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Managed Care- How Have You Fared?

Janine Mangione, CPA, Partner 585.249-2800 / jmangione@bonadio.com Kelley DeMonte, CPA, Principal 585.249.2864 / kdemonte@bonadio.com

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Agenda

• Managed Care – Background

• Value Based Payment Model – What’s it Going To Look Like?

• Managed Care – What are we seeing?

• Strategic Positioning Questions to be Asked and Answered by Your Organization

• Considerations of IPA’s

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Polling Question

• How well versed are you in managed care?– A) I could teach this session

– B) For the most part I get it, but it’s hard to keep up

– C) I am well versed, but still have a hard time getting paid

– D) Just hoping it will go away

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Managed Care – Background

• Implemented in Upstate NY July 1, 2015. We are currently in a transition period through 2017– Most providers have contracts with plans at a

rate at or above Medicaid benchmark rate

• As part of the state budget, managed care organizations will still be required to reimburse nursing homes at the Medicaid benchmark rate through December 31, 2020

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Managed Care – Background

• By 2019, 80-90% of total managed care payments to the PPS and providers must be made via at least Level 1 (upside shared Savings) value based payment (VBP)– Part of DSRIP Initiative

– Moves Medicaid payment from current fee-for-service system to alternative payment arrangements (i.e. bundling, risk sharing, capitation)

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Value Based Payment

• Levels– Level 0 VBP – FFS w/ Quality Bonuses*

– Level 1 VBP – FFS w/ Upside Shared Savings

– Level 2 VBP – FFS w/ Risk Sharing (Upside, Some Downside)

– Level 3 VBP – Full PMPM Capitation & Risk (Full Upside and Downside Risk)

– * The State has agreed to count these types of arrangements between MLTC plans and providers as Level 1. They are “Level 0” for mainstream plans and providers.

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Value Based Payment

• How does this impact long-term care providers?– Many homes are not positioned to take the

risk required with VBP models

– Homes that are capable of reporting quality statistics stand a chance of benefiting from the upside shared savings

– Expected that most homes will only be able to accept and move to Level 1 VBP arrangements

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Value Based Payment

• Medicare– SNF VBP beginning in FY2019

– 2 percent withhold of Part A payments with an opportunity to earn back based on certain quality metrics

– Re-hospitalization rate

– Level of improvement

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Value Based Payment

• What will these Medicaid VBP contracts look like?– Pilots?

– Plans are in the early stages of developing these contracts

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Polling Question

• How many managed care plans do you currently have contracts with?– A) Zero

– B) 1-2

– C) 3-5

– D) more than 5

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Managed Care – What are we seeing?

Plans behaving different– Plans less eager to contract with long term

care providers

– Plans not willing to negotiate above benchmark

– Plans attempting to amend contracts

Plans are finding that the payment model that they are receiving from NYS is unsustainable

Under the current payment model, plans will be tempted to contract with providers that have the lowest cost

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Polling Question

Has a plan attempted to terminate a contract with you? A) Yes

B) No

C) I can’t get a plan to even contract with me

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Managed Care – What are we seeing?

• Contract language is changing– NAMI

– The right to amend contracts

– Contract terms

– Definition of patient co-pay or customer expense

– More specifications related to revenue codes, and electronic claim submissions

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Managed Care – What are we seeing?

• Net Available Monthly Income (NAMI)– As part of the NH transition policy, the responsibility

to collect NAMI amounts is being assumed by the plans. Plans may delegate the collection of NAMI to the NH, but this must be expressly agreed to by the provider in the participating provider contract. Monthly premium payments to the plans will reflect an offset for NAMI amounts.

– If the plan retains responsibility to collect NAMI, it should pay the facility the full contract rate multiplied by the days of care provided. If the plan delegates NAMI collection to the facility, the NAMI amount should be deducted from payments to the NH for those time periods during which the NAMI is collected by the NH.

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Strategic Positioning Questions to be Asked and Answered by Your Organization

• With the Department of Health (DOH) now driving the bus, healthcare service providers with reduced administrative costs will be one of the sources of achieving efficiency. What is the provider doing proactively to address its administrative cost efficiency and, more broadly, the State’s desire for mergers, affiliations, and shared service organizations to achieve a more efficient healthcare delivery system?

• Evaluate the merits of joining a Regional IPA and/or MSO. If you don’t know what those acronyms mean, consider yourself to be in trouble!

