SNF Admissions Process

Introduction

Presented by:

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The Interdisciplinary Team

The successful collection of a Skilled Nursing Facility’s revenues depends on the successful communication between the interdisciplinary team, which consists of the Business Office, Nursing, Rehabilitation, Social Services

and Admissions Departments.

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The KEY to success is working together as a TEAM. This process will provide you with the necessary tools to function as a critical member of the SNF interdisciplinary team!!!

FACT* 12-19 % of revenue is lost during the admissions process due to incorrect or unverified information.

You will have gained valuable knowledge and resources to help protect your facility from loss due to bad debts or regulatory non-

compliance.

Revenue loss fact: 12-19% of revenue is lost during the admissions process, for incorrect or unverified information!!!!!

STOP and think before the patient is admitted-these steps MUST be followed!!!!

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Admission details:◦ Managing Admission Financial Details – Verification of benefits◦ How to determine eligibility, where, what, how, why?

◦ Understanding the CWF(common working file)

◦ Medicare verification

◦ Medicaid verification

◦ Managed Care verification

◦ Commercial Insurance verification

◦ VA benefits verification

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Managing Admission Financial Details – Verification of benefits(Continued)

Daily Census, who is responsible and why?

Admissions package sign in(providing examples)

Admission Agreement(3 examples)

Clinical Consents

HIPAA agreements

Welcome letter

Face sheet data entry and distribution

FOLLOW UP

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Managing Admission Financial Details – Verification of benefits

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◦ Admissions Process – Familiarize yourself with your facility’s Admission documentation and process as well as which tasks are performed by each staff member within the team:

Receive Referrals, provide tours and take admission applications, coordinate financial and clinical review

Verification of benefits Admissions Committee meetings or flow of an admission communication

form Admission Package Sign-In – Admission Agreement, Clinical Consents,

HIPAA and other notifications, Welcome Letter Face Sheet data entry and distribution

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Managing Admission Financial Details – Verification of benefits(Continued)

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◦ Financial Admission Communication Form

Admission details such as date, admit from location, expected length of stay

Resident demographics (DOB, Soc. Security #, contact information) Primary Payer Secondary and Supplemental (Coinsurance) Payers Verification of Benefits - requirements or limitations, contact

information, authorizations, policy numbers, etc. Internal approvals per company policy

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Medicaid

Determine eligibility from State Medicaid Agency

◦ Medicaid Eligibility ◦ Policy #◦ Type of coverage (Standard)◦ Clinical screening or authorization◦ Other insurance (TPL)

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Managing Admission Financial Details – Verification of Benefits

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New York State Medicaid Benefit Verification

Determine eligibility via:

eMedNY site Self Help at www.emedny.org Audio Response Unit (ARU) see MEVS Telephone Quick Reference Guide

1-800-997-1111 MEVS ePACES – online verification system (requires internet connection

and registration) see ePACES Quick Reference Guide Contact eMedNY Call Center at 1-800-343-9000 You will need to provide your NPI#

Other HIPAA options see MEVS Methods Guide at emedny.gov

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Managing Admission Financial Details – Verification of Benefits

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The Common Working File (CWF)

What is it???

How does it work??

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ePACES InquiryePACES Help Document - V 1.6 click here

Logging Into ePACESBefore logging into ePACES, you must have a UserID and Password. If you do not have a User ID or have forgotten your password, please contact your ePACES System Administrator or Provider Relations.

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ePACES Inquiry

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ePACES Inquiry

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ePACES Inquiry

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Managed Care/Commercial Insurance/VA Benefits

Determine eligibility via: Register for online access to Insurance Carrier’s website when available Telephone Inquiry

Clinical Case Management contact Policy and coverage information contact

Required Eligibility information Prior Authorization # Rate/level of care Dates covered in Authorization Outliers (pharmacy stop-loss, etc) Case Manager contact information and requirements

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Managing Admission Financial Details – Verification of Benefits

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Secondary and Supplemental Payer Verification

◦ Supplemental payer must be indicated when Medicare A is primary payer Some insurance plans have an extended primary coverage when

Medicare benefits exhaust

◦ Some Managed Care and Medicare Advantage plans also require a co-pay

◦ Supplemental Insurance (Medigap) coverage must be verified Carrier Name Policy # Subscriber Name and relation if resident is not subscriber Date Active Pre-certification required? Coverage limitations (ie, day 21-30 only of Medicare stay) Claims address

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Managing Admission Financial Details – Verification of Benefits

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Daily Census Activity

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In order to report census information consistently and accurately on a daily basis, the data needs to be managed by each discipline without error and without delay. Each discipline in the center, to include the Nursing, Admissions, Case Management, and Business Office Departments, should be educated in each of their roles in the census reporting process.

Midnight Census – Nursing Department◦ Obtain Midnight Census Worksheet from Business Office◦ Indicate on Worksheet all activity beginning at 12:01 am through 12 midnight ◦ All Admissions/Readmissions, Discharges, LOA, Bed Transfers must be

indicated to include time, location (from or to), date◦ Worksheet to include midnight physical count of residents – total by unit◦ Worksheet to be signed by Nursing Supervisor verifying accuracy and completion

of all information◦ Completed Worksheet to be forwarded to Business Office by 9:00 each morning

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Daily Census Activity

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Admission Information – Admissions Department◦ Information distributed by 9:00 each morning for the following day’s admissions◦ Admissions Form/Prelim Face Sheet distributed to appropriate staff ◦ Payor verifications (Medicare CWF, Private Insurance/Coinsurance verifications,

Medicaid online eligibility printout, etc) to Business Office if completed by Admissions staff

Census Entry, Verification – Business Office◦ Compile and review all documentation received for previous day census activity◦ Calculate totals by payor using previous day’s reconciled census report and reconcile

to totals provided by Nursing Dept. If variance exists, coordinate review with Nursing for correction

◦ Enter all census changes in Revenue/Billing system◦ Run daily Census Reports for distribution to all facility departments◦ Run Midnight Census Worksheet for current date and forward to Nursing for use at

end of day.◦ Maintain signed Midnight Shift Worksheet along with daily Census Report in a file

marked “Census” for each month and keep with Month End Financial files for audit purposes

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Pre-Billing

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Policies for billing and collecting Private Pay charges vary greatly. Your facility policy and Resident Admission Agreement must be reviewed carefully prior to submitting any billing or instituting any collection activity.

