New RCM Academy offers Interdisciplinary Approach to Revenue Management<p>​AHCA/NCAL has launched <a href="https&#58;//educate.ahcancal.org/p/RCM" target="_blank">Revenue Cycle Management (RCM) Academy,</a> an online training program that educates facilities of all sizes on the interdisciplinary approach toward revenue management.&#160; </p><p>As reimbursement models move from fee-for-service toward value-based reimbursement, more complex patient characteristic-based methodologies and accurate claims processes must extend beyond billing offices. SNFs operating without successful and integrative Revenue Cycle Management may be receiving insufficient payment for the care they deliver. Developing and implementing successful Revenue Cycle Management (RCM) strategies will coordinate the clinical and administrative functions necessary to improve patient outcomes, ensure timely and accurate collections, and lower administrative costs. </p><p>“The skilled nursing profession is in the most serious crisis in its history with workforce shortages and increasing operation costs,” said Mike Cheek, Senior Vice President of Reimbursement Policy for AHCA/NCAL. “AHCA developed Revenue Cycle Management Academy as a tool during this crisis. While the Academy is not a silver bullet, the training offers solid, time-tested financial management strategies to help during these troubling times. Specially, the Academy provides training on how to build solid internal controls, policies and procedures to ensure skilled nursing providers have adequate reimbursement to deliver quality of care.”</p><p>RCM Academy covers the process from pre-admission to payment, and includes topics such as claims submission, third-party follow-up, strategies to navigate managed care, and best practices associated with coordinating with MDS coding leads. Participants will learn about the attributes of high performing teams, systems to assure proper and timely payment, and best practices for managing all payer sources to maximize revenue and minimize avoidable losses. To bolster the learning experience RCM Academy includes short videos profiling providers’ experiences running effective RCM programs, and additional webinars and resources will be developed throughout the year. </p><p>“I am very grateful for AHCA’s latest resource for providers&#58; Revenue Cycle Management Academy,” said Sarah Schumanm, Vice President of Operations for Brookside Inn. “Now more than ever providers must ensure the proper management of all financial aspects from pre-admission through post-discharge of all residents and patients.&#160; The wisdom these subject matter experts bring to the training is particularly beneficial for Independent Owners like myself. The profession has needed easy access to this consolidated information for a long time. Thank you AHCA for once again delivering solutions to meet our needs.”</p><p>The cost of the course is $350 for AHCA/NCAL members and $650 for non-members. Upon successful completion, the course is approved for 6.75 NAB CEs. Participants will need to login to ahcancalED with their AHCA/NCAL usernames and passwords to register for <a href="https&#58;//educate.ahcancal.org/p/RCM" target="_blank">Revenue Cycle Management Academy.</a> For assistance obtaining usernames and passwords, members should e-mail <a href="mailto&#58;educate@ahca.org" target="_blank">educate@ahca.org</a> with their name and facility contact information.</p>2022-02-09T05:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/healthcare_finance.jpg" style="BORDER&#58;0px solid;" />ReimbursementAHCA/NCAL StaffRCM Academy covers the process from pre-admission to payment, and includes topics such as claims submission, third-party follow-up, strategies to navigate managed care, and best practices associated with coordinating with MDS coding leads.
CMS Proposes 1.3 Percent Increase to Medicare Rates for SNFs in 2022<p>The Centers for Medicare and Medicaid Services (CMS) on Thursday released the Skilled Nursing Facility Prospective Payment System (SNF PPS) FY 2022 draft rule in which the agency proposed a 1.3 percent increase in Medicare rates for nursing homes.</p><p>In response, Mark Parkinson, president and chief executive officer of the American Health Care Association (AHCA), said the 1.3 percent rate hike for SNFs in the next fiscal year would result in an increase of approximately $444 million in Medicare Part A payments. </p><p>“Nursing homes across the country continue to dedicate extensive resources to protect their residents and staff from COVID-19,” he said. </p><p>“This ongoing work makes government support and robust reimbursement rates more important than ever. With the skilled nursing profession grappling with an economic crisis and hundreds of facilities on the brink of closure due to the pandemic, it is critical that Medicare remain a reliable funding source and reflect the increasing costs providers are facing.”</p><p>Parkinson added that “we also recognize the importance of quality measures associated with COVID-19, including a proposed measure of the COVID-19 Vaccination Coverage among health care personnel. We thank [CMS] Acting Administrator [Liz] Richter and the [Biden] administration for their support through the pandemic.”</p><p>For further information, go to <a href="https&#58;//www.federalregister.gov/public-inspection/current">Federal Register &#58;&#58; Federal Register Documents Currently on Public Inspection. </a></p>2021-04-08T04:00:00Z<img alt="" src="/Breaking-News/PublishingImages/740%20x%20740/DC-at-night.jpg" style="BORDER&#58;0px solid;" />Reimbursement;PolicyPatrick ConnoleThe hike for SNFs in the next fiscal year would result in an increase of approximately $444 million in Medicare Part A payments.