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Strategic Positioning Questions to be Asked and Answered by Your Organization• The following areas are of highest priority in evaluating the

question above:

a) Partnering/merger/affiliation with other service providers

b) Participation in regional provider networks

c) More sophisticated cost accounting and electronic records for all program components

d) Restructuring your billing and accounts receivables systems to accommodate revised contract payment methodologies (e.g. incentive payments for achieving performance goals, P4P)

e) Incremental cost structures on administrative infrastructure (technology, compliance, etc.) will be a significant challenge in assessing your organization’s future services and structure.

Ask yourself the question, are we sophisticated enough to survive in a VBP reimbursement environment that demands high service quality and desirable outcomes?

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Polling Question

• Is your organization currently part of an IPA?

• A) Yes

• B) No

• C) In the process of forming one

SNF Managed Care

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Fee-for-Service (FFS) Managed CareWho does Medicare or Medicaid pay?

Pays each provider for each service rendered

Pays a flat monthly fee (capitation) to insurance plan

Who does provider bill?

Provider bills Medicare or Medicaid directly

Bills the Managed Care plan which pays from a monthly capitation rate from Medicare or Medicaid

Providers available Any provider who accepts the insurance

Only providers in the insurance plan’s network

Permission needed for services?

Sometimes. Medicaid – need approval for PCS, CDPAP, etc. but not all medical care

Often. Plan may require authorization to see specialists or for many services. May not go out of network.

Policy – incentive to give too much/little care?

Incentive to bill for unnecessary care offset when authorization is needed for services

Plan has incentive to DENY services and keep part of capitation rate for profit

What package of services is available?

All Medicare and Medicaid services

Package of services may be “partial” (MLTC) or “full” (PACE = all Medicare and Medicaid services

Pre-Billing

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RatesMedicare Advantage Negotiated per diem rates or Medicare rate

Commercial Plans Negotiated rates

o “Pay lesser of daily rate or billed UCC rate”

Medicaid Managed Care Rate – 3 year current FFS (benchmark) rate or negotiated Must be increased if rate falls below current benchmark rate If previously negotiated rate: pay benchmark during transition

unless other arrangement is agreed to

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Bed Hold MethodologyMedicaid Managed Care Bed hold methodology – unless otherwise negotiated, MCO

required to follow current Federal/State Medicaid bed hold regulations (CFR 483.12 and 10YCRR 415.8 and 18NYCRR 505.9) – prior authorization may be required

Reimbursement Limitations

LOA temporary hospitalization / health care professional therapeutic

0 Hospital bed hold payments eliminated effective 4/1/17

LOA non-hospitalization / health care professional therapeutic

95% Not to exceed 10 days in any 12 month period

Must have been resident for at least 30 days and unit to which recipient will return has a vacancy of no more than 5%

If plans not paying – contact Vallencia Lloyd (Mainstream) vallencia.lloyd@health.ny.gov OR

Mark Kissinger (MLTC) mark.kissinger@health.ny.gov

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Billing / Payment CycleMedicare Advantage and Commercial Billing cycle – monthly Payor specific payment cycle and remittance

retrieval options

Medicaid Managed Care Billing Cycle – at least every 2 weeks or twice a month

o Not generally mentioned in provider/billing manuals – don’t make assumptions

o Does billing department needs to change current process? Payor specific payment cycle and remittance retrieval options

Medicaid Weekly payment cycle

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Enrollment

Medicare Advantage and Commercial plans Enrollment changes not limited to open enrollment periods

although many changes occur then Families often not good at communicating changes Facilities don’t routinely verify coverage

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EnrollmentMedicaid Managed Care – New Eligible/Not in a Medicaid

MCO Coming from home to NH (long term): Apply for Medicaid following

all current regulations, including physician recommendation, PASRR process, Patient Review Instrument (PRI), etc.

LDSS has 45 days to complete determination for long term Medicaid eligibility

Once approved and any penalty period has elapsed and NAMI amount is identified resident has 60 days to choose an MCO

NY Medicaid Choice will assist in education, plan selection and enrollment (in a plan with which the nursing home contracts)

Auto enrolled if not select MLTC: No lock-in so enrollment may change

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EnrollmentMedicaid Managed Care – Already Medicaid MCO Enrolled MCO must authorize all long term placements and pay the

NH while long term eligibility is being conducted by LDDS NH and MCO assist with submitting documentation to LDDS

(send MCO authorization with 3559) Member has 90 days from date long term placement is

determined to submit the application for coverage of long term custodial placement to the LDSS