◦ Private Pay Room and Board payment- Just like paying RENT!!!! Due on the first of each month Collected upon arrival of private pay admissions Collected on the first day of Medicare or Managed Care non-coverage (conversions) Statement should indicate the date that payment is expected

◦ Ongoing pre-billing Each month around the 25th

Room and board charges for the coming month Usually contain any ancillary charges incurred during the previous month

◦ Patient Liability can be pre-billed Payment due no earlier than the 3rd of the month

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Pre-Billing

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Common Private Pay Collection Processes Collection begins 10 days following due date

Telephone call to the person responsible for making payment

Mailed reminders within 30 days of billing

Other actions to prompt payment can include: Petitions for conservators for residents who are not competent Notices of Involuntary Discharge Property liens Use of collection agencies Legal court actions

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Medicaid Billing and Collection

NY State Medicaid Billing and Collection

◦ Approval and notification of Resident admission and discharge Level of care approval obtained for admission

DMS-1 assessment (pre and post-admission) Facility responsibility within 5 days of admission/readmission to SNF

DMS-4 approval from LPD Admitted from community - pre-certification from referring source Admitted from another SNF, pre-certification from transferring facility Admitted from Hospital, pre-certification from Hospital DC Planner

Readmissions for hospital stays longer than 20 days require a new pre-cert from Hospital

DSS-3559 (or W-434 for NYC beneficiaries) submitted to local DSS within 48 hours of discharge from SNF

◦ NAMI – Net Available Monthly Income Deducted from NY State Medicaid payment and is collected from resident by SNF

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HIPAA Agreements

Health Insurance Portability Accountability Act

PRIVACY ACT

What are they? What do they mean?

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HIPAA

Rule addresses all issues concerned with saving/accessing/sharing medical & personal information of an individual. The concept of a Covered Entity is at the core of Privacy Rule regulations. All Healthcare Providers and Health Plans are called Covered Entities. Here, Health Plans include state, federal, private and employee & veterans’ welfare

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The Welcome Letter…what it needs to say

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Admission Note /Letter

◦ Should contain the following: Time and date of admission Reason for admission Age Primary Diagnosis Pertinent Medical History Level of functioning prior to hospitalization Describe how the resident was assisted to bed or chair List of all assessments and their outcomes upon

admission List of all other skilled needs that have been identified

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To accomplish these goals, admissions documentation must have the following basic

characteristics:

◦ Accurate◦ Legible◦ Supports the quality of resident care◦ Identifies the need for skilled services◦ Observation and assessment by licensed nurse◦ Support subjective and objective information and

services delivered

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Online Resource Links as Referenced in this Presentation

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NY State Medicaid MEVS Telephone Quick Reference Guidehttp://www.emedny.org/ProviderManuals/AllProviders/MEVS/QuickReferenceGuides/MEVS_Telephone_Quick_Refer

ence_Guide/2010-2/MEVS_Telephone_Quick_Reference_Guide.pdf

NY State Medicaid MEVS Methods Guidehttp://www.emedny.org/ProviderManuals/AllProviders/MEVS/QuickReferenceGuides/MEVS_Methods/2010-

1/MEVS_Methods.pdf

eMedNY Electronic Medicaid System UB04 Billing Guidelineshttp://www.emedny.org/ProviderManuals/ResidentialHealth/PDFS/ResidentialHealth_Billing_Guidelines_UB04.pdf

eMedNY Electronic Medicaid System General Policy Guidelinehttp://www.emedny.org/ProviderManuals/AllProviders/PDFS/Information_for_All_Providers-General_Policy.pdf

NY State Medicaid Program Residential Health Services Policy Guidelineshttp://www.emedny.org/ProviderManuals/ResidentialHealth/PDFS/ResidentialHealth_Policy_Guidelines.pdf

NY State Medicaid Edit/Error Knowledgebase Tool (Claim denial reasons)http://www.emedny.org/hipaa/edit_error/knowledgebase.html

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Online Resource Links as Referenced in this Presentation

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Social Security Forms (Representative Payee Request and Accounting)http://www.ssa.gov/online

General Explanation of the Major Categories for SNF Consolidated Billinghttp://www.cms.gov/SNFConsolidatedBilling/Downloads/06MajorCategoryExplanation.pdf

CMS.gov Medicare Advantage Plan Directoryhttp://www.cms.gov/MCRAdvPartDEnrolData/PDMCPDO/itemdetail.asp?filterType=none&filterByDID=-

99&sortByDID=2&sortOrder=descending&itemID=CMS1211780&intNumPerPage=10

CMS NPI information and registrationhttps://nppes.cms.hhs.gov

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Please feel free to address questions at this time!

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Thank you for your participation!Our PAC team appreciates your attendance…

888.688.5224info@postacuteconsulting.comwww.postacuteconsulting.com

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