experience momentum // cpas & advisors understanding the financial links between clinical and...

experience momentum //

CPAs & ADVISORS

UNDERSTANDING THE FINANCIAL LINKS BETWEEN CLINICAL AND BILLING

Sherri Robbins/Julie Bilyeu

UNDERSTANDING THE FINANCIAL LINKS BETWEEN CLINICAL & BILLING

Clinical

Billing

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PAYMENT STARTS AT ADMISSION

Pre-Admission Screening

Defined Process/Checklist

Scanning Key Documents into Software

Authorization Tracking

DETERMINING COST OF CARE

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CONSOLIDATED BILLING

Inclusions/Exclusions• Major Category Exclusions• Statutory Exclusions• Place of Service Impact

Provider Responsibilities• Negotiating Contracts• Timely Payment• Notice of Skilled Stay

CMS Resources• Major Category

Explanation• HCPCS File• Fee Schedules/Rates

TECHNOLOGY

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7

SNF Performance

30 Days Medicare Medicaid

Private

60 Days Insurance

90 Days Coinsurance

A/R MANAGEMENT

Monthly A/R Meetings

KnowledgeBilling and Software

Rate ChangesPayer Variances

Contractual Adjustments

Bad Debt Write Offs

Sequential Billing

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INCREASED PAYER SCUTINY

ADR RAC

ZPIC

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DOCUMENTATION RISK AREAS

ADL Prior Level of Functioning

Isolation

Daily Skilled Need

Therapy

Medical Necessity

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CLINICAL OVERSIGHT

• RUG Distribution• ADL Distribution

• Average length of stay• Length of stay by

condition/diagnosis• PEPPER

• Quality Indicators• Quality Measures• Staffing

MANAGING SKILLED CARE-OVERSIGHT

Don’t miss the boat on skilling residents for skilled nursing

UNSCHEDULED ASSESSMENTS

Change of Therapy

End of Therapy

End of Therapy-Resumption

Start of Therapy

Short Stay

EARLY/LATE/MISSED ASSESSMENTS

Early

• Bill Default for # days out of compliance

Late

• Bill Default for # days out of compliance

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TRIPLE CHECK

Patient Demographic Info

Admission and Physician Documentation

General Claims Data

Specific Billing Codes

MDS Data

Ancillary Charges

Discharge Information

COMMUNICATION IS KEY

Daily Nursing & Therapy

Communication

Weekly Medicar

e Meetin

gs

Monthly Triple Check

ICD-10

Effective 10/1/2015 servicesPractice dual coding now!!Invest in coding resources

PLAN

PRACTICE

PREPARE

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BKD THOUGHTWARE

Subscribe for Free http://pages.bkd.com/SubscriptionManagement_Center.html

19 // experience momentum

THANK YOU

FOR MORE INFORMATION // For a complete list of our offices and subsidiaries, visit bkd.com or contact:

Sherri Robbins, RN // Senior Managing Consultantslrobbins@bkd.com // 417.865.8701

Julie Bilyeu //Directorjbilyeu@bkd.com // 417.865.8701