LDSS will notify MCO, enrollee and NHo If eligible – MCO keeps paying NH and NAMI is collectedo If ineligible – MCO recoup payment from NH and coordinate safe

discharge into the community

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Enrollment

Medicaid Managed Care If a permanent nursing home FFS resident is hospitalized and

ineligible for nursing home bed hold, upon return the resident will be viewed as a new permanent placement and will be required to enroll in a managed care plan

Medicaid re-certifications – the resident or designated representative is still responsible for submitting a Medicaid recertification. Nursing homes and MCOs are encouraged to assist. o “If an enrollee does not appear on the plan’s 1st or 2nd roster the plan is

not obligated to pay the nursing home”

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Enrollment ConsiderationsHow do you track open enrollment changes?How will you track initial Medicaid managed care enrollments?How will you track enrollment changes?

“The provider must check eligibility and enrollment status at the time of service or weekly for NH services for billing purposes” FAQ March 2015

Develop policies and procedures and provide staff training Failure to track may result in untimely billing to the correct payor 834 electronic enrollment files or will payor provide a roster? Enhanced communication with families?

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Admission AuthorizationsMedicare Advantage and Commercial Authorization is generally required

o Revenue Code or Level of Care

Medicaid Managed Care If enrolled in a plan, MCO must authorize all long

term care placements and will pay the nursing home while long term eligibility is being conducted by LDSS

Authorization is generally required

Responsibility for initiating authorization and timing is payor specific Ultimately SNF bears the risk if authorization is required but not

obtained

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Admission Authorizations Considerations

All Managed Care Always verify if an authorization is needed and for what

services – admissions, routine services, supplies, equipment, etc.

Payors may require authorizations for some plans but not otherso Specific plan determines authorization requirements

Document contact person and telephone numbers for future authorization extensions and reassessments

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Admission Authorizations Considerations

All Managed Care When is re-authorization required? What form? Portal or

paper?o Electronic ~ $13.00 cost saving potential

Can current staff handle the increase in work due to Medicaid Managed Care? o Case management vs floor staff vs billing staff vs new

position?

Coordination between billing and prior authorization staffo When/how/does billing get the authorization number?

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Insurance Verification Medicare, Medicare Advantage Plan, Medicare Part D, Supplemental

Plans, Medigap, Commercial Plans, Medicaid, Medicaid Managed Care, Medicaid Long Term Care

Dual Eligible with original Medicare, Medicare Part D, Medigap and MLTC will have 5 insurance cards

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ePACES Eligibility Example

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Insurance VerificationMedicaid Managed Care Provider must check eligibility at the time of service and before

billingo Currently may not be checking eligibility before billing Medicaido Is this going to be a new process? o Will you do it for all payors?o Who is going to do it? o What resources will they use?

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Insurance VerificationMedicare FISS/Connex Check for each resident – not just Medicare Part A admissions

Payor websites or phone calls to each insurance Clearinghouse insurance verification portalBatch eligibility verification (271 / 271 files) Prior to billing submit 270 file for eligibility verification via

clearinghouse Possible: submit excel spreadsheet to clearinghouse if billing

system can’t create a 270 file

ePACES / Plan Rosters Look at eligibility and Restriction/Exemption codes (institutional

Medicaid, spend down)

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Insurance Verification

Best Practice Suggestions Staff training Identify type of coverage (MA, MLTC, Dual Advantage, MAP,

etc.) AND name of plan (to be able to easily reference payor manuals)

Document every call/contact in your billing system Complete verification before admission and billing

Billing and Post-Billing

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Revenue Code/Level of CareMedicare Advantage and Commercial Billing formats may vary

Revenue Code

Excellus Medicare Advantage and

Commercial

UHC EverCare MVP

191 Skilled Nursing Level I Level A – Continuing Care

199 Level Ia192 Sub-acute Therapy Level II Level B – Low Rehab193 Sub-acute

RehabilitationLevel III – Intensive

Service DeliveryLevel C – High

Rehab194 Level D – Medically

Complex

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Revenue CodeMedicaid Managed Care

Description Fidelis Care at Home Revenue Code

Healthfirst Revenue Code

Bed Hold – Temporary Hospitalization

0185 0185

Bed Hold – Therapeutic LOA 0183 0183Bed Hold – Other Therapeutic LOA 0189 N/A

Room and Board + Ancillary Services

0190, 0191, 0192, 0193 0100 (all inclusive custodial & respite)

Room and Board Only 0190, 0191, 0192, 0193 0100 (all inclusive custodial & respite)

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RateWhat rate is used? Medicare or Medicaid Rate Negotiated Per Diem UCC (Usual and Customary Charge) Pays lesser of daily rate or billed UCC rate

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Billing Format

Every new format creates added work Set up like another payor or plan? Which revenue codes? What rate? Which modifiers? Itemized or just room & board? Excluded services?

