Top 10 Warning Signs of Missed SNF Reimbursement August 21, 2014

Transcription

1 Tp 10 Warning Signs f Missed SNF Reimbursement August 21, 2014 Julie Bilyeu Directr jbilyeu@bkd.cm Lisa McIntire, CPA Senir Managing Cnsultant lmcintire@bkd.cm AUGUST 21, 2014 HEALTH CARE GROUP T Receive CPE Credit Individual Attendee Participate in entire webinar Answer plls when they are prvided Grup Attendees Cmplete grup attendance frm with Title & date f live webinar Yur cmpany name Yur printed name, signature & address All grup attendance sheets must be submitted t training@bkd.cm within 24 hurs f live webinar Answer plls when they are prvided If all eligibility requirements are met, each participant will be ed a CPE certificate within 15 business days f live webinar 2 1

2 Tp 10 Warning Signs f Missed SNF Reimbursement Grwing A/R A/R mnitring Pr cmmunicatin A/R reprting Sftware bstacles Turnver Bad debt Flawed prcesses Payment perplexity Increase in denials 3 Grwing A/R Decreasing/incnsistent cash flw A/R benchmarks Medicare/Medicaid/Private 30 days Insurance Primary days Cinsurance days 4 2

3 A/R Reprting Mst billing sftware prgrams cntain the fllwing reprts A/R aging Listing f utstanding balances by payr/mnth Payr lgs Charges & expected reimbursement by payr Transactin analysis reprts Shuld be able t print fr all transactins made in sftware Adjustments Payments Write ffs Charges 5 A/R Reprting N billing sftware Difficult t track paid vs. unpaid balances Hard t track infrmatin fr cst reprt Excel tracking Breakdwn f A/R Payment amunts/dates Cllectin effrts Charges by revenue type Days by RUG Exhibit 1 bad debts 6 3

4 Write Offs Bad debt shuld be a rarity in the SNF envirnment Nnpayment f cinsurance by Medicaid Exhibit 1- Part A cinsurance nly Nnpayment f private pay cinsurance Exhibit 1- Part A cinsurance nly Private pay Medicaid pending Timely filing denials Denials after medical review Dcumentatin nt supprting services prvided Exhausted appeals ptins 7 Write Offs Defined prcess Apprval Dllar threshld Levels f apprval Timing Capturing Exhibit 1 eligible bad debts mnthly Management versight Print reprts mnthly t verify all bad debt entries were apprved Cmparing level payments t actual write ffs mnthly Review prir t year-end Private pay Medical review denials 8 4

5 Write Offs Exhibit 1 Bad Debts True Part A cinsurance N Medicare Advantage r Part B Medicaid nnpayment f Part A cinsurance Remit shuld cntain apprpriate denial cde Write-ff date must be in applicable cst reprt year Private pay uncllected Part A cinsurance Must have been billed at least three times Reasnable & custmary attempts t cllect the bill must have been undertaken & dcumented Debt must remain unpaid mre than 120 days frm date first bill was mailed t beneficiary Write-ff date must be in applicable cst reprt year 9 A/R Mnitring Aging review Excel exprts Cllectin ntes Management versight Mnthly A/R meetings Review cllectin effrts fr every utstanding balance Address private pay cllectins & establish actin plan Accuntability measures Perfrmance-based feedback Enfrcement f A/R cllectin plicies 10 5

6 Flawed Prcesses Pitfalls f flawed r nnexistent prcesses Incnsistent cash flw Inaccurate A/R reprting Cmpliance & risk Negative impact n verall peratins Lack f accuntability Unnecessary cmplexity 11 Flawed Prcesses Claims submissin guidelines Private pay Bill within the first tw business days mnthly Pre-billing is ideal Medicaid Medicaid pending Direct receipt f SSI Determine frequency f billing per state guidelines & cash flw needs Census recnciliatin issues 12 6

7 Flawed Prcesses Medicare/Managed care Billing within first 8-10 business days mnthly Setting expectatins with yur ancillary service prviders Cinsurance Review Medicare remits daily fr nn-crssvers 13 Flawed Prcesses A/R fllw-up expectatins Private pay Defined cllectins prcess When t make first phne call When t mail first cllectin letter Cllectin agency invlvement Dcumentatin f cllectin effrts Medicaid Using web prtals fr fllw up Immediately crrect any rejectins 14 7

