The Centers for Medicare & Medicaid Services (CMS) restarted Recovery Audit Contractor (RAC) and nursing home billing medical review audits in August.
Here’s what you should be aware of and how you can make sure your nursing home is prepared for the case of the need for an audit.
Nursing Home Billing
The RACs and MACs are back
The COVID-19 public nursing home billing services has brought a variety of modifications to health facilities such as an interim suspension of all CMS reviews on the 30th of March in 2020. The suspension was accompanied by medical reviews prior to and after payment carried out in the hands of MACs along with RACs.
Then, in July nursing home billing companies that were resuming medical review activity in August, regardless of the situation that the PHE.
Audit activity was ramped up on August 17 with a focus on post-payment reviews of COVID claim submissions prior to March 1st 2020. Although CMS hasn’t yet made a public announcement the time when audits of claims made on or after March 1st will begin, they are likely to begin in the coming months.
Ensure Accurate and Timely Billing
Rejection of claims by insurance companies or for the failure of filing claims correctly is regarded as the end of the road for medical practices. This is always a sign that you are not getting paid as much.
Watch page now uses data that comes directly from home health billing companies which gives you the most recent survey data to help you prepare for surveys. NHC Data is refreshed every month in contrast to the earlier OSCAR data is refreshed on a quarterly basis.
Improved Cash Flow
In the medical field the old adage “cash is king,” is very true. Furthermore, the revenue cycle management is the core of the financial health of a medical practice.
The faster your claims are paid, the better your business will run. When your receivables payable (A/R) number is higher than 40 days then you need to work to increase the number. Any delay in payment could directly affect the cash flow of your business.
The reduction of the time in home health billing companies as well as denials of claims are two of the most important ways to maximize the profits of your practice.
What you should be aware of
CMS has stated it will conduct audits conformity with the existing statutes and regulatory provisions, which include skilled nursing home facility billing and coding requirements.
Tips for responding to audits
CMS acknowledges that skilled nursing facilities are unable to provide capacity and resources for responding to audits at this time.
Choose someone to handle the ADR and the denial process
- Quickly respond to each payment and audit notice (ADR)
- Do not make any payments that are overdue prior to taking note of and accepting the audit findings
- Make sure you include the correct details in the ADR to speed up the process.
- Make sure that the documentation you provide is legible and that it supports MDS Coding as well as the UB-04
The reporting requirements for which timelines are being rescinded are:
- The job category of every direct-care staff member.
- Resident census data
- The tenure of staff and turnover
- The amount of care hours per staff member per day.
Direct-care staff are classified as an employee of the facility or agency worker or independent contractor
A nursing home billing company’s policy made public on the 24th of April, was valid for up to 60 days. The change, as per CMS, was created to shift away from the reimbursement based on volume to a quality-of-care model. Residents typically come from hospitals with distinct workflows.
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The importance of tools and technology to aid patient communication
Home health billing companies improve the patient experience and boost efficiency while improving staff efficiency beginning with self-service tools. Although Medcare MSO nursing home billing is a partner for Medicare healthcare providers across all kinds, it has a particular concentration on facilities that are post-acute through applications that are compatible with EHRs.
The details of the eligibility criteria
One of the greatest stressors for patients is to figure out their financial obligations when seeking treatment. Real-time eligibility verification aids in managing benefits, and also provides more financial clarity for patients.
Technology can also stop the organization from relying solely on a single individual for information on eligibility and billing.
Medcare MSO nursing home billing Insurance Discovery Delivers The Major Benefits For Providers:
- Demographic verification – Check nine essential elements in real-time Note missing data and get complete, accurate details for every patient and make a claim.
- Coverage identification active – Several database searches reveal the unique primary, secondary, and tertiary coverages. They rank this coverage, and show benefits and managed care plans.
- Expanded search of payers – The average is thirteen transactions for each patient. You can locate up to double the number of payers as compared with other providers.
- Search for players in the geographic area – Search across the nation and search for those who are most pertinent to you with the most advanced matching algorithms.
- Customizable workflow capabilities – Create custom exclusions to remove false coverage and create rules that are based on the location or patient’s state of residence, as well as the payer.
- What effect has this had on the collection rate? Learn about the way in which one Medcare MSO nursing home billing company’s client in Florida saw double-digit growth in insurance collection rates for hospitals and various other services.
Transfers of residents
In order for facilities to establish groups to take care of residents diagnosed with COVID-19. CMS waives a variety of transfer requirements as long as the facility has agreed to accept residents from another facility.
In the wake of the COVID pandemic skilled nursing facilities were faced with an increased need for surveillance and reporting of infections. The Medicare MSO Medical Billing infection watch has become a preferred tool to monitor during the public health crisis. The app allows for simple reports on COVID test results, the cases, and vaccinations.