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Billing FormatMedicaid Managed Care Claim format may be similar to Medicaid format because rate

code is required Claim format may be similar to HMO because authorization

number is required

Look at each plan and determine if a new claim format needs to be built Requires testing

Maintain examples of clean claims for various bill types and service types for each payor and plan in your billing office

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Billing SystemConsider the structure/design of your billing system Example: If only have Fidelis as a financial class it may be

insufficient because there may be multiple Fidelis plans (not just MLTC plans) in your area and each plan is likely to have different billing and claiming requirements

How does system handle rate variations within the same plan for level of care billing (higher rates for additional therapy utilization or nursing care)?

Are rates loaded so contractual adjustments are calculated at billing which results in $0 balance when payment is posted? o Are contractual allowances correct for each plan/payor? If incorrect – relies on staff to know if paid correctly and requires

additional time at payment posting to enter contractual adjustments

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Billing SystemCan billing system easily produce a “clean” claim? How many human interventions are needed?

Electronic or paper or Direct Data Entry (DDE)? All Medicaid MCOs must be able to accept electronic claims

Medicaid Managed Care Need to submit multiple batches of claims to multiple payors – no

longer just 1 weekly batch to Medicaid More time needed for submission and acceptance monitoring

Can system produce payor and plan specific billing reports? How can system contribute to a denial management program?Set-up, tables, dictionary modifications needed?

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Timely FilingKnow timely filing requirements for each payor Most payors have a 90 day timely filing requirement

Bill at least monthly – no later than the 15th

Bill as often as payor will allowMaximize billing and payment cycle For Example: Medicaid Cycle 2082

o Start date = Thursday, 7/6/17 o End date = Wednesday, 7/12/17o Check date = Monday, 7/17/17 o Check release date = Wednesday, 8/2/17 (3 weeks after end date)

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Follow up / CollectionsKeep all claims alive with follow up Document every submission, mailing, phone call, etc. No more than 30 - 45 days between follow up attempts Verify receipt of claim – acceptance reports, fax confirmation,

registered mail Utilize billing system collections module

o If none – write follow up on calendar Prioritize follow up by large dollar and nearing

timely filing Group calls by payor

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DenialsPer AMA 1.38% – 5.07% of claims are denied on 1st

submission Aetna – 6.00% UHC – 4.30% Cigna – 3.80% Medicare –

2.30%

Need to work electronic rejection/acceptance reports Must review 999 and 277CA

o 999 confirms that a file was received. However, the 999 includes additional information about whether the received transaction had errors. Accepted (A), Rejected (R), Accepted with errors (E)

o 277CA acknowledges all accepted or rejected claims in the file

Must work payor denials – review remittances

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DenialsIndustry shift toward managed care requires SNF to focus on

denial managementDenial management is “old news” to physicians and hospitals Long ago addressed in their billing systems and processes

SNF billing systems and SNF process deficiencies: Many billing systems don’t capture payment codes Many billing systems can’t generate denial management reports Minimal use of clearinghouses and available denial-related reports Many SNFs don’t post zero payments Most SNFs do not have a robust denial management program

Consider additional report writing add-on software or programming

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Denials• Cost to re-work a claim

Staff time $10.67Supplies $ 1.50Interest $ 1.75Overhead $ 1.00TOTAL $14.92

• Key Performance Indicators (KPIs): % of denied claims

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AppealsKnow each payors appeal process for each type of appeal Time limits (60 days, 90 days, per contract) Payment discount for timely filing appeal Specific forms

Review your process for each type of appeal Who gathers the necessary documents? Who submits? Who monitors status? Are outcomes shared with all?

o Are you learning from denied appeals?

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NAMI CollectionEstimate at admission and attempt to collectMedicaid Managed Care Initial implementation shifts responsibility to MCO and MCO

may delegate it to NH or other entity o Should be outlined/agreed to during contractingo Make sure you have an internal process in place if agreement is

different than your current normo Long term plan – State or designee will assume financial and

operational responsibility to distribute NAMI and collect NAMI income

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NAMI CollectionTwo important questions Who manages Social Security and other income? Does NH manage a resident fund of PNA money?

