims in the Medicare system, including no-pays, will all need proper sequencing. Claim by claim review can reveal one item out of order that can break an entire payment line. Coding Watch for span codes, condition codes, and HIPPS codes. A mistake in one spot will cause payments to be held up. Understand which codes go where on each claim and then verify for accuracy. When you work with LTC Consulting, we aggressively pursue and collect money for you. We overcome challenges posed by timely filing and Medicare errors and take proactive action to protect you from bad debt. Our experienced teams are standing by and can't wait to work with you! Visit our website and contact us for a free trial www.ltcconsulting.com

#skillednursingfacilitybilling #nursinghomebilling #snf #healthcarebillingnursinghomes #nursinghome #nursinghomebusinessoffice #nursinghomeaccountsrecievable

[ltc-consulting-specialists]

Subscribe to our Newsletter

Stay tuned for timely business office news and perspectives delivered straight to your inbox. We will never spam or sell your information. You can unsubscribe at any time.

https://mailchi.mp/0e251d36083c/subscribe-to-ltc-consulting-specialists-newsletter

[ltc-consulting-specialists]

LTC Consulting Specialists

Since 1982, LTC has provided steadfast, professional service to skilled nursing and assisted living providers nationwide. We take decisive action to protect your cash flow and deliver the results you need every day. 

Please call  (916) 786 3582 for a free trial

Visit http://www.ltcconsulting.com