Inventive Solutions Boost Managed Care Relationships<p>Offering innovative solutions for quality care across the spectrum of settings, even when it means creating partnerships with unorthodox entities, will result in more successful managed care relationships, participants at <em>Provider’s</em> Executive Roundtable in October concluded. The roundtable was sponsored by American HealthTech. </p> <p><img class="ms-rteImage-0 ms-rtePosition-1" alt="Provider Executive Roundtable" src="/Monthly-Issue/2014/PublishingImages/ProviderRoundtable.jpg" style="margin&#58;10px 5px;" /><br>In California, for example, two nursing home providers are considering the addition of adult day health care services and a geriatric care practice to their buildings. “You have to look at repurposing the building,” says Jim Gomez, president and chief executive officer (CEO) of the California Association of Health Facilities. “Two of my members are coming together and repurposing their space. I’m talking about taking part of their building and putting a geriatric practice into it for adult day health care. So they will have a better link to the community, provide a wide range of services, and it will bring flow to them.” <br></p> <p>The benefit of this, says Gomez, is so that when providers are working with health maintenance, managed care, or accountable care organizations, they can they have a doctor’s office, long term care services, and adult day health care all in one building.<br></p> <p>“You can say, ‘I can take care of the patient throughout this,’” says Gomez, who negotiated for an HMO for many years and notes that “they will look to you for solutions, and when you come up with a solution you may be able to capture a significant amount of the marketplace because you are doing more than just the typical long term care provider.”<br></p> <p>Building on the concept of innovation and serving the community, Medicalodges Chief Operating Officer Fred Benjamin sees a “great opportunity” for providers with regard to Medicaid programs.<br></p> <p>“In Kansas, the program serves many kinds of subpopulations, including frail elderly and women and children. And it goes to creating different kinds of programs—dialysis, for example, home health, and if you have extra land, creating a low-cost senior apartment building on the campus,” he says. “It’s all about serving the managed care company as your customer. They have issues they want to take care of with these subpopulations … and we can create a series of programs that solve their problems and their issues.”<br></p> <p><img class="ms-rtePosition-2" src="/Monthly-Issue/2014/PublishingImages/0214/roundtable1.jpg" alt="" style="margin&#58;10px;" />Summing up the consensus was Ken Lund, president and CEO of Kennon S. Shea and Associates&#58; “Ultimately, [MCOs] are like any other customer. They want you to create the solution, they want it to be affordable, and probably equally important, they want it to be easy and convenient.”<br></p> <p>Lund described an innovation that he says has been very successful for his company. “The model we’ve built is to deliver a continuum with a single point of entry so that whoever is the trusted advisor of the patient, when they come to us, we don’t have to say ‘we’ve got these skilled beds for you.’ Instead, we can say, ‘where do you want to go in the continuum?’” he says. <br></p> <p>“We’ve literally tried to abolish the word discharge in our vernacular, because what we really see as our opportunity is being able to follow that patient through a lifetime rather than just through an episode. We’re finding that very effective because we bought a home health care company, and in 10 months it’s our single largest operation without doing any external marketing.”<br></p> <p>Garen Cox, president and CEO of Medicalodges, explained that a majority of his companies’ buildings are in rural areas where the hospitals are struggling. <br></p> <p>“So we’ve spent a lot of time building a backbone to our infrastructure … and we’ve found ourselves becoming the health center for the community. <br></p> <p><img class="ms-rtePosition-1" src="/Monthly-Issue/2014/PublishingImages/0214/roundtable2.jpg" alt="" style="margin&#58;10px;" /><br>“We are not only the largest employer in some of these areas, but we’re the place where folks go for health care,” he says. “So, in some of our facilities we’ve looked at bringing in physicians to operate a clinic out of the centers. We’re also partnering with other entities to offer other services.”<br></p> <p>Gomez took this concept a step further with the suggestion that providers consider partnering with federally qualified health centers. “If there’s a center out there that wants to expand, some of our members are considering housing the community center in an empty wing,” he says. “You then get people coming into the facility and developing that community relationship.”<br></p> <p>Visit our <a href="http&#58;//www.youtube.com/playlist?list=PLdaXQI95Z7j8-7u4mrjdbwPjb7X4oZ69Q">YouTube </a>channel to see interviews with roundtable participants.<br></p>2014-02-01T05:00:00Z<img alt="" src="/Monthly-Issue/2014/PublishingImages/Roundtable_thumb.jpg" style="BORDER&#58;0px solid;" />Management;Quality;Quality Improvement;ReimbursementMeg LaPorteOffering innovative solutions for quality care across the spectrum of settings, even when it means creating partnerships with unorthodox entities, will result in more successful managed care relationships, participants at Provider’s Executive Roundtable in October concluded.