If NH is rep pay it will never be free from NAMI responsibilityDevelop a spreadsheet to track

$1,000 incomeResident = $1,000Plan collects from

resident = $950 Resident give NH $50

PNA (or keep) Plan pay NH $950

$1,000 incomeNH rep payee = $600

Plan collects from resident = $400

NH keep $50 PNA NH keep $550 of NAMI Plan pay NH $400

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Polling QuestionDo you feel like you have the proper structure in place to

effectively bill and get paid in a managed care environment? A) My current system seems to be working just fine B) We have had to make some changes and have been successful

getting paid timely C) We are struggling and need to make some changes

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Billing Department Re-Design

Current silo structure may become ineffective Medicaid Managed Care

o May be too much work for one person to handleo Medicare Advantage/Commercial blurring into Medicaid

Managed Care

Consider alpha-split or unit/floor split or shift additional FTE to Medicaid managed care billing

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ClearinghouseVendor that serves as a middleman between facility and payorsClaims submission: Rather than sending paper claims or electronic

claims to each payor as a separate transmission the clearinghouse is a centralized portal that receives your claims and forwards claims to the appropriate payors $2.04 per transaction savings opportunity

Provides other valuable billing-related services: electronic remittance, eligibility verification, claim status, resident statement printing/mailing, payment portal

If use ABILITY for Medicare now (IVANS NOW or EASE) – consider CHOICE All-payor Claims and COMPLETE (eligibility) Others may be less expensive with equal or better service – don’t settle just

because ABILITY is what your biller is used to Remember that free isn’t always the best answer for operational efficiency

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Expect More From Our SystemsCommon SNF Billing System / EHR Deficiencies Insurance verification (batch 270/271 files) Payment code posting Need reader for remittances Inadequate reporting and need for additional report writing software

o Crystal reports, analytics programs, SQL database programmer Difficulty generating “clean” claims Difficulty in programming contractual adjustments Account notes and tickler system Lack of sophistication to handle VB arrangements

o Bundled paymentso Hospital readmissions by diagnosis reportso Length of stay by diagnosis reports

Other Opportunities

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Internal Communication

Inter-departmental – must understand key components of plan and how they impact reimbursement and resident care/ coordination

Contract, provider manuals, billing manuals available to all key players

Develop summary page of each plan Need to keep updated

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External CommunicationsFamilies Enrollment status updates NAMI collection

Hospital discharge plannersPayors Make sure you are assigned a provider representative Develop a partnership with each payor representative Hold regular meetings They would much rather help up front

than deal with you when you are frustrated

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Clinical Implications – Medicaid Managed CareAuthorizations/notifications for transfers and other care

services (routine, elective, urgent) Clinical staff will have to coordinate with payor case manager

for many more residents Significant increase in time

Coordination with vendors/suppliers More time required to coordinate coverage and

benefits

Clinical Appeals More time spent by clinical, HIM, others

Documentation changes needed?

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Case ManagerOften a Nurse or Social Worker Certification through the Commission for Case Manager

Certification (CCMC) or the American Nurses Credentialing Center (ANCC) Function as intermediary between SNF, residents and the

payor – balancing the fine line between the discharge goals of the payor, the needs of the resident and working with facility staff to recognize how care delivery changes may be needed to satisfy the discharge requirements of particular payor

Monitor expiration, medical record submission dates and approvals of initial, ongoing and ancillary service authorizations

Communicate care plan/service changes with payor

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St. Ann’s Community

Managed Care-How Have We Fared?

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Adelaida Samuels, CMC, CMBSI, Director of BillingSabrina McLeod, Director of Finance

Agenda Maximizing the EMR system Transforming the billing department Managing the MLTC’s Financial difference for Organization Cost Accounting

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Maximizing the EMR system Check to see if the reimbursement rules are set up for each payer Can your system post payments electronically

(ERA) without staff having to touch each account? EFT set up for all plans

95% of our claims are submitted electronically to payers. Make sure to review the 999 and 277CA

Can your system produce specific billing reports by plan

Do you utilize a clearing house?

Utilize a clearing house that will allow you to run reports for denials by plan, days in AR, batch eligibility and claim analysis.67

Managing the EMR system cont..Can your system post payments electronically (ERA) without staff

having to touch each account?A)YesB)NoC)N/ACan your system produce specific billing reports by plan?A)YesB)NoC)N/ADo you utilize a clearing house?A)YesB)NoC)N/A

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Transforming the Billing Department Review duties each staff was assigned to do, surprisingly enough 50% of what they did was AR! That is not enough, as a biller the main job is AR. 80% of their time was devoted to collections and other duties were assigned appropriately.