8 Flawed Prcesses A/R fllw-up expectatins Medicare View accept/reject reprts fr transmitted claims Immediately crrect any rejected claim batches Daily fllw up until paid status Immediately crrect any rejected r RTP claims Ntificatin prcess fr ADRs Managed care If electrnically submitted, check daily until received by payr Check status in payer websites within 30 days Reslve rejectins/denials immediately Cinsurance Fllw up mnthly until paid Reslve rejectins/denials immediately 15 Flawed Prcesses A/R psting expectatins Defined expectatins fr frequency f psting cash receipts Electrnic uplad f 835 Immediately investigate/reslve payment differences MPPR Sequestratin Full pay vs. c-pay days Cntractual adjustments (managed care) Apprval prcess fr manual cntractual adjustments Part B deductibles Medicaid surplus variances Patient respnsibility (after insurance payment) 16 8

9 Flawed Prcesses Mnth-end expectatins Clear cut ff fr mnth-end clse Census recnciled Medicaid surplus accunted fr & accurate Charges entered & recnciled A/R recnciled MDS assessments cmpleted, transmitted & accepted Payments/adjustments/bad debts psted & recnciled Cash recnciled t bank statement Resident trust recnciled 17 Pr Cmmunicatin Admissins Business Office Imprtance f identifying the crrect payr prir t admissin Verifying days used tward skilled care Pre-authrizatin/re-authrizatin Financial infrmatin Cpies f cards MSP frms Scanning infrmatin int sftware if applicable Demgraphic infrmatin Wh is respnsible fr input in sftware (i.e., QHS, plicy number, etc.)? 18 9

10 Pr Cmmunicatin Business Office Resident Benefits & eligibility Estimated ut-f-pcket expenses Payment expectatins Management Team Business Office Mnthly A/R meetings Disruptins t prcesses 19 Pr Cmmunicatin Clinical Team Business Office TRIPLE CHECK Demgraphic infrmatin Charges n claim agree t surce dcumentatin HIPPS cdes are accurate & reflect crrect payment perid ARDs are accurate & within allwed windws Diagnsis cdes are accurate & prperly sequenced Admissin & discharge infrmatin n claim is accurate Qualifying hspital stay is accurate & meets three-day requirement Attending physician name & NPI are crrect Billing cdes (i.e., cnditin & ccurrence cdes) are captured apprpriately Medical dcumentatin is cmplete & required items signed by physician MDS s have been accepted & agree t validatin reprts 20 10

11 Sftware Obstacles Sftware transitins Set-up issues Updating prcesses t accmmdate new sftware Inaccurate/missing balance frward amunts Risk f missed cllectins Billing delays EDI rejectins Charge imprt template changes Extraneus cding Cmpatibility with ther prgrams GL mapping 21 Sftware Obstacles Lack f knwledge/training Understanding sftware capability vs. required manual input Bypassing sftware in favr f wrkarunds Nt understanding reprting capabilities Lack f sftware Difficult t track unpaid balances Cannt bill nn-crssver cinsurance withut UB04 claim frms 22 11

12 Turnver Access A/R/clearinghuse/cnnectivity sftware DDE/Medicaid/insurance EDI & ERA lgin & passwrds General infrmatin MAC Prvider infrmatin Where is billing infrmatin stred? Where are remits stred? Prcess fr dwnlading/submitting Status f current & prir billing 23 Payment Perplexity Private Services encmpassed in daily rate vs. items separately billed Imprtance f maintaining accurate Medicaid surplus recrds Medicaid Payment methds vary by state Imprtance f having accurate rate & surplus infrmatin Medicare 24 Charges have n bearing n payment MDS effect n payment windws Impact f late/early/missed assessments Sequestratin MPPR Full pay/c-pay days 12

13 Payment Perplexity Managed care Varius payment methds based n payr/plan PPS Charges Per diem Level f care Imprtance f understanding cntract prvisins Annual review f cntracts Practively capturing & billing patient respnsibility Prmptly adjusting A/R fr cntractual bligatins Cinsurance Medicare supplement versus secndary plicy Practively capturing & billing patient respnsibility 25 Denials Billing Technical errrs nt reslved Triple check Lack f fllw-up Timely filing Medicare ne year frm thrugh date n claim Medicaid typically ne year Insurance varies by payr/cntract Lack f fllw up 26 13

14 Denials Medical Dcumentatin des nt supprt medical necessity Triple check Inadequate dcumentatin fr services perfrmed Establishing prir level f functining Diagnsis cding Nt capturing ADL cding Lw ADL scres yet high therapy utilizatin Nt fully respnding t ADR requests Nt prviding all requested infrmatin Nt respnding timely 27 Questins? 14

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16 Thank Yu! Julie Bilyeu Lisa McIntire