Providers Grapple With Managed Care Inevitabilities<p><em>This is the first of a two-part series covering a recent </em>Provider<em> roundtable held in conjunction with the AHCA/NCAL convention in Phoenix, Ariz., in October. The purpose of the forum was to convene long term and post-acute care providers from a variety of states and markets around the country to shed light on how they are tackling the many issues that accompany the ever-growing cadre of managed care and Accountable Care Organizations around the country. The roundtable was sponsored by American HealthTech, at <a href="http&#58;//www.healthtech.net/" target="_blank">www.HealthTech.net</a>.</em><br><br><img class="ms-rtePosition-1" alt="Provider Roundtable, Phoenix, Arizona" src="/Monthly-Issue/2014/PublishingImages/0114/Phoenix-Roundtable_0347.jpg" width="283" height="185" style="margin&#58;5px 15px;" /><br>Lengths of stay, hospital readmission rates, and five-star ratings remain buzzwords for long term and post-acute care providers as managed care works its way into markets around the country, according to a recent gathering of roundtable participants. </p> <p>Be it a managed care organization (MCO) or an Accountable Care Organization (ACO), the consensus of the gathering was that it’s not a matter of whether it’s coming but a matter of when it’s coming. And the corollary to that is&#58; Providers must know their quality measures, and they must know them very well. <br><br>In Kansas, where Medicaid managed care is just nine months old, all beneficiaries have been assigned to one of three MCOs, reports Fred Benjamin, chief operating officer of Medicalodges in Coffeyville, Kan. In fact, his company has embraced the roll-out of managed care in the state. “It’s been interesting so far,” he says. “I’m excited about it because we have an opportunity to rebuild the health care system the way we want to rebuild it. It’s not being dictated to us by the hospitals, and it’s not being dictated to us by somebody else. We have a fairly good relationship with a couple of MCOs. We have an opportunity to partner with them, and they seem very receptive to it.”&#160; <br><br>On the West Coast, California is currently enduring the “throes of managed care,” says Jim Gomez, chief executive officer of the California Association of Health Facilities. He notes that California now has 13 MCOs within the state’s eight largest counties, representing about 25 million people. “For about the last two-and-a-half years, I’ve been preaching to my members that it’s coming,” he says. <br><br><img class="ms-rtePosition-2" alt="/archives/2014_Archives/PublishingImages/0114/roundtable_thumb.jpg" src="/Monthly-Issue/2014/PublishingImages/0114/Phoenix-Roundtable_0373.jpg" width="279" height="192" style="margin&#58;5px 10px;" />“I meet with the head of the [health maintenance organization] association on a monthly basis to make sure those relationships are connecting and we’re saying the same thing. My biggest fear is the loss of independent providers in the state. The bigger companies, I believe, can integrate vertically and horizontally, and they are going to present a different picture to MCOs than an independent owner/operator who does only skilled nursing.”<br><br>In an effort to stave off this fear, Gomez has been educating independent operators in the state “so they’re in front of the curve,” he says. “I would say this at every workshop&#58; All administrators should know their rehospitalization rates and their lengths of stay. And any administrator who doesn’t know these data should be fired.” Regarding length of stay, Gomez believes that it will drop from an average of 28 days to 21 days as a result of managed care. He points to Kaiser Health System, the largest player in the Sacramento area, as evidence&#58; “Their average length of stay is 12 days,” he says. “They put their own nurse practitioners and docs in the nursing homes.” <br><br>In Massachusetts, ACOs are the main focus, as opposed to MCOs, says Naomi Prendergast, chief executive officer of D’Youville Life and Wellness Community in Lowell, who has been working with the state association to create a model ACO contract for other providers in the state. <br><br>“Forty percent of all fee-for-service Medicare beneficiaries are going through an ACO,” she says, adding that they are also creating educational programs for providers in order to get ACOs and skilled nursing facilities on the same page with regard to expectations on both sides.&#160; <br><img class="ms-rtePosition-1" alt="/archives/2014_Archives/PublishingImages/0114/roundtable_thumb.jpg" src="/Monthly-Issue/2014/PublishingImages/0114/Phoenix-Roundtable_9103.jpg" width="308" height="170" style="margin&#58;15px 10px;" /><br>“One ACO is in the process of going from 500 down to 50 [skilled nursing facilities] in its network,” says Prendergast. <br><br>“The sands around us are shifting constantly. We need to be aware of who now is affiliating with whom. It’s changing almost daily.” <br></p>2014-01-01T05:00:00Z<img alt="" src="/Monthly-Issue/2014/PublishingImages/0114/roundtable_thumb.jpg" style="BORDER&#58;0px solid;" />Management;Reimbursement;Quality ImprovementMeg LaPorteThis is the first of a two-part series covering a recent Provider roundtable held in conjunction with the AHCA/NCAL convention in Phoenix, Ariz.