Follow up every 30 days EDUCATE, EDUCATE, EDUCATE!! Each Resident account rep is a Certified Medical Biller Specialist (12 CEU’s needed a year)

Ongoing staff training Each contact/call is documented in the billing system Each rep is responsible for a payer(s)

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Billing Department Changes

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Are your billers certified as medical billers?A)Yes B)No

All Resident account reps are Certified Medical Billers Cross training staff Loading the reimbursement rules in EMR system to create a clean claim Understanding the timely filing by payer AR follow up within 30 days Utilizing Clearinghouse for electronic submission and EFT DOCUMENT, DOCUMENT & DOCUMENT

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Increased Administrative work for SNF’sIf the resident is enrolled in a MLTC plan, the plan must authorize all LTC placements. MLTC ‘s are authorizing every 6 months and every 6 months reimbursement has to call and renew the authorization. If no authorization is obtain no payment $$$Coordination between billing, admissions and reimbursement is key!

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Managing MLTC’s Have you hired someone to handle your MLTCs?A) Yes B)NoDue to authorization and care coordination between the SNF’s and MLTC we needed to hire a MLTC Reimbursement Case Manager and Financial Liaison. MLTC case manager is responsible for:

Obtain initial authorization and ongoing authorization Provide MLTC with Monthly clinical follow up for their members, including notifying them of LOA, Hospitalization and major clinical changes. Coordinate the scheduling of MLTC on-site initial and quarterly assessment with MLTC Nurse and family member. Assist Resident and Family members with the selection of MLTC and providing them with information to make that selection. Central Point of contact for Resident, Family and Staff with any concerns with MLTC coverage.

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Managing MLTC’s continue..Medicaid Managed Care Rate-is the current FFS (benchmark) rate or negotiated rate

https://www.health.ny.gov/facilities/long_term_care/reimbursement/nhr/ If you negotiate you will need to renegotiate if it falls below current benchmark rate Submitting claims weekly to MLTC’s Clean claim should pay within 4 weeks Know who your provider rep is for each plan, set up quarterly meetings

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Financial Liaison Works in the same office as admissions Verifies insurance and review insurance coverage upon admissions Keeps track of private pay residents and counsels them on Medicaid when balances reach $25,000 Handles the LTC Medicaid application, outsource to agency if needed Works with resident and or family for Medicaid recertification Explains the MLTC and refer to MLTC reimbursement case manager

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What did this mean for St. Ann’s?St. Ann’s Community has seen an increase in the number of Medicaid residents. As residents enroll into Medicaid it is mandatory they pick an MLTC plan. The process and timing of payments from plans to providers will be different than dealing with NYS Medicaid. This will cause an increase in AR due to payments coming in sporadically.

Educate Medicaid billers on all the different MLTC plans and requirements. Provide a cheat sheet with revenue codes, type of bill and payer timelines.

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The Billing Department redesign has financially benefited the organization by:1. Marked decrease in AR – not only in dollars but in days in AR2. Increased cash flow for the organization

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How has this made a financial difference?

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Decrease in AR – Dollars

000’s omitted

Decrease of $3.5M

Accounts Receivable - At the start - 2015

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Current56%

60+ Days19%

120+ Days12%

180+ Days13%

56% was current – under 60 days outstanding

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Current76%60+ Days11%

120+ Days5% 180+ Days8%

Accounts Receivable - Currently (2017)76% of outstanding receivables are under 60 days outstanding

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What does the future hold? Are you ready for rate negotiations with MLTC

plans, including knowing how much it costs to care for individual residents?

A)Yes B) No Get ready for rate negotiations with the MLTC plansThat means…knowing our costs down to the patient level

How do we do that?Cost accounting system

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What does the future hold? – Cost Accounting Do you have a cost accounting system?A) Yes B) No

A system that allows us to filter all of our financial information and compares that with our patient/resident census, diagnosis, pharmacy and other ancillary costs so that we can analyze costs down to the patient and/or diagnosis level For example – we can evaluate the difference in costs for a sub acute patient that comes in after joint replacement with no co-morbidities, and one that may have co-morbidities This gives us the information we will need to negotiate rates –whether that is part of a bundled payment or just negotiating for a daily rate with an insurance company Gets us out of the “per diem” thinking