experience momentum // cpas & advisors understanding the financial links between clinical and...
TRANSCRIPT
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
2 // experience momentum
PAYMENT STARTS AT ADMISSION
Pre-Admission Screening
Defined Process/Checklist
Scanning Key Documents into Software
Authorization Tracking
DETERMINING COST OF CARE
4 // experience momentum
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
6 // experience momentum
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
8 // experience clarity
INCREASED PAYER SCUTINY
ADR RAC
ZPIC
9 // experience momentum
DOCUMENTATION RISK AREAS
ADL Prior Level of Functioning
Isolation
Daily Skilled Need
Therapy
Medical Necessity
10 // experience momentum
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
15 // experience clarity
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
18 // experience momentum
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 [email protected] // 417.865.8701
Julie Bilyeu //[email protected] // 417.865.8701