Revenue Cycle in Post- Acute Care Deloitte & Touche LLP Victor Shutack, Senior Manager June 2015

Transcription

1 6/9/2015 Revenue Cycle in Post- Acute Care Deloitte & Touche LLP Victor Shutack, Senior Manager June 2015

2 Discussion topics Changing healthcare environment Understanding the home health care environment and specific metrics Revenue cycle issues related to Skilled Nursing Facilities Durable Medical Equipment leading practices

3 Why post-acute care? Changing healthcare environment 2010 Affordable Care Act Declining hospital margins Post-acute care providers accounted for $62 billion of Medicare spending in 2012 and have grown steadily 1 1; Medpac, Health care spending and Medicare Program: Post-acute care, June 2013

4 Why post-acute care? Positioning for value-based care Tighter coordination with post-acute care providers may reduce readmissions Post-acute care may offer growth opportunities

5 Home healthcare risks Recent settlements: 2014: Caring Nurse Home Health, Corp. and Good Quality Home Health, Inc. ordered to pay $35 M in restitution and company presidents sentenced to a combined 13 years and 3 months in prison 1 1

6 Home healthcare Specific revenue cycle components: Outcome and Assessment Information Set (OASIS) completion CMS-485 completion and quality assurance (QA) Face-to-Face (F2F) requirement Low Utilization Payment Adjustments (LUPA) Request for Anticipated (RAP) submission Final claims

7 Home healthcare OASIS completion Measure start of care (SOC) to completion date If delayed- Why? 485 and order completion and QA What is the time frame for review? Is there able QA staff? Communication delays

8 Home healthcare F2F requirement Days to receive tracking? LUPA percentages RAP submissions Days from SOC to RAP? Final claims Days from end of episode (EOE) to final claims date?

9 Leading practices - home care OASIS completed and locked Goal 2-3 days LUPA percentages Goal between 5% and 7% RAPS submission Goal within 7 days of SOC Final claims submission Goal within 14 days of EOE

10 Skilled Nursing Facilities (SNF) Specific revenue cycle components: Resident Admission Agreements Physician Certification processes Minimum Data Set (MDS) completion Resource Utilization Groups (RUGS)

11 Skilled Nursing Facilities (SNF) Specific revenue cycle components: Activities of Daily Living (ADL) scores Use of therapy services Rehabilitation RUGS Restorative Care Nursing Services

12 SNF revenue considerations Specifically initiate consistent processes for completion: Resident Admission Agreements Physician Certification processes MDS completion, consistent ADL scores and Rehabilitation RUGS Restorative Care Nursing Services

13 SNF revenue considerations Resident Admission Agreements Goal: 100% completed on admission Physician Certification processes Develop a consistent process and monitor completion MDS completion, ADL scores, Rehabilitation RUGS Monitor PEPPER reports and address outliers Restorative Care Nursing Services Initiate and train CNAs

14 Durable Medical Equipment (DME) Specific revenue cycle components: Test and understand processes to obtain Certificates of Medical Necessity (CMNs) Who is responsible for initiating and following up on outstanding CMNs? For items that required a Detailed Written Order (DWO) prior to delivery What is the verification process and what controls are in place?

15 Durable Medical Equipment (DME) Specific revenue cycle components: Consider utilizing a documentation specialist to verify complete documentation is obtained prior to claim submission Review the type and number of ICD-9 coding associated with certain types of claims

16 Durable Medical Equipment (DME) Specific revenue cycle components: Develop item check lists to be completed Checklist should be item-specific and not generalized Should based on coverage determination guidelines Claims are only submitted if check